Anxiety disorders Flashcards
What is the amygdala of the brain?
Amygdala acts as the emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response (milliseconds).
Amygdala is primarily involved in emotion, memory, and the fight-or-flight response
Amygdala is a small, almond-shaped structure located in the medial temporal lobe of the brain
How does the body act against acute stress?
acute stress leads to dose-dependent increase in catecholamines and cortisol
cortisol acts as to mediate (& shut down) the stress response
through negative feedback it acts on the pituitary, hypothalamus, hippocampus and amygdala, these sites are responsible for the stimulation of cortical release.
acute stress increases cortisol levels. true/false?
true
Biological (Physical) symptoms of anxiety?
Sweating, hot flushes or cold chills
Trembling or shaking
Muscle tension or aches and pains
Numbness or tingling sensations
Feeling dizzy, unsteady, faint or lightheaded
Dry mouth (not due to medication or dehydration)
Feeling of choking
A sensation of a lump in the throat, or difficulty in swallowing
Difficulty breathing
Palpitations or pounding heart, or accelerated heart rate
Chest pain or discomfort
Nausea or abdominal distress (e.g. churning in stomach)
Cognitive symptoms of anxiety?
Fear of losing control, “going crazy or dying
Feeling keyed up, on edge or mentally tense.
Difficulty in concentrating, “mind going blank”
Feeling that objects are unreal - derealization
Feeling that the self is distant or “not really here” -depersonalisation
Hypervigilance (internal and external)
Racing thoughts
Meta-worry (worry about everything, worrying about worrying)
Health anxiety
Beliefs about the importance of worry
Preference for order and routine
Behavioural symptoms of anxiety?
Avoidance of certain situations
Exaggerated response to minor surprises or being startled
Difficulty in getting to sleep because of worrying
Excessive use of alcohol/drugs (prescription or “recreational”)
Restlessness and inability to relax
Persistent irritability
Seek reassurance from family/GP
Checking behaviours
What is GAD (generalised anxiety disorder)?
Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is “free-floating”).
GAD dominant symptoms?
The dominant symptoms are variable but include complaints of persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort.
GAD summary?
Lifetime prevalence of GAD is 9%
Typical age of onset between 20-40
Chronic, fluctuating course
2:1 female:male ratio
Commonly seen in primary care and general medical settings
→associated with disability, medically unexplained physical symptoms, and overutilisation of health care services and resources.
→often approached as “diagnosis of exclusion” with unnecessary medical investigations and delay of symptom improvement (but doesn’t need to be!)
90% are co-morbid with other psychiatric disorders,
e.g. depression, substance abuse, other anxiety disorders
GAD treatment?
Cognitive Behavioural Therapy
SSRIs / SNRIs
Pregabalin
Benzodiazepines I.e. Valium/diazepam (short term only)
What is CBT (cognitive behavioural therapy)?
An evidence based psychological treatment
Based on identifying an individual’s automatic thoughts, cognitive biases and schemas
Help the individual identify thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety
What is panic disorder?
The essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable.
Dominant symptoms of panic disorder?
The dominant symptoms include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization).
Often also a secondary fear of dying, losing control, or going mad.
What is derealisation and depersonalisation?
Derealisation = alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or falsified.
Depersonalisation = consist of a detachment within the self, regarding one’s mind or body, or being a detached observer of oneself. Subjects feel they have changed and that the world has become vague, dreamlike, less real, lacking in significance or being outside reality while looking in.
Panic disorder can occur both with and without agoraphobia. true/false?
True
Agoraphobia = fear of particular places and situations that the person feels anxious or panics, such as open spaces, crowded places and places from which escape seems difficult.
