Anxiety disorder: generalised Flashcards
Define anxiety. What is the purpose of anxiety in general?
Constellation of psychological and physiological responses to potential/uncertain threat.
Exists to automatically motivate us to avoid harm.
What is trait anxity vs state anxiety? How does this cause anxiety illness?
Trait anxiety - individual’s potential to experience state anxiety. This is still not a mental illness but is genetically linked. Having high trait anxiety is usually useful. People with low trait anxiety have a high mortality rate under the age of 25yrs.
State anxiety - the problem with this is that it (1) causes avoidance, so you cannot unlearn the fear you have of that situation so it makes the anxiety worse. (2) Attentional and cognitive bias also occurs whereby the way you perceive the world changes. (3) Negative automatic thoughts is where your brain generates these constantly. This again leads to (4) poor sleep. Each of the factors causes perpetuation of anxiety.
Enough trait anxiety with state anxiety can lead to mental illness of anxiety.
What kind of questions do you ask in anxiety?
What are the physical symptoms of anxiety?
Brain - Feeling worried • Poor concentration • Irritability • Depersonalization / derealization • Difficulty falling asleep
Skeletal muscle - Tremor • Headache • Muscle aches • Restlessness
GI system - Dry mouth • Indigestion • Flatulence • Frequent / loose motions
Respiratory - Tachypnoea / Hyperventilation (CO2 loss) • Dizziness • Difficulty inhaling • Constricted chest
Cardiac - Chest discomfort • Palpitations
Uterus - Urinary frequency • Erectile dysfunction • Amenorrhea
OR
- Restlessness
- Tremor
- Dry mouth
- Butterflies
- Nausea
- SOB
- Palpitations etc
Define generalised anxiety disorder.
- Excessive and uncontrolled anxiety NOT triggered by a specific stimulus
- Continuous (present for most days over 6 months)
- Motor tension, restlessness, irritability
- Somatic symptoms
- Often comorbid depression, OCD, Panic disorder
How common is GAD? Who is most affected?
- F>M (2:1)
- 1 yr prevalence 3-8%
- More common in 20’s
What are the risk factors for GAD?
- History of physical / emotional trauma
- Low socioeconomic status
- Substance abuse
- Chronic painful illnesses
What are the differential diagnoses for GAD?
- Depression
- Dementia
- Caffeine
- Alcohol / drugs
- Organic causes
What investigations are used in GAD?
- Same as panic attacks
- Rule out organic causes
- Urine drug screen
- ECG
- Collateral history
- Rating scales (e.g. GAD-7)
What are the steps to managment of GAD?
Step 1: education & active monitoring
Step 2: low intensity psychological interventions
Step 3: high intensity psychological intervention with / without drug treatment
Step 4: specialist assessment
Medication: SSRI, SNRI, Pregabalin
What rating scale is used in GAD?
Common thinking errors in CBT:
- Jumping to conclusions
- Emotional reasoning
- Labelling
- Magnification (catastrophising) and minimisation
- Should & must
- Personalisation
- All or nothing thinking
- Over generalising
- Disqualifying the positive
What is the aim of CBT?
- Identifies unhelpful thoughts(1) and feelings(2)
- Identifies safety behaviours (3)
Manages problems by changing the way someone thinks and behaves
Deal with current problems rather than issues from past
Identify practical ways to improve someone’s state of mind on a daily basis
