Week 8 - Anxiety Disorders

Question 1

Anxiety vs Fear

Answer 1

• Fear: An emotional response to an immediate threat and is more associated with a fight or flight reaction
• Anxiety: Associated with anticipation of a future concerns

Question 2

What is the function of anxiety and arousal?

Answer 2

• Functional and adaptive
• Important and helpful in shaping behaviour and voiding aversive/dangerous stimuli
• High levels aversive

Question 3

What are the autonomic responses in fear/anxiety?

Answer 3

• Perceptions of threat triggers sympathetic nervous system for “fight-or-flight” response
• Stress hormones (incl. epinephrine, norepinephrine, cortisol) trigger and maintain variety
• Resolution of threat associated with reduction of activation in sympathetic nervous system and increased activation of parasympathetic nervous system

Question 4

Explain the Anxiety Disorder and anxiety-related difficulties

Answer 4

• Anxiety disorders; Differ from normal feelings anxiousness and involve excessive fear or anxiety
• Typically lead to avoidance of stimuli/situations which impacts psychosocial functioning (e.g., job, school, work, relationships)
• Typically characterised by fear or anxiety out of proportion to the situation and/or significant impact on functioning
• Most common group of mental disorders and affect nearly 30% of adults at some point in their lives
• Number of effective treatments available

Question 5

Name five common Anxiety Disorders

Answer 5

• Specific Phobia
• Panic Disorder
• Social Phobia/Social Anxiety Disorder
• Generalised Anxiety Disorder (GAD)
• Agoraphobia

Question 6

Explain the Anxiety Disorder: Specific Phobia

Answer 6

• Marked fear or anxiety about a specific object or situation
• Exposure to stimuli elicits an intense fear response

Question 7

Explain the Anxiety Disorder: Panic Disorder

Answer 7

• Recurrent unexpected panic attacks
• Persistent concern or worry about additional panic attacks or their consequences and/or significant maladaptive change in behaviour related to the attacks

Question 8

Explain the Anxiety Disorder: Social Phobia/Social Anxiety Disorder

Answer 8

• Persistent fear and avoidance of social and performance situations
• Fears typically concern potential negative evaluations by others as a result of anxiety symptoms and/or social performance
• Lifetime prevalence estimates up to 12% in UK
• Onset typically during adolescence (~15 yo)

Question 9

Explain the Anxiety Disorder: Generalised Anxiety Disorder (GAD)

Answer 9

Chronic, persistent and excessive anxiety and worry about a number of events or activities that individuals find difficult to control

Question 10

Explain the Anxiety Disorder: Agoraphobia

Answer 10

Fear of being in situations where escape may be difficult or embarrassing, or help might not be available in the event of panic symptoms
- ex. using public transport, open spaces, being in enclosed places, etc.

Question 11

Explain Post-traumatic Stress Disorder (PTSD)

Answer 11

• Develops in some people after experiencing extremely traumatic events (ex. combat, assault, natural disaster)
• Symptoms typically begin within 3 months after trauma
• Consists of a variety of clinical symptoms:
  *Intrusion
  *Avoidance
  *Negative alterations in cognition and mood
  *Hyperarousal
• Relative predominance of different symptoms may vary over time

Question 12

What are the common cognitive symptoms in fear/anxiety?

Answer 12

• Fears of:
  *Losing control/not coping
  *Impending death or injury
  *Negative evaluation by others
  *“Going crazy”
• Thinking about matters with focus of threat may become more difficult
• Hypervigilance
• Threat-related imagery/memories
• Impaired reasoning process

Question 13

What are the common behavioural symptoms in fear/anxiety?

Answer 13

• Avoidance of threat
• Behaviours to mitigate against perceived threat (safety behaviours)
• Escape/flight
• Reassurance seeking
• Restlessness/agitation
• Freeze response

Question 14

What is the common affective symptom in fear/anxiety?

Answer 14

Nervousness, wound up, frightened, fearful, jumpy, jittery, frustrated, and impatient

Question 15

Explain the prevalence of anxiety disorders

Answer 15

• Comorbidity is the norm; 40-80% of individuals with DSM-IV anxiety disorder meet criteria for two or more disorders
• Anxiety disorders have a number of shared clinical features and common hypothesised maintenance processes
• Often chronic and will not display spontaneous remission of symptoms

Question 16

What is a panic attack?

Answer 16

• An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
• Up to 28% of population will experience an occasional, unexpected panic attack sometime in their life

Question 17

What are the symptoms of a panic attack?

Answer 17

• Pounding heart, tachycardia (rapid HR), palpitations
• Sweating, trembling, or shaking
• Experience of choking, shortness of breath
• Fears of losing control, dying, or going crazy
• Pain or discomfort in the chest
• Tingling sensations
• Nausea
• Dizziness, light headedness
• Feelings of being detached from self
• Hot flashes or chills

Question 18

What are the cognitive maintenance factors of Social Phobia/Social Anxiety Disorder?

Answer 18

• Information & interpretation bias
• Interpret performance significantly more critically
• Show self-focused attention
• Indulge in excessive post-event processing of social events

Question 19

Explain the Obsessive Compulsive Disorder (OCD)

Answer 19

• Recurrent and persistent appearance of intrusive thoughts that is experienced beyond a person’s control and generally cause anxiety/distress
• The obsessions are ego-dystonic
• Lifetime prevalence of 2%-6%
• Usually begins gradually in adolescence or early adulthood

Question 20

Define obsessions in the context of OCD

Answer 20

Recurrent, unwanted, intrusive thoughts or images or impulses that cause distress

Question 21

Define compulsions in the context of OCD

Answer 21

Repetitive behaviours that an individual feels driven to perform to reduce distress or to prevent some dreaded event from happening

Question 22

Explain anxiolytics as a treatment for anxiety

Answer 22

• Sedative and calming effects
• Too much causes sleepiness (and death)
• Usually start working immediately

Question 23

Anxiolytics: Explain barbiturates

Answer 23

• Powerful sedative effects (hypnotic)
• Side effects include reduced respiration
  *Too powerful … led to several accidental suicides
  *Reduced prescription dramatically in the 1990s
  *However, the replacements were deadly too

Question 24

Anxiolytics: Explain benzodiazepines

Answer 24

• Replaced barbiturates to treat anxiety
• Increase effectiveness of GABA (inhibition), non-direct effects towards GABA
• Safer compared to barbiturates, but still deadly in high doses
• Commonly prescribed today (e.g., Xanax)

Question 25

Anxiolytics: Explain safe alternatives

Answer 25

• Buspirone (affects serotonin)
• Anticonvulsant drugs (affects GABA)
• Beta blockers

Question 26

Anxiolytics: Explain beta blockers

Answer 26

• Block physiological response to anxiety
• Cognition remains mostly unaffected (e.g., less sedation)
• More common for less severe cases of anxiety
• ex. Proplanolol, Acebutolol, Bioprotol

Question 27

What are the causes of anxiety?

Answer 27

• Increased activity in the brain (Amygdala, Thalamus, Hippocampus)
• Overexcitation is caused by excess neurotransmitters (Glutamate, Epinephrine/Norepinephrine)

Question 28

Explain the Yerkes-Dodson Law

Answer 28

• Performance increases with mental arousal (stress/anxiety) but only up to a point
• When an individual’s level of stress is too high or too low, their performance deteriorates

Question 29

What are the issues with the medication for anxiety?

Answer 29

• Not as effective compared to certain types of therapy
• Not effective for mild cases of depression
• Placebo effect (though the placebo effect is likely as effective as the antidepressants)