L7 Anxiety disorders: clinical picture Flashcards
What are the symptoms of acute stress?
Feelings of being numb or dazed Insomnia Restlessness Poor concentration Autonomic arousal Anger / anxiety / depression Withdrawal
Describe an acute stress reaction
Lasts hours to 3 days Response to exceptionally stressful events Initial daze Mixed & usually changing picture Individual vulnerability
What is an adjustment disorder?
Wide range of emotional or behavioural symptoms
Stressor not necessarily life threatening
Out of proportion to stressor
Lasts up to 6 months
What is PTSD?
Response to exceptionally threatening or catastrophic event
Experienced, witnessed event that involved actual or threatened death or serious injury or threat to physical integrity of self or others
Response involved intense fear, helplessness or horror
What are the symptoms of PTSD?
Re-experiencing flashbacks / nightmares Numbness / detachment Avoidance Hypervigilance / startle Insomnia Anxiety / depression
Describe the course of PTSD
Usually immediate onset Most recover within 1 year Rape victims: -94% at 2 weeks -65% at 1 month -42% at 6 months
What are the psychological symptoms of GAD?
Fearful anticipation Irritability Sensitivity to noise Restlessness Poor concentration Worrying thoughts
What are the physical symptoms of GAD?
Gastrointestinal Repsiratory Cardiovascular Genitourinary Neuromuscular
What is the epidemiology of GAD?
Lifetime prevalence: 8.9%
Women > men
Estimated to be 3X higher in patients in primary care clinics
Describe the attachment theory
Parents or other consistent caregivers serve important function in a child’s development
Provide protective & secure base from which the child can operate
Disruption leads to anxious apprehension & dependency
Severe disruption leads to withdrawal & depression
What effect did it have if adults rated their parenting as more protecting and less caring?
Had higher trait anxiety scores
Met more criteria for GAD & panic disorder
What are the psychic symptoms of panic?
Fear of losing control Going mad Fainting Dying Derealisation Depersonalisation
What are the somatic symptoms of panic?
Palpitations Tachycardia Sweating Trembling Dyspnoea Choking Chest pain Nausea Urgency Dizziness Faintness Paraesthesia
What are some differential diagnoses for panic disorder?
Endocrine: hypoglycaemia, phaecromocytoma, carcinoid Cardiovascular: arrhythmia Respiratory: asthma Drugs Neurological: seizures, vestibular
What is the epidemiology of panic?
Panic attacks: 7-9% of population
Panic disorder: 1.5-2.5% lifetime prevalence
Peak onset at 15-24 & 45-54
What is the genetic predisposition of panic?
Increased risk in 1st degree relatives - 7 fold
Increased concordance in all but 1 monozygotic twin study
At least 50% environmental influences
What are some environmental factors contributing to aetiology of panic?
Separation / loss
Relationship difficulties
New responsibilities
Traumatic early life events: early parental separation, traumatic childhood event, early sexual abuse
Describe the biological model of panic
Panic attacks triggered in locus coeruleus. Increased firing associated with increased CO2
Noradrenergic agents stimulate attacks in sufferers
SSRIs are effective
GABA has a role
Cholecystokinin causes panic attacks in animals & pentagastrin causes attacks in panic disorder patients
What is a specific phobia?
Inappropriate anxiety in presence of one or more particular objects or situations
Characterised by adding name of stimulus
Avoid jargon
What are some subtypes of specific phobias?
Blood, injection, injury
Animals & insects
Aspects of natural environment e.g. heights
Situational e.g. flying
Other e.g. dental / medial procedures, choking
What is the response during a blood-injection-injury?
Biphasic anxiety reaction Initial short-lived sympathetic arousal Followed by parasympathetic arousal May result in vasovagal syncope Subjective experience tends to disgust & repulsion rather than pure apprehension
What is social phobia?
Inappropriate anxiety in situations where person is observed & situations where there is potential for criticism
Leads to avoidance of trigger situations
What are the symptoms of social phobia?
Anticipatory anxiety Feeling anxious Blushing Trembling Relieved by alcohol
What is OCD?
Obsessional thoughts / images
Compulsions reduce anxiety
Cleaning / checking
Precision
What is the epidemiology of OCD?
Men & women equally
During adolescence it is more common in boys
Mean onset age is 20 years
Prevalence: 2-3%
What does OCD increase the lifetime risk of?
Alcohol disorders Social phobia Specific phobia Panic disorder Eating disorder Schizophrenia Tic disorders
