1. in phobic anxiety disorders when is the anxiety evoked?
    in well defined situations or by certain objects which are not currently dangerous
  2. what are 3 features of all phobias (a's!)
    • 1. anxiety symptoms: physical (ANS) and mental state (fear)
    • 2. anticipatory anxiety
    • 3. avoidance
  3. what is the prominent feature of agoraphobia?
    • fear of open space, crowded space, travelling alone/away from home
  4. who is agoraphobia more common in? gender and age
    • women
    • early in adult life
  5. when do social phobias usually start?
  6. 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
  7. what is the gender link in social phobias?
    equal m=f
  8. what physical ways may social phobias present as?
    • blushing
    • hand tremor
    • nausea
    • urgency of micturition
  9. what is a complication of severe social phobia?
    social isolation
  10. when do specific phobias usually arise (age)?
    • childhood
    • early adult
  11. 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
  12. 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
  13. 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
  14. what are the dominant symptoms of panic disorder?
    • chest pain
    • palpitations
    • dizziness
    • choking
    • feelings of unreality: depersonalisation, derealisation
    • secondary feeling of dying, losing control, going mad
  15. what is the time frame for diagnosis of panic disorder?
    several severe attacks of autonomic anxiety should have occurred within 1 month
  16. 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)
  17. what is the type of anxiety in GAD?
    free floating
  18. who suffers more GAD m or f?
  19. what is the time frame for diagnosis of GAD?
    most days for several weeks (6months)
  20. 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
  21. how may GAD present in children?
    • frequent need for reassurance
    • recurrent somatic complaints
  22. what is the maximum time BDZ should be taken for anxiety?
    2 weeks
  23. 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
  24. 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
  25. 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
  26. 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
  27. what else do people with OCD tend to develop?
  28. what is gender and age pattern in OCD?
    • m=f
    • onset: childhood or early adult
  29. 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
  30. what causes acute stress reaction? give eg
    • exceptional physical or mental stress
    • natural catastrophe, accident, battle, criminal assault, rate
  31. what increases risk of acute stress reaction disorder developing?
    if physical exhaustion or organic factors eg in the elderly are present
  32. 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
  33. what are the initial symptoms of acute stress reaction?
    daze: constriction of field of consciousness, narrowing of attention, inability to comprehend stimuli, disorientation
  34. 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).
    • OR
    • agitation and over activity
  35. 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
  36. what is PTSD?
    • delayed response to a stressful event
    • which is likely to cause pervasive distress in almost anyone
  37. give eg of PTSD event/situation
    • natural/man made disaster
    • war
    • witness violent death
    • victim of torture, terrorism, rape
  38. what are predisposing factors for PTSD?
    • compulsive/asthenic (ie weak, lack strength) personality traits
    • previous history of neurotic illness
  39. 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
  40. 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
  41. what may complicate symptoms of PTSD?
    excess alcohol or drugs may complicate things
  42. when is the onset of PTSD?
    • after a latency period after the trauma - from a few weeks to months
    • rarely exceeds 6months
  43. what is the course of PTSD?
  44. what is prognosis if PTSD?
    • majority recover
    • some - chronic then turns into enduring personality change
  45. 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
  46. 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
  47. how can adjustment disorder manifest?
    • depressed mood
    • anxiety
    • worry
    • feeling of inability to cope, plan ahead or continue in the present situation
    • disability in performance of daily routine
  48. what may be assoc with adjustment disorder in adolescence?
    conduct disorder eg aggressive or dissocial behaviour
  49. how may children present with adjustment disorder?
    • bed wetting
    • babyish speech
    • thumb sucking
  50. what is the onset of adjustment disorder?
    usually within 1 month of the occurrence of the stressful event or life change
  51. what is the duration of symptoms of adjustment disorder?
    does not go over 6 months
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