Wk 27 - Anxiety 1 Flashcards
What is anxiety?
- Normal response to threat or danger
- Mental health problem if response exaggerated, lasts more than 3 wks + interferes w/ daily life
What is anxiety characterised by?
- Worry + agitation
- Rapid breathing
- Fast heart beat
- Sweats
What are symptoms of anxiety?
- Goosebumps
- Muscles tense
- HR inc
- Pupils dilate
- Terror
- Anticipate harm
- Avoidance
- Dec appetite
What is generalised anxiety disorder characterised by?
- Excessive + inappropriate worrying that is persistent
- Comorbid w/ depression, panic disorder, phobia + OCD
What is panic disorder characterised by?
- Recurrent unexpected surges of severe anxiety w/ anticipatory anxiety
- Panic attack peak w/in 10mins + last 45 mins
- Develop fear of further panic attacks
- 2/3 develop agoraphobia
What is agoraphobia?
Fear in places or situation where escape is difficult or not available in event of panic attack
What is social phobia characterised by?
- Marked, persistent + unreasonable fear of being observed or evaluated negatively by other people in social situations
- Associated w/ physical + psychological anxiety symptoms
What is specific phobia characterised by?
- Excessive or unreasonable fear of single people, animal, objects or situations avoided or endured w/ significant personal distress
What is PTSD characterised by?
- History of exposure to trauma w/ response of intense fear
- W/ later development of re-experiencing symptoms, avoidance symptoms + hyperarousal symptoms
- W/in 6 months of exposure to trauma
What is OCD characterised by?
Mental health condition where you have recurring thoughts + repetitive behaviours that you cannot control
Based on NICE guidelines, what is step 1 of anxiety disorders?
Identification:
- Identify + communicate diagnosis of GAD early
- Consider diagnosis if presenting w/ worry or attend primary frequently bc of chronic physical health problems/somatic symptoms
After step 1 identification, what happens?
Education, treatment + monitoring:
- Provide education about GAD + options for treatment
- Monitor symptoms + functioning
- Discuss OTC med
Based on NICE guidelines, what is step 2 of anxiety disorders?
Low intensity treatment
- For GAD that has not improved after education + active monitoring in step 1
- Individual non-facilitated self-help
- Individual guided self-help
- Psychoeducational groups
Based on NICE guidelines, what is step 3 of anxiety disorders?
High-intensity treatment
- For GAD w/ marked functional impairment or not improved after step 2
- CBT or applied relaxation or drug treatment using SSRI
- Don’t offer antipsychotic
- Don’t offer benzodiazepines as ST
What happens if the patient has inadequate response to step 3 interventions?
Not responded to:
- High intensity psychological intervention - offer drug treatment
- Drug treatment - high intensity psychological intervention or alternative drug treatment
- Partially responded - high intensity psychological intervention in addition to drug
When is referral to step 4 required?
- Severe anxiety + marked functional impairment
- Risk of self-harm + suicide
- Significant co-morbidity
- Self-neglect
- Inadequate response to step 3 interventions
Based on NICE guidelines, what is step 4 of anxiety disorders?
Highly specialist treatment
- Psychological + drug treatment
- Antidepressant combination
- Augmentation of antidepressant w/ other drugs
Outline the biological basis of anxiety
- Dec 5-HT NT
- NA systems overactivity
- Deficient inhibition of GABA interneurons w/ red sensitivity to postsynaptic GABAA receptors
- Excessive activity of glutamate neurons at NMDA receptors in amygdala (fear conditioning)
- Super sensitivity of receptors for peptide NT (cholecystokinin + neuropeptide Y)
