Generalised Anxiety, panics and phobias

Question 1

What are the physical symptoms of anxiety? (12)

hat are the cognitive symptoms of anxiety? (11)

Answer 1

-sweating, hot flushes/cold chills
tremor
muscle tension/aches/pains
numbness and tingling 
dizziness/unsteady 
dry mouth 
feeling of choking
SOB
palpitations, raised HR
chest pain 
nausea/GI distress

-fear of losing control
felling tense
difficulty concentrating 
derealisation 
depersonalisation 
hyper vigilance
racing thoughts 
Meta-worry 
Health anxiety 
Beliefs about importance of worry, preference of order and routine

Question 2

Anxiety and fear

-what are they?

Answer 2

a genetically ingrained function of the NS with adaptive evolutionary significance

Question 3

Stress response

• what area of the brain is involved?
• what does acute stress cause the release of?
• function of cortisol?

Answer 3

-Amygdala acts as the emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response
modified by later-received cortically processed signal
event; stimulation of the adrenal gland causes the release of cortisol

• cortisol and catecholamines
• acts to mediate the stress response via negative feedback acts on pituitary, hypothalamus, hippocampus and amygdala which normally stimulate cortisol release so acute stress = Inc cortisol

Question 4

Anxiety disorder

-when is it pathological? (3)

Answer 4

-in extent (more extreme)
in content (in situations that do not normally provoke anxiety)
causes significant distress and impairment of social, occupational/other functioning

Question 5

Give the 5 major types of anxiety & phobia disorders?

Answer 5

generalised anxiety disorder
panic disorder
Agoraphobia
Social Phobia
Specific phobia

Question 6

Generalised anxiety disorder (GAD)

• what is it?
• presentation? (9)
• how severe does it need to be?
• age of onset?
• pattern?

Answer 6

• anxiety that is generalised and persistent in any particular environmental circumstances
• persistant nervousness, trembling, muscular tension, sweating, lightheadedness, palpitations, dizziness, epigastric discomfort. Fears that patient of relative will get ill or have an accident are often expressed

-long lasting (every day ish for 6 months)
not controllable
significant distress/impaired function

• 20-40
• chronic, fluctuating, comorbid with other mental health issues

Question 7

Panic disorder

• what is it?
• symptoms? (7)
• onset?
• often assoc with?
• pattern?
• how might they be triggered?
• what part of brain effected?

Answer 7

• recurrent of severe anxiety which are not restricted to any situation and so are unpredictable.
• sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealization). There is often also a secondary fear of dying, losing control, or going mad
• mid-30s
• Agoraphobia
• chronic, waxing and waning, comorbid with other anxiety disorders, depression, drug and alcohol misuse
• By an infusion of lactate or by re-breathing CO2
• PET has inc metabolism in the temporal lobe, parahippocampal gyrus

Question 8

Phobias

• onset?
• features? (2)

Answer 8

-Agoraphobia- early20s- 30s
Social and specific phobias - adolescence

-fear recognised as irrational and typified by avoidance and anticipatory anxiety

Question 9

Agoraphobias

• what are they?
• hallmarks?

Answer 9

-clister of phobias embracing fear of leaving home, entering shops, crowds, public places, travelling alone.
avoidance prominent

-can avoid phobia by having others do shopping, drinking alcohol to overcome fear, shopping at night, internet shopping

Question 10

Specific phobia

-what is it?

Answer 10

-marked or persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
exposure evokes immediate anxiety response

-

Question 11

Social phobia

• what is it?
• symptoms?
• brain changes?

Answer 11

-persistant fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
they fear they will act in a way that will be embarrassing or humiliating

-blushing or shaking
fear of vomiting
urgency or fear of micturition

-incrased bilateral activation of the amygdala and inc rCBF to the amygdala, normalises with treatment