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in phobic anxiety disorders when is the anxiety evoked?
in well defined situations or by certain objects which are not currently dangerous
what are 3 features of all phobias (a's!)
- 1. anxiety symptoms: physical (ANS) and mental state (fear)
- 2. anticipatory anxiety
- 3. avoidance
what is the prominent feature of agoraphobia?
- fear of open space, crowded space, travelling alone/away from home
- NO EASY ESCAPE TO A SAFE PLACE
who is agoraphobia more common in? gender and age
when do social phobias usually start?
what are social phobias centred around?
- a fear of SCRUTINY by other people in small groups (not crowds)
- eg public speaking or speaking to opposite sex
what is the gender link in social phobias?
what physical ways may social phobias present as?
- hand tremor
- urgency of micturition
what is a complication of severe social phobia?
when do specific phobias usually arise (age)?
what are the 3 aspects to diagnostic criteria for any phobias?
- 1. the psychological or autonomic symptoms must be primary manifestations of ANXIETY and not secondary to other symptoms eg delusions or OCD
- 2. the anxiety must be RESTRICTED to the presence of the phobic object/situation
- 3. phobic situation is AVOIDED wherever possible
what is the management of any phobia?
- 1. full assessment to exclude other diagnosis, consider secondary gains, explore pt management strategies eg companion, alcohol, drugs?
- 2. psychological therapies = mainstay of phobia Rx
- a) behavioural: graded exposure and desensitisation or flooding (not as good)
- b) psychodynamic: explore UNCONSCIOUS conflicts and anxieties
- 3. medication: BZD (potentiate GABA - inhibitory) for short term use with 2a
- antidepressants esp increase 5HT eg SSRI citalopram
- note AEDs can also increase GABA effect
what is the main difference between phobia and panic disorder?
panic disorder - the anxiety is NOT restricted to any particular situation or set of circumstances, so it is UNPREDICTABLE
what are the dominant symptoms of panic disorder?
- chest pain
- feelings of unreality: depersonalisation, derealisation
- secondary feeling of dying, losing control, going mad
what is the time frame for diagnosis of panic disorder?
several severe attacks of autonomic anxiety should have occurred within 1 month
what are the 3 diagnostic features of panic disorder?
- 1. circumstance where there is NO OBJECTIVE DANGER
- 2. without being confined to known or predictable SITUATIONS
- 3. freedom from anxiety symptoms BETWEEN ATTACKS (although anticipatory anxiety is common)
what is the type of anxiety in GAD?
who suffers more GAD m or f?
what is the time frame for diagnosis of GAD?
most days for several weeks (6months)
What 3 aspects of anxiety need to be present to diagnose GAD?
- 1. apprehension: worries about future misfortunes, feeling on edge, cant concentrate
- 2. motor tension: fidget, tension headache, cant relax, tremble
- 3. autonomic overactivity: lightheaded, sweat, tachycardia, tachypnoea, epigastric discomfort, dizzi, dry mouth
how may GAD present in children?
- frequent need for reassurance
- recurrent somatic complaints
what is the maximum time BDZ should be taken for anxiety?
what is the management of GAD?
- 1. social: reassurance, normalise, attend to social STRESSORS, anxiety management: relaxation skills, breathing exercises, exercise, yoga, meditation
- 2. psycho: CBT, psychotherapy, psychoanalysis
- 3. bio: anxiolytics - benzos, buspirone (USA), beta blockers (propranolol but beware CCF, DM, asthma), SSRI, TCA, carbamazepine, SNRI - venlafaxine
what is mixed anxiety and depressive disordeR?
- when symptoms of anxiety and depression are present but neither set of symptoms, considered separately, is sufficient to justify a diagnosis
- but must have some ANS symptoms
what are obsessional thoughts?
- ideas, images, impulses that enter the individuals mind REPETITIVELY in a stereotyped form
- distressing: because violent, obscene or senseless
- sufferer tries to resist
- recognised as own thoughts
- even tho involuntary
what are compulsive acts
- stereotyped behaviours that are repeated
- not enjoyable
- pt often views them as preventing some objectively unlikely event
- behaviour usually recognised as pointless
what else do people with OCD tend to develop?
what is gender and age pattern in OCD?
- onset: childhood or early adult
how long do OCD symptoms have to be present for to diagnose it?
- most days for at least 2 weeks
- and be a source of distress or interference with activities
what causes acute stress reaction? give eg
- exceptional physical or mental stress
- natural catastrophe, accident, battle, criminal assault, rate
what increases risk of acute stress reaction disorder developing?
if physical exhaustion or organic factors eg in the elderly are present
what is the time frame for onset and offset of symptoms in acute stress reaction
- onset few mins / immediate
- offset 24-48 hours symptoms subside
what are the initial symptoms of acute stress reaction?
daze: constriction of field of consciousness, narrowing of attention, inability to comprehend stimuli, disorientation
after the daze, what symptoms follow in acute stress reaction?
- further withdrawal from the surrounding situation, could even lead to dissociative stupor (ie no voluntary movement, don't respond to external stimuli, no speech).
- agitation and over activity
what is the diagnostic criteria for acute stress reaction disorder? 2 main points
- 1. mixed and changing picture: daze, depression, anxiety, anger, despair, overactivity, withdrawal - no one type of symptom predominates for long
- 2. resolve RAPIDLY
what is PTSD?
- delayed response to a stressful event
- of an EXCEPTIONALLY THREATENING or CATASTROPHIC nature
- which is likely to cause pervasive distress in almost anyone
give eg of PTSD event/situation
- natural/man made disaster
- witness violent death
- victim of torture, terrorism, rape
what are predisposing factors for PTSD?
- compulsive/asthenic (ie weak, lack strength) personality traits
- previous history of neurotic illness
what are the symptoms of PTSD?
- repeated reliving of the trauma in intrusive memories (flashbacks) or dreams
- person also feels numb, no emotions, detached from others, unresponsive to surroundings
- anhedonia of activities/situations which remind them of the trauma
- fear and avoidance of cues that remind them of truma
- dramatic, acute bursts of fear, panic or aggression, triggered by stimuli arousing a sudden recollection of trauma
what kind of 'state' and mood do people with PTSD have?
- state: autonomic hyperarousal with hypervigilance, an enhanced startle reaction and insomnia
- anxiety and depression, suicidal ideation
what may complicate symptoms of PTSD?
excess alcohol or drugs may complicate things
when is the onset of PTSD?
- after a latency period after the trauma - from a few weeks to months
- rarely exceeds 6months
what is the course of PTSD?
what is prognosis if PTSD?
- majority recover
- some - chronic then turns into enduring personality change
what is crucial to the diagnosis of PTSD? 2 things
- 1. evidence of trauma
- 2. repetitive, intrusive RECOLLECTION/reliving of event in memories/daytime imagery/dreams/flashbacks/nightmares, within 6 months of event
what is adjustment disorder?
- distress and emotional disturbance interfering with social functioning
- arising during adaption of a significant life change or stressful life event including serious physical illness
how can adjustment disorder manifest?
- depressed mood
- feeling of inability to cope, plan ahead or continue in the present situation
- disability in performance of daily routine
what may be assoc with adjustment disorder in adolescence?
conduct disorder eg aggressive or dissocial behaviour
how may children present with adjustment disorder?
- bed wetting
- babyish speech
- thumb sucking
what is the onset of adjustment disorder?
usually within 1 month of the occurrence of the stressful event or life change
what is the duration of symptoms of adjustment disorder?
does not go over 6 months