Anxiety

Question 1

what is normal anxiety

Answer 1

Normal anxiety is an expected, normal, transient response to stress; it may be a necessary cue for adaptation and coping.

anxiety is a normal human disorder

Anxiety is a natural response and is needed for survival so don’t want to eradicate it entirely. Body’s preparatory mechanism to cope with stress. Need a certain level of anxiety in order to do anything and take action.

Question 2

what is pathological anxiety

Answer 2

Pathological anxiety results from an unknown internal stimulus, or is inappropriate or excessive when compared with existing external stimulus.

Question 3

most common type of anxiety

Answer 3

GAD as most common (7% of world’s population at any one time). Almost rivals depression in prevalence. There is a massive overlap between depression and anxiety though, occurs together in about 78% of people.

Question 4

Define Anxiety according to ICD-10 GAD

Answer 4

(a) At least 6 months of prominent tension, worry, and feelings of apprehension about everyday events and problems

(b) At least four of the following 22 symptoms must be present, at least one of which must be from the autonomic arousal cluster

Question 5

what are the symptoms that can be present

Answer 5

Autonomic arousal symptoms: palpitations or pounding heart or accelerated heart rate; sweating; trembling or shaking; dry mouth (not due to medication or dehydration)

Symptoms involving the chest and abdomen: difficulty in breathing; feeling of choking; chest pain or discomfort; nausea or abdominal distress

Symptoms involving mental state: feeling dizzy, unsteady, faint or lightheaded; derealization or depersonalization; fear of losing control, ‘going crazy’, or passing out; fear of dying

General symptoms: hot flushes or cold chills; numbness or tingling sensations

Symptoms of tension: muscle tension or aches and pains; restlessness and inability to relax; feeling keyed up, or on edge, or mentally tense; a sensation of a lump in the throat, or difficulty in swallowing

Other non-specific symptoms: exaggerated response to minor surprises or being startled; difficulty in concentrating, or mind ‘going blank’ because of worrying or anxiety; persistent irritability; difficulty getting to sleep because of worrying

Question 6

what is GAD

Answer 6

• Is a negative emotion that occurs in response to perceived threats and an inability to predict or control the threatening situation
• Anxiety and depression tend to co-occur
• Anxiety is common in cardiac patients
• Findings on the role of anxiety as a prognostic factors are mixed
• Many studies have found a relationship between anxiety and adverse clinical events

Question 7

What is the criteria in distinguishing pathological anxiety?

Answer 7

• Autonomy
  
  • Intensity
  • Duration
  • Behaviour

Issues/problems with this view? We all do the weird things at some times in our lives. What is occurring pathologically is not a really abnormal thing but is a much more intense situation. Not like psychosis where you lose insight and touch with reality. Insight is not lost in anxiety disorders. However, this insight makes the anxiety worse. You know you’re doing something that you cant control - an element of magical thinking and also an element of compulsion.

Question 8

What is the existential view of anxiety?

Answer 8

This would say that anxiety is absolutely necessary and useful, and if we are all deeply engaged in living then we should all be anxious. Has been found that normal individuals are positively biased (more good things will happen to them than reality, and less bad things - depressed individuals are actually more accurate).

Question 9

Why is the medical/biological model of anxiety?

Answer 9

SSRIs most current treatment, suggests that the mann biological candidate is serotonin so there is a biological element.

Question 10

What are the manifestations of anxiety?

Answer 10

• Affective symptoms (feelings of edginess, ‘losing control’, ‘going to die’)
• Physical symptoms (tachycardia, diarrhoea, dizziness, lightheadedness)
• Behaviour (avoidance, compulsions)
• Cognitions (apprehension, worry, obsessions)

Question 11

What is generalised anxiety disorder (GAD)?

Answer 11

• Uncontrollable, persistent anxiety and worry
• Constant level of anxiety unrelated to specific stimulus
• People with GAD worry about their health and daily concerns
• Personality style of catastrophising
• Usually do not seek treatment
• Difficult to treat
• More common among women than men
• 6 months continuous duration

These things have to be present constantly for 6 months in order to be diagnosed.

Less than 30% of patients with anxiety disorders seek treatment.

Women to men 2:1

Question 12

What is the prevalence of GAD?

Answer 12

Lifetime prevalence between 4.3 and 5.9% in European epidemiological studies.

Major issue - comorbidity with depression

depression where roughly 6/10 individuals with GAD will simultaneously have a major depression diagnosis.

Question 13

Autonomic arousal symptoms

Answer 13

palpitations or pounding heart or accelerated heart rate; sweating; trembling or shaking; dry mouth (not due to medication or dehydration)

Question 14

Symptoms involving the chest and abdomen

Answer 14

difficulty in breathing; feeling of choking; chest pain or discomfort; nausea or abdominal distress

Question 15

Symptoms involving mental state

Answer 15

: feeling dizzy, unsteady, faint or lightheaded; derealization or depersonalization; fear of losing control, ‘going crazy’, or passing out; fear of dying

Question 16

General symptoms:

Answer 16

hot flushes or cold chills; numbness or tingling sensations

Question 17

Symptoms of tension:

Answer 17

muscle tension or aches and pains; restlessness and inability to relax; feeling keyed up, or on edge, or mentally tense; a sensation of a lump in the throat, or difficulty in swallowing

Question 18

Other non-specific symptoms

Answer 18

: exaggerated response to minor surprises or being startled; difficulty in concentrating, or mind ‘going blank’ because of worrying or anxiety; persistent irritability; difficulty getting to sleep because of worrying

Question 19

About substance-induced anxiety disorder

Answer 19

Drug related
Intoxication
- Caffeine
- Cocaine

Withdrawal

- Alcohol
- Opioid and opiates
- Sedative-hypnotics

Question 20

What is the treatment of substance induced anxiety disorder?

Answer 20

Pharmacotherapy = SSRIs, antidepressants, anxiolytics

Psychological therapy = cognitive, emotional, behavioural, systematic desensitisation, exposure

Question 21

What are techniques used in intervention studies in anxiety/substance induced anxiety?

Answer 21

• Relaxation training
• Cognitive behavioural stress management
• Meditation
• Group emotional support
• Cognitive therapy

Question 22

What is the prognosis of anxiety?

Answer 22

Only 40% of people seek help - afraid to leave house, afraid to drive, afraid to see GP, what if its serious, aware of not being in a normal frame of mind, etc.

Question 23

what are the 9 various anxiety disorders?

Answer 23

• Panic disorder with or without agoraphobia
• Generalised anxiety disorder
• Obsessive-compulsive disorder
• Acute stress disorder
• Social phobia
• Simple phobia
• Anxiety disorder fur to medical condition
• Substance-induced anxiety disorder
• Anxiety disorder NOS

Question 24

Anxiety disorder due to medical condition

Answer 24

Medical illnesses:

- Endocrinologic (hyperthyroidism, hyperparathyroidism, hypoglycaemia, PMS)
- Cardiovascular (angina, arrhythmias, etc)
- Neoplastic (pheocromocytoma, insulinoma, carcinoid)
- Neurologic (vestibular dysfunction, seizures, TIA ('mini stroke'))
- Pulmonary (COPD, PE, asthma)

Question 25

The future of anxiety treatment and techniques

Answer 25

Poulin et al, 2013
Helping others significantly eliminates association between stress and mortality in 5 year prospective study.

Keller et al., 2013
Perception of stress being harmful and amount associated with mortality but not if don’t’ perceive stress as harmful.

Jamieson et al., 2012
Appraising stress in a positive way resulted in adaptive cardiovascular stress responses.

Big literature on social helping to get better. Volunteer to help people that are less fortunate than yourself. In terms of cognitive bias - tend to have habitual thought that is only you. When in a depressed or anxious state then you may know it is only focussed on yourself.

Perception of the stress being harmful and of mortality.

Keller at al. - Found that if you believe stress is negative then it is, if you believe it isn’t bad then it stops being bad.

Question 26

Prognosis of anxiety

Answer 26

• Only 40% of sufferers seek treatment
• 5 years after initiation of treatment only 40% show partial or full remission
• Those with comorbid conditions are harder to treat

Only 40% of people seek help - afraid to leave house, afraid to drive, afraid to see GP, what if its serious, aware of not being in a normal frame of mind, etc.