Biochemical ‘engineering’ ‘Final straw’ Medicophysical model Alarm reaction, physio=logical adaption & stressor if persists Psychological model Balance between cognitive processing of perceived threat & perceived ability to cope

Counselling - advice regarding caffeine, alcohol, exercise etc. Relaxation training Medication Antidepressants – SSRIs or TCA Sedatives high risk of dependency CBT (better remission than medication)

Anxiety Disorders Flashcards by Amber Rendall

What are anxiety disorders

Anxiety is normal response to threat but can become exaggerated

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Epidemiology of anxiety

F:M = 2:1

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Pathophysiology of anxiety

Coping mechanisms of stress – problem or emotion focussed

Flight or fight response

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Cause of anxiety

Biochemical ‘engineering’

‘Final straw’

Medicophysical model

Alarm reaction, physio=logical adaption & stressor if persists

Psychological model

Balance between cognitive processing of perceived threat & perceived ability to cope

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Presentation of anxiety

Psychological arousal

Autonomic arousal

Muscle tension

Hyperventilation

Sleep disturbance

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Psychological arousal in anxiety

Fearful anticipation

Irritability

Sensitivity to noise

Poor concentration

Worrying thoughts

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Autonomic arousal in anxiety

Dry mouth
Swallowing difficulties
Dyspepsia, nausea, wind
Frequent loose motions

Respiratory - Tight chest, difficulty inhaling

Cardiovascular

Palpitations/missed beats
Chest pain

Genitourinary

Frequent/urgency of micturition
Amenorrhoea/dysmenorrhoea
Erectile failure, decreased libido

CNS - Dizziness, sweating

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Muscle tension in anxiety

tremor

headache

muscle pain

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Hyperventilation in anxiety

causing CO2 deficit hypocapnia

Numbness if extremities -> carpopedal spasm (frequent involuntary movement of hands/feet due to low calcium)

Breathlessness

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Sleep disturbance in anxiety

Initial insomnia

Frequent waking

Nightmares/terrors

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Types of anxiety disorders

Generalised anxiety disorder

Phobic anxiety disorders

Post-traumatic stress disorder

Obsessive-compulsive disorder

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Differential diagnosis of anxiety

Psychiatric conditions

Depression
Schizophrenia
Dementia
Substance misuse

Physical conditions

Thyrotoxicosis
Pheochromocytoma
Hypoglycaemia
Asthma and/or arrythmias

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What is generalised anxiety disorder (GAD)

Persistent (several months) anxiety, symptoms not confined to a situation or object

Present most days

Excessive, persistent, unreasonable anxiety

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Epidemiology of GAD

1-year prevalence of around 4.4%

Women>men

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Cause of GAD

Stressor acting on a personality predisposed to the disorder by a combination of genetic factors & environmental influences in childhood

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Presentation of GAD

All symptoms of anxiety can occur

Restlessness, irritability, difficult concentrating

Difficulty sleeping

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Differential of GAD

Hyperthyroidism

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Management of GAD

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Counselling - advice regarding caffeine, alcohol, exercise etc.

Relaxation training

Medication

Antidepressants – SSRIs or TCA
Sedatives high risk of dependency

CBT (better remission than medication)

What are phobic anxiety disorders

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Anxiety experienced in specific circumstances or perceived threat of circumstances (anticipatory anxiety)

Person behaves to avoid these circumstances -> phobic avoidance

Avoidance differentiates from fear

Fears are normal, phobia interferes with life

Epidemiology of phobic anxiety

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F>M

What are phobic anxiety disorders associated with

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Anxiety disorders (OCD)
Substance misuse
Depression

Presentation of phobic anxiety disorders

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Symptoms of anxiety - at presence or though

Social phobia – blushing & tremor predominate

Types of phobic anxiety disorders

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Specific phobias

Social phobia

Agoraphobia (public spaces)

Management of phobic anxiety

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CBT - gradual exposure

Education & advice

Medication - SSRI

What is OCD

Experience of recurrent obsessional thoughts and/or impulsive acts

Epidemiology of OCD

1-year prevalence 2% M=W Onset in childhood-early adulthood

Pathophysiology of OCD

Obsessional thoughts * Ideas, images, impulses * Occurring repeatedly not willed – very difficult to resist * Unpleasant& distressing (often of the antithesis personality type) * Recognised as the individuals own thoughts (not a voice) Key anxiety symptoms arise because or distress of thoughts or attempts to resist

Cause of OCD

Genetic – gene coding for 5HT receptor 5HT function abnormalities

Risk factors of OCD

First degree relative Depression Tourettes

Presentation of OCD

Anxiety symptoms – as a result of resistance Compulsive acts/rituals * Stereotypical behaviours repeated again & again * Not enjoyable or helpful * Often viewed by sufferer as preventing harm to self or others Interferes with daily life

Differential of OCD

Obsessive compulsive personality * Obsessive thoughts not as strong a feature * Not as distressing, their ‘normal’

management of OCD

Education & explanation Serotonergic drugs – SSRI (fluoxetine), clomipramine CBT – exposure & response prevention Psychosurgery (if treatment resistant)

What is PTSD

Delayed and/or protracted reaction to a stressor of exceptional severity (that would distress anyone) Often within 6 months

Epidemiology of PTSD

1-year prevalence 1-4% * Variable due to cultural factors, exposure to disaster W:M = 2:1 * Highly associated with sexual assault

Cause of PTSD

Trigger * Combat * Natural/human-caused disaster * Rape * Assault * Torture * Witnessing any of the above Genetic component

Risk factors for PTSD

Mood disorder, other mental health disorder Previous trauma (especially as child) Lack of social support Interpersonal trauma \> accidents Protective factors * Higher education & social group * Good paternal relationship

Presentation of PTSD

Hyperarousal Re-experiencing trauma Avoidance of reminders Hypervigilant

Pneumonic for remembering presentation of TSD

**HARD** * **H**ypersoursal * **A**voidance * **R**e-experiencing * **D**istress

Hyperarousal in PTSD

Persistent anxiety Irritability, outbursts Insomnia Poor concentration

Hypervigilant in PTSD

Constantly on guard

Re-experiencing trauma in PTSD

Intrusive imaged - flashbacks when awake, nightmare when asleep

Avoidance reminders in PTSD

Emotional numbness – detachment to other people Cue avoidance Recall difficulties Diminished interests – not responding to their environment like they normally would, anhedonia

management of PTSD

Survivors of disasters screen at 1 month Mild symptoms – ‘watchful waiting’ and review after 1 month Trauma focused CBT - exposure, group Eye movement desensitisation & reprocessing SSRI or TCA

Complications of PTSD

Associated with depression & anxiety Alcohol problems/substance misuse due to 'self medication'

Anxiety Disorders Flashcards

(44 cards)