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NS30 - Psychological Disorders 1 - Anxiety Disorders (ii) (GAD…
NS30 - Psychological Disorders 1 - Anxiety Disorders (ii)
Anxiety aetiology
biological factors
genetic predisposition (supported by studies-concordance in twins)
increased GABA circuits
acquired through classical conditioning + observational learning
maintained through operant conditioning
cognitive factors: perceived threat
neurotic personality (-ve bias)
stress = precipitator
social determinants
social class
employment
marital status
education
home renter
urban residence
homelessness
prisoners
Anxiety prognosis
usually good
50% recover in 2 years with no treatment
70% of those treated recover
50% still have symptoms 1 yr after seeing GP
50% of those seen by a psychiatrist won't be fully able to function after 4 years
poor prognosis factors
chronic/severe symtoms on presentation
persisting social problems
inadequate support
GAD
continuous/episodic
excess worry about multiple things (work, family, health, finances, minor matters)
worry for most days for @ least 6 months
not tied to any specific threat
x2 common in females
9% lifetime risk
often begins @ 15-25 y/o, prevalence peaks @ middle age
pure GAD rare (usually mixed with depression
disturbed sleep, irritability, restlessness, poor concentration, fatigue, muscle tension, dizziness, trembling, sweating, palpitations
Phobic disorder
specific focus
persistent irrational fear of non-dangerous object/situation
3 types
specific
onset usually before 10 y/o
natural environment (heights, water, storms)
situational (open/enclosed spaces, airplanes)
animals/insects
social anxiety
fear of possible scrutiny
onset age: 8-15 y/o
agoraphobia
anxiety around @ least 2: public transport, open/enclosed spaces. crowds, being outside home alone
active avoidance (risk of becoming house-bound)
fear of escape being difficult / help not being available if a panic attack begins
before diagnosis: consider cultural context
panic disorder
sudden unexpected recurrent attacked of overwhelming anxiety
ANS over activation -> paralysis
fears of dying/losing control
lasts a few min
normally anxiety free between attacks
increases risk of developing agoraphobia
x2-3 more common in women
onset age= 20-24 y/o
OCD
obsessions: persistent uncontrollable intrusive unwanted thoughts
e.g. suicide, inflicting harm on others, sexual acts, personal failures
compulsions: urges to engage in senseless rituals
hand-washing, repetitive cleaning, rechecking locks
lifetime prevalence = 2/3%
chronic, with periods of exacerbation