Lecture - Anxiety 1 Flashcards
So anxiety is on a spectrum but what does it become a disorder?
It becomes a disorder when it impairs functioning (social, occupational, routines) or is distressing)
What are the three roles of normal fear/anxiety
- When we are presented with objective dangerous or threatening situations, it is a response to that
- It protects us from hard
- Anxiety or fear leads to constructive action.
So there are a cluster of responses across four domains - physiological, cognitive, affective and behavioural. Tell me about each of them
- So the physiological response is all about the fight or flight response. You have the whole increase in HR, adrenalin released, sweating, tension in muscles etc
- Cognitive is about how you think. You’ll have a perception of danger and threat/loss such as, “We need to get out of here.” Usually with anxiety, your changes in cognition will either make you sharp + clear or confused + foggy
- Affective is about how you feel such as nervous, fear, anxious, terror etc
- The last component of the response to threat is behaviour and that’s about what you do such as fight or flight or avoid or carry out safety behaviours (like become hyper vigilant)
What is abnormal anxiety? I’ve just described normal anxiety above
Abnormal anxiety is when the DEGREE OF FEAR OR ANXIETY IS GREATLY OUT OF PROPORTION to the risk and severity of possible danger. So if you have a phobia (specific phobia) of dogs (an anxiety disorder) then you will feel terrified of the dog even if it’s a cute little puppy. They’ll be overestimating the danger associated with it
Abnormal anxiety is also inaccurate appraisal of threat to wellbeing such as OVERESTIMATING DANGER or overestimating the probability of it hurting you etc. Like if you see a mouse, you won’t think much of it but maybe get scared. Some people will think this thing has disease and I’ll get it and I’ll die. When you talk about abnormal anxiety – it’s irrational and extreme
Abnormal anxiety also occurs or continues to occur even if the objective danger has passed or doesn’t exist. The intensity of it, duration of it and all impair function.
What is the DSM V?
It’s the diagnostic and statistical manual of mental disorders 5th edition. It’s the guidelines for making diagnosis and whether the symptoms the patient is present fit and also whether the threshold is met for the disorder
What is differential diagnosis important?
- With anxiety – number of disorders. Not like depression where one or two types
- You need to know what it is they fear or they avoid – that will hekp with diagnosing what type of disorder
They is to find the object or situation they are fearing or avoiding
Panic disorder:
1. What is the criteria?
You need to have recurrent expected panic attacks
And at least one of the attacks has been followed by 1 month (or more) of one/both of the following:
=persistent concern or worry about having additional attacks/consequecnes (like, maybe I’m going crazy)
=a significant maladaptive change in behaviour related to the attacks
-so like, if you just worry about having another attack only 3 days after and then don’t worry or have nothing wrong then you don’t have panic disorder
For this the lifetime prevalence is 4.7% and median age is 20-24yrs
What is a panic attack?
It is an intense abrupt surge of fear that includes 4 or more of the following symptoms within 10mins:
- shortness of breath
- trembling
- chest pain
- fear of losing control/dying
- sweating
- chills
etc
Things to note with panic disorder:
You can’t diagnose “panic attack” - it’s either panic disorder or another disorder where you experience panic attacks
o People start associating panic attacks with e.g. shops they had it from and then those shops becme the cue for panic attack because people become fearful. But the criteria is that you have recurrent unexpected panic attacks (you probably can have some expected ones but need to have unexpected too)
It’s frequently comorbid with like agoraphobia
With panic disorder, what should you consider as other factors that could be causing it?
The conditions that may produce panic life symptoms are angina, epilepsy, pulmonary embolus etc. So some substance abuse could be causing those symtppms and you need to consider medical conditions that might produce these symptoms
Also substance use like weed can cause panic attack symptoms
Agoraphobia:
A-F what are the criteria?
A: you need to have a marked fear or anxiety about two or more of the following: using public transport, open spaces, closed spaces, standing in line/crowd, being outside of home alone. So it doesn’t have to be a single fear - it’s across domains.
B: You have the fear/avoid situations due to concerns that you wont be able toe space or help wont be available or you’ll do something embarrasing
C: It almost always provokes fear/anxiety
D: It’s avoided (like you don’t go in a car) or you need some companion with you (like Sam with Isaac) or you. endure the intense fear
E: It’s out of proportion to the actual danger that’s posed
F: It has to be persistence (6mnths or more)
And it must cause distress or impairment in functioning too
Agoraphobia: what sort of disorder is it? Like, how does it affect the individual?
It is debilitating and may affect all areas of functioning. You do avoid the thing you fear so you can’t go about your daily life
Low prevalence though - only 1.4%
You may have substantial impairment though like no longer being able to carry out household duties or becoming confined to home or have ANTICIPATORY ANXIETY
What’s specific phobia? What’s the criteria?
Same C-F as agoraphobia
So:
A: Marked fear or anxiety about a specific object or situation
B: always provokes fear or anxiety
C: It’s avoided or endured
D: Fear is excessive
E: Persistent (6mnths plus)
F: You avoid the thing you fear and it impairs functioning
More prevalent like 7.2 - 11.%
What’s specific phobia like for kids?
They might not always identify the physiology or thoughts so they’ll say there have a funny feeling etc.
Usually they’ll avoid the thing, have somatic symptoms (like feel sick) or cry if they don’t wanna go there
What is separation anxiety disorder? What are the 8 things that identify it?
It is a developmentally inappropriate (so like when you experience it as a grown kid - not 2 year old) and excessive fear concerning separation from those the individual is attached to. You need 3 of the following 8:
- You have recurrent excessive distress when anticipating or experiencing separation
- Persistence or excessive worry about losing attachment figure or something harming them
- You’ll have persistent worry about an event that causes separation like an accident or they’ll be kidnapped
- You’ll have reluctance or refusal to go out due to fear of separation
- Reluctance to be alone or without them in home/other place
- Reluctance to sleep away from home/without the person there
- Nightmares involving separation
- Physical symptoms when separated (headache, stomach ache etc)
It needs to be persistent and causes significant distress/impairment in functioning
