Week 8 - Anxiety Disorders Flashcards
Anxiety vs Fear
- 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
What is the function of anxiety and arousal?
- Functional and adaptive
- Important and helpful in shaping behaviour and voiding aversive/dangerous stimuli
- High levels aversive
What are the autonomic responses in fear/anxiety?
- 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
Explain the Anxiety Disorder and anxiety-related difficulties
- 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
Name five common Anxiety Disorders
- Specific Phobia
- Panic Disorder
- Social Phobia/Social Anxiety Disorder
- Generalised Anxiety Disorder (GAD)
- Agoraphobia
Explain the Anxiety Disorder: Specific Phobia
- Marked fear or anxiety about a specific object or situation
- Exposure to stimuli elicits an intense fear response
Explain the Anxiety Disorder: Panic Disorder
- 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
Explain the Anxiety Disorder: Social Phobia/Social Anxiety Disorder
- 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)
Explain the Anxiety Disorder: Generalised Anxiety Disorder (GAD)
Chronic, persistent and excessive anxiety and worry about a number of events or activities that individuals find difficult to control
Explain the Anxiety Disorder: Agoraphobia
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.
Explain Post-traumatic Stress Disorder (PTSD)
- 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
What are the common cognitive symptoms in fear/anxiety?
- 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
What are the common behavioural symptoms in fear/anxiety?
- Avoidance of threat
- Behaviours to mitigate against perceived threat (safety behaviours)
- Escape/flight
- Reassurance seeking
- Restlessness/agitation
- Freeze response
What is the common affective symptom in fear/anxiety?
Nervousness, wound up, frightened, fearful, jumpy, jittery, frustrated, and impatient
Explain the prevalence of anxiety disorders
- 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
What is a panic attack?
- 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
What are the symptoms of a panic attack?
- 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
What are the cognitive maintenance factors of Social Phobia/Social Anxiety Disorder?
- Information & interpretation bias
- Interpret performance significantly more critically
- Show self-focused attention
- Indulge in excessive post-event processing of social events
Explain the Obsessive Compulsive Disorder (OCD)
- 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
Define obsessions in the context of OCD
Recurrent, unwanted, intrusive thoughts or images or impulses that cause distress
Define compulsions in the context of OCD
Repetitive behaviours that an individual feels driven to perform to reduce distress or to prevent some dreaded event from happening
Explain anxiolytics as a treatment for anxiety
- Sedative and calming effects
- Too much causes sleepiness (and death)
- Usually start working immediately
Anxiolytics: Explain barbiturates
- 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
Anxiolytics: Explain benzodiazepines
- 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)
Anxiolytics: Explain safe alternatives
- Buspirone (affects serotonin)
- Anticonvulsant drugs (affects GABA)
- Beta blockers
Anxiolytics: Explain beta blockers
- 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
What are the causes of anxiety?
- Increased activity in the brain (Amygdala, Thalamus, Hippocampus)
- Overexcitation is caused by excess neurotransmitters (Glutamate, Epinephrine/Norepinephrine)
Explain the Yerkes-Dodson Law
- 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
What are the issues with the medication for anxiety?
- 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)
