ic14 anxiety Flashcards
what are the types of anxiety disorders (per DSM-5 classification) and differentiate between them
general anxiety disorder (GAD): excessive anxiety and worries >6m
panic disorder: anticipatory anxiety of recurrent panic attacks
social anxiety disorder (SAD): fear of being scrutinised or humiliated by others in public
obsessive compulsive disorder (OCD): obsessional thoughts or impulses that causes anxiety, f/b compulsive behaviours to relieve that anxiety
post traumatic stress disorder (PTSD): re-experiencing of trauma, persistent avoidance, incr arousal
what is stress and what is anxiety
stress refers to the overpowering pressure of an adverse force or influence exerted on the body
anxiety is the body’s response to that stress, results in psychological and physical sx that generally subsides after trigger subsides
what is the definition of “anxiety disorder”
anxiety disorders refers to severe, excessive and persistent anxiety and irrational fears that impairs daily living and functioning, and is out of proportion to the actual danger or threat of the situation
anxiety sx typically persists long after original trigger disappears (for more than 6m)
what is the prevalence of GAD and OCD in SG
GAD: 1.6%
OCD: 3.6%
what is the etiology and pathophysiology of anxiety disorders
two circuits that are overruning: fear circuit and worry circuit
fear circuit and sx are regulated by amygdala while the worry circuit and sx are regulated by the cortico-striatal-thalamic-cortical (CSTC) loop
the systems that are responsible for various actions are: defense system and behavioural inhibition system
defense system is responsible for fear, fight or flight responses and thus it originates in the amygdala of limbic system and it makes someone respond to both learned and unlearned threats vs behavioural inhibition system is responsible for avoidance behaviours and it originates in the hippocampus and septum of limbic system
ultimately anxiety disorders is resulting from neurochemical dysregulation of neurotransmitters: 5HT, GABA, NE
anxiety disorders may potentially be perinatal trauma or genetically caused
anxiety disorders can also be caused by medical conditions or is drug-induced
medical conditions assoc w anxiety disorder incl
i) CV (angina, arryhthmia, CHF, IHD, MI)
ii) endocrine/ metabolic (cushing’s disease, hyperparathyroidism, hyperthyroidism, hypoG, hypoNa, hyperK, vit B12/ folic acid deficiency)
iii) neurologic (dementia, delirium, migraine, PD, seizure, stroke, neoplasm, inadequate pain control)
iv) pulmonary (asthma, COPD, pulmonary embolism, pneumonia)
drugs that can induce anxiety disorders incl
i) sympathomimetics (pseudoephedrine)
ii) stimulants (amphetamines, cocaine)
iv) methylxanthines (theophylline, caffeine)
v) antidepressants
vi) corticosteroids (prednisolone)
vii) thyroid hormones (levothyroxine)
viii) dopamine agonist (levodopa)
ix) beta adrenergic agonist (salbutamol)
x) antihypertensives
xi) drug withdrawal (from alcohol, caffeine, sedatives, benzodiazepines, antidepressants, nicotine)
xii) drug intoxication (from anticholinergics, antihistamines, digoxin)
what are the NT involved in the etiology and pathophysiology of anxiety disorder
5HT, GABA, NE (among others like DA, CCK etc)
what constitutes as a “panic attack”
a panic attack is a discrete period of intense fear or discomfort in which at least 4 of the following sx that developed abruptly and reach a peak within 10mins and usually do not last more than 20-30min
sx incl
i) palpitations (incr HR)
ii) sweating
iii) trembling or shaking
iv) sensations of shortness of breath
v) feeling of choking
vi) nausea, abdominal distress
vii) feeling dizzy, unsteady, lightheadedness, faint
viii) derealisation or depersonalisation
ix) fear of losing control or going crazy
x) fear of dying
xi) parasthesia (numbing or tingling sensation)
xii) chills or hot flushes
it can be expected or unexpected
what is the clinical presentation of GAD (what is the criteria for the sx presented)
excessive anxiety and worry occurring more days than not for at least 6m
sx of anxiety and worry incl
i) restlessness or feeling on edge
ii) being easily fatigue
iii) difficulty concentrating or mind going blank
iv) irritability
v) muscle tension
vi) sleep disturbances (insomnia, restless unsatisfying sleep)
so should have at least 3 sx from above list on majority of the days in for at least 6m
sx should result in functional impairment and should not be due to another medical condition or drug/substance induced
sx are not better accounted for by another mental condition
what is the clinical presentation of PD (and what are the criterias of the sx)
panic disorder can present w/wo agoraphobia (fear of not being to escape when things go wrong)
sx should fulfil i) and ii)
i) recurrent unexpected panic attacks
ii) at least one of the panic attack is followed by 1m or longer of at least one of the following: persistent anticipatory worry about having additional panic attacks, worry about implications of the panic attack, significant change in behaviour relating to the panic attacks
sx should not be caused by a medical condition or drug/substance induced
sx are not better accounted for by another mental condition
what is “agoraphobia”
it refers to anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help may not be available in the event of having unexpected situationally predisposed panic attack or panic-like sx
what is the clinical presentation of SAD (and what is the criteria for the sx)
marked and persistent fear of one or more social or performance situations in which they would be exposed to unfamiliar people or subjected to scrutiny by others or peers, and he or she is fearful of acting in a humiliating or embarrassing manner
duration >6m
these situations are either avoided or endured with intense anxiety or distress
the avoidance, anxious anticipation or distress in the feared situation significantly impairs functioning
sx should not be caused by another medical condition or drugs/ substances
what is the clinical presentation of OCD (and what is the criteria for the sx)
obsession and compulsions
obsession:
i) persistent and recurrent thoughts or images or impulses that are intrusive and inappropriate and are causing marked anxiety or distress
ii) not simply just excessive worries about real-life problems
iii) person tries to ignore or suppress these thoughts or images or impulses, or tries to neutralise them through another action or thought
iv) person recognises that these thoughts or images or impulses are a product of their own mind
compulsions:
i) repetitive behaviour or mental acts that are done in response to an obsession
ii) to prevent or reduce the distress but is not realistically connected to what it is designed to neutralise or prevent, or are just clearly excessive
*person also recognises that these obsessions or compulsions are excessive or unreasonable
*the obsession or compulsions cause marked distress and are time consuming (>1hr a day) or significantly impairs functioning
sx should not be due to another medical condition or drug or substance induced
what is the clinical presentation of PTSD (what are the categories to consider and what are the criterias)
categories for PTSD: stressor, intrusion sx, avoidance, neg alterations in cognition and mood, alterations in arousal and reactivity
(A) stressor (exposure to)
i) direct exposure
ii) witnessing in person
iii) indirectly, by learning that a close relative or close friend was exposed to it
iv) repeated or extreme indirect exposure to aversive details of the trauma (usually bc of profession duties)
(B) intrusive sx (persistently re-experience of trauma)
i) recurrent involuntary and intrusive memories
ii) traumatic nightmares
iii) dissociative reactions (flashbacks)
iv) intense or prolonged distress bc of reminders
v) marked physiologic reactivity after exposure to related stimuli
(C) avoidance (effortful avoidance of related stimuli)
i) trauma related thoughts or feelings
ii) trauma related external reminders
(D) negative alterations in cognition and mood (either began or worsened after the trauma)
i) inability to recall key features of the traumatic event
ii) persistent (and often distorted) negative beliefs and expectations about oneself and the world
iii) persistent distorted blame of self of others for causing the event or for its consequences
iv) persistent negative trauma related emotions
v) marked diminished interest in significant activities
vi) feeling alienated from others
vii) constricted affect: persistently unable to experience positive emotions
(E) alterations in arousal and reactivity (either began or worsened after event)
i) irritability or aggressive
ii) reckless or self-destructive
iii) hypervigilance
iv) problems in concentration
v) exaggerated startled response
vi) sleep disturbance
*for A-C, each only req at least 1 subpoint but for D and E, each req at least 2 subpoints
*sx in BCDE must be persistent
*diagnosis can only be made at least 6m after trauma even if onset of sx is immediate
*significant functional impairment or sx related distress
*sx not due to other medical conditions, drugs or substances
what is the ddx for SAD
avoidant personality disorder
what are some specifiers that can be included in diagnosis of PTSD
- w dissociative sx (derealisation, depersonalisation)
- w delayed expression
