Anxiety.txt

in well defined situations or by certain objects which are not currently dangerous

• 1. anxiety symptoms: physical (ANS) and mental state (fear)
• 2. anticipatory anxiety
• 3. avoidance

• fear of open space, crowded space, travelling alone/away from home
• NO EASY ESCAPE TO A SAFE PLACE

• women
• early in adult life

adolescence

• a fear of SCRUTINY by other people in small groups (not crowds)
• eg public speaking or speaking to opposite sex

equal m=f

• blushing
• hand tremor
• nausea
• urgency of micturition

social isolation

• childhood
• early adult

• 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

• 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

panic disorder - the anxiety is NOT restricted to any particular situation or set of circumstances, so it is UNPREDICTABLE

• chest pain
• palpitations
• dizziness
• choking
• feelings of unreality: depersonalisation, derealisation
• secondary feeling of dying, losing control, going mad

several severe attacks of autonomic anxiety should have occurred within 1 month

• 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)

free floating

females

most days for several weeks (6months)

• 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

• frequent need for reassurance
• recurrent somatic complaints

2 weeks

• 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

• 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

• 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

• stereotyped behaviours that are repeated
• not enjoyable
• pt often views them as preventing some objectively unlikely event
• behaviour usually recognised as pointless

depression

• m=f
• onset: childhood or early adult

• most days for at least 2 weeks
• and be a source of distress or interference with activities

• exceptional physical or mental stress
• natural catastrophe, accident, battle, criminal assault, rate

if physical exhaustion or organic factors eg in the elderly are present

• onset few mins / immediate
• offset 24-48 hours symptoms subside

daze: constriction of field of consciousness, narrowing of attention, inability to comprehend stimuli, disorientation

• further withdrawal from the surrounding situation, could even lead to dissociative stupor (ie no voluntary movement, don't respond to external stimuli, no speech).
• OR
• agitation and over activity

• 1. mixed and changing picture: daze, depression, anxiety, anger, despair, overactivity, withdrawal - no one type of symptom predominates for long
• 2. resolve RAPIDLY

• delayed response to a stressful event
• of an EXCEPTIONALLY THREATENING or CATASTROPHIC nature
• which is likely to cause pervasive distress in almost anyone

• natural/man made disaster
• war
• witness violent death
• victim of torture, terrorism, rape

• compulsive/asthenic (ie weak, lack strength) personality traits
• previous history of neurotic illness

• 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

• state: autonomic hyperarousal with hypervigilance, an enhanced startle reaction and insomnia
• anxiety and depression, suicidal ideation

excess alcohol or drugs may complicate things

• after a latency period after the trauma - from a few weeks to months
• rarely exceeds 6months

fluctuating

• majority recover
• some - chronic then turns into enduring personality change

• 1. evidence of trauma
• 2. repetitive, intrusive RECOLLECTION/reliving of event in memories/daytime imagery/dreams/flashbacks/nightmares, within 6 months of event

• distress and emotional disturbance interfering with social functioning
• arising during adaption of a significant life change or stressful life event including serious physical illness

• depressed mood
• anxiety
• worry
• feeling of inability to cope, plan ahead or continue in the present situation
• disability in performance of daily routine

conduct disorder eg aggressive or dissocial behaviour

• bed wetting
• babyish speech
• thumb sucking

usually within 1 month of the occurrence of the stressful event or life change

does not go over 6 months