Flashcards in Anxiety Disorders Deck (42)
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1
What is Anxiety?
Fear/Panic
Response to threat
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Three systems of Anxiety
Physical: Fight/Flight, SNS activation --> mobilising response
Cog
Behavioural
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Eliciting conditions for Anxiety
Realistic/objective threat to self
Specific "prepared" stimuli
Novel Stimuli
Threat appraisal --> Expectancy of harm --> Anxiety
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Threat appraisal
Generates expectancy of harm (e.g. public transport)
Product of perceived probability and perceived cost
Often based on past experience (cond, rft), obs learning, and instruction
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Separation Anxiety
Anxious about being away from primary caregiver
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Specific phobias
Excessive and Inappropriate fear about specific targets
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Social phobia
Fear of negative social evaluation
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General Anxiety Disorder (GAD)
Excessive & Uncontrollable worry about a range of outcomes
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Panic disorder
Unexpected/spontaneous panic attacks
Anxiety about having more panic attacks
Agoraphobia (fear of public/open places) - can result from excessive avoidance of places where panic attacks have previously occurred. Complication of Panic Disorder
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OCD
Obsession: Intrusive Thoughts/impulses
- Hard to avoid thought
- Belief: Think thought --> bad event will happen
Compulsion: Ritualistic behaviour that relieves anxiety caused by obsession
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PTSD
Intrusive thoughts/memories about past traumatic event
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Anxiety: Comorbid conditions
Anxieties comorbid with each other, depression & substance abuse
General bio vulnerabilities: Genetics, Neuroticism
General psych vulnerabilities: Trait anxiety, low perceived control
Specific psych vulnerabilities: Focus of threat-related beliefs
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Biological treatment for Anxiety Disorders?
Barbituates - quick, common relapse, but addictive & interacts with alcohol
Benzodiazepines - quick, common relapse, interacts with alcohol
SSRIs/antidepressants - slower, common relapse, less side effects
14
Psychological treatment for Anxiety Disorders/CBT? (Cog + behavioural techniques)
CBT:
Aim: To reduce (biased) threat appraisal by reducing perceived probability and cost of event while increasing (biased) coping appraisal.
Cognitive techniques:
- Thought diaries --> increased awareness of anxious thoughts
- Thought challenging - leading questions --> self-realisation of irrationality of thoughts
Behavioural techniques: EXPOSURE
- Exposure: in vivo or imaginary exposure
- Either flooding (highest fear level) or systematic desensitisation
-
15
Anxiety Disorders: Changes from DSM-IV to DSM-V
Selective mutism added
PTSD, OCD and Acute Stress Disorder have their own chapters now
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DSM-V: Which disorders are in the chapter of Obsessive Compulsive and Related Disorders?
OCD
Hoarding Disorder
Trichotillomania
Excoriation Disorder
Body Dysmorphic Disorder
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Hoarding Disorder
Excessive hoarding - unwilling to discard items, regardless of value
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Trichotillomania
Excessive hair-pulling, to relieve anxiety caused by intrusive thoughts/images
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Excoriation Disorder
Excessive skin-picking, to relieve anxiety caused by intrusive thoughts/images
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Body Dysmorphic disorder
Preoccupation with perceived defects/flaws in physical appearance. Extreme manifestation of vanity
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Panic Attack (mention >4 symptoms)
Influx of fear/discomfort within minutes, reflective of >4 symptoms:
- increased HR/palpitations
- sweating
- Trembling
- Choking sensation
- shortness of breath
- dizziness
- nausea
- Chill/heat sensation
- Fear of losing control
- Fear of dying
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Panic Attack: two types of attack
Expected (cued) attack:
- Trigger: specific or social phobias
- Context: most anxiety disorders
Unexpected (uncued) attack:
- Unidentifiable trigger
- Context: Panic Disorder
- >2 unexpected attacks --> Panic Disorder
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Panic Disorder
>2 unexpected attacks
Persistent concern/worry about having another attack
Significant maladaptive change in behaviour related to attacks
Symptoms for >1 mth
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Panic Disorder: Other information (e.g. comorbidity, etc.)
One-year incidence: 2-3%
Median age onset: 20-29
Course: Chronic, but waxing/waning
Comorbid: Other anxieties, Depression, alcohol use (10-65%)
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Cognitive Theory of Panic (Clark, 1988)
Panic comes from fear of bodily sensations --> misinterpret their consequences (e.g. heart palpitations --> impending heart attack) - positive feedback between increased anxiety and increased symptoms
Misinterpretations are maintained by safety behaviours: protective actions to prevent harmful events
- prevents learning that bodily sensations are safe
Risk factors: neuroticism, anxiety sensitivity
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Agoraphobia - DSM edition changes, Symptoms
DSM edition changes:
- DSM-IV: Always accompanied Panic Disorder
- DSM-V: Separate entity, as often occurs without panic
Symptoms:
- Avoidance of public transport, open/enclosed public places, being part of a crowd/line, and being outside alone
- Anxiety that they would not be able to escape when panic-like symptoms will occur
- Not like normal phobias: added fear of embarrassment/incontinence, etc, on top of panic symptoms
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Why does Agoraphobia develop?
(Social fears)
- heightened childhood dependence
- lowered perception of self-coping ability
- History of separation anxiety & social phobia
- physical concerns that weakness --> Panic --> embarrassment/incontinence
- has increased social evaluative concerns
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Treatment of Panic/Agoraphobia
Biological: Anxiolytics (Barbiturates, Benzos) and Antidepressants
Psych/Cog-behav:
- Cog restructuring
- Exposure to: Interoceptive stim (Panic) or Avoided situations (Agoraphobia)
- decrease safety behaviours
- CBT: Effective in 80-85% of Panic Disorder Patients
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GAD Diagnostic criteria
Excessive, uncontrollable worry about a variety of events/outcomes
occurs more days than not, for >6mths
>3-6 somatic symptoms: Restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance - NO SNS AROUSAL
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