Anxiety disorders - clinical picture Flashcards

Question

What is the attachment theory

Answer 1

* Parents or other consistent caregivers serve important function in a child’s development * They provide a protective and secure base from which the child can operate * Disruption leads to anxious apprehension and dependency * Severe disruption leads to withdrawal and depression

Answer 2

- a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed

Answer 3

Psychic - fear of losing control, going mad, fainting, dying, derealisation, depersonalisation

Answer 4

Somatic: Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes

Answer 5

* Hypoglycaemia * Phaeocromocytoma * Carcinoid

Answer 6

- Arrythmia

Answer 7

* Anxiety in specific context: * Away from home * In crowds * In situations they cannot easily leave

Answer 8

- Anxiety symptoms and panic attacks - Anxious cognitions about fainting and loss of control are common - Avoidance is common

Answer 9

- 7-9% of the population - 1.5-2.5% lifetime prevalence - Onset has two peaks 15-24 and 15-54

Answer 10

* Widowed, divorced or separated individuals in cities | * Limited education, early parental loss & physical/sexual abuse

Answer 11

- Females>males - Agoraphobia is especially prevalent in females - Males - longer duration but less agoraphobia and depression

Answer 12

* Increased risk in 1st degree relatives ~ 7 fold * Increased concordance in all but one monozygotic twin study * Modest inheritability suggested by family & twin studies * At least 50% environmental influences

Answer 13

* Precipitating events in 60-96% of cases * Separation / loss * Relationship difficulties * New responsibilities * Traumatic early life events * Early parental separation * Traumatic childhood event – 3 fold increase * Early sexual abuse (<5 years of age)

Answer 14

- Locus coeruleus | - Increased firing associated with increased CO2 etc

Answer 15

- Yohimbine and isoproterenol stimulate attacks in sufferers

Answer 16

- Effective but contradictory findings regarding the role of serotonin

Answer 17

* γ-Aminobuyric acid (GABA) has a role: * Benzodiazepine agonists are clearly effective * Benzodiazepine antagonist (flumazenil) aggravates attacks

Answer 18

- Causes panic attacks in animals

Answer 19

- Causes attacks in panic disorder patients

Answer 20

* Inappropriate anxiety in the presence of one or more particular objects or situations * Characterised by adding the name of the stimulus (e.g. Spider Phobia) * Avoid jargon (e.g. Arachnophobia)

Answer 21

* Inappropriate anxiety in the presence of one or more particular objects or situations * Characterised by adding the name of the stimulus (e.g. Spider Phobia) * Avoid jargon (e.g. Arachnophobia)

Answer 22

* Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction: * Initial short-lived sympathetic arousal * Followed by parasympathetic arousal * May result in vasovagal syncope * The subjective experience tends to disgust and repulsion rather than pure apprehension

Answer 23

* In other subtypes, exposure to the phobic stimulus evokes intense anxiety that may meet the criteria for a situationally bound panic attack * There is extreme apprehension and desire to escape or avoid the phobic stimulus

Answer 24

- 15 years

Answer 25

- Women>men | - Blood-injection-injury phobia did not differ

Answer 26

* All Specific Phobias: evidence for genetic transmission * 31% of 1st degree relatives affected * Animal phobias: * monozygotic 26% * Dizygotic 11%

Answer 27

• Psychoanalytic approach: Symptoms related to unresolved unconscious conflicts

Answer 28

phobias are learned through association of negative experience with an object or situation

Answer 29

• Marks’ ‘preparedness’ theory maintains that commonly feared objects are those that historically threatened the survival of the individual or the species

Answer 30

• Large number of studies suggest that phobias may be acquired via observational learning

Answer 31

* Inappropriate anxiety in: * Situations where the person is observed * Situations where there is potential for criticism * Leads to avoidance of trigger situations * Eating in public * Dinner parties * Committees, seminars, public speaking

Answer 32

* Anticipatory anxiety * Feeling anxious * Blushing * Trembling (observed writing is a problem) * Relieved by alcohol (potential for abuse)

Answer 33

• Possibly as high as 7% of primary care patients • Lifetime risk 2.4 – 13.3% depending upon the definition of “caseness” 81% at some time meet the criteria for another psychiatric disorder (very high comorbidity)

Answer 34

• Onset usually early in life • 1st peak before age 5 • 2nd peak between 11 – 15 Presentation unusual after age 30

Answer 35

• Women > men, but men more likely to present

Answer 36

* Both genetics and environmental factors contribute, with genetics contributing < ⅓ of the variance in the transmission * 16% of relatives of probands vs 5% of relatives of controls * Monozygotic > dizygotic

Answer 37

* Obsessional thoughts / images * Words, ideas, beliefs and/or images * Recognised as own * Intrude forcibly into the mind * They are resisted * Compulsions reduce anxiety * Cleaning/checking * Precision – ‘just right’

Answer 38

- Contamination - washing | - Doubts - checking

Answer 39

* Obsessional impulses * Urges to perform acts * Obsessional rituals * Magic words or numbers * Desire to complete acts (e.g. hand washing) * Compulsions – the need to act on the obsessions

Answer 40

* Several researchers have reported lifetime prevalence of 2-3%1,2 * This rate has been confirmed across different cultures2 * Others suggest that the diagnosis of OCD by the Diagnostic Interview Schedule administered by lay people leads to over-diagnosis, and so have proposed lower prevalence rates of 1-2%3,4

Answer 41

* Men = women * Some reports suggest a slight female predominance * During adolescence, boys > girls. * Mean age of onset is ~ 20 years of age. * Prevalence 2-3%

Answer 42

* Major depressive episode: ~67% lifetime prevalence * ↑ lifetime risk for: * alcohol disorders * social phobia * specific phobia * panic disorder * eating disorders * Schizophrenia * tic disorders (~ 40% in juvenile OCD) * ↑ prevalence of Tourette’s syndrome in relatives * Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD

Answer 43

* Serotonin dysregulation: * Evidence from efficacy of various serotonergic drugs * Dopamine dysfunction: * Evidence from abundance of OCD symptoms in basal ganglia disorders (Tourette’s syndrome, Sydenham’s chorea, & postencephalitic parkinsonism) * The therapeutic benefits from co-administration of dopamine blockers and SSRIs in a subset of patients with OCD and tic disorders

Answer 44

* Monozygotic >> dizygotic | * First-degree relatives of patients with childhood-onset OCD have a higher than expected incidence of OCD

Answer 45

* Obsessions are conditioned stimuli: when a relatively neutral stimulus is coupled with an anxiety-provoking stimulus, it produces anxiety when presented alone * Compulsions reduce anxiety and the patient repeats them and learns them in order to avoid anxiety * Avoidance strategies are learned and become fixed

Answer 46

* Obsessional Neurosis first described by Freud | * The disorder was thought to result from a regression from the Oedipal Phase to the Anal Phase

Anxiety disorders - clinical picture Flashcards

(73 cards)