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Samenvatting GGZ2024 Anxiety And Related Disorders ALLE taken en colleges
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This is an elaboration of all sources of all tasks and also the lectures of the course 'anxiety and related disorders'.
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By: samstappers • 2 year ago
By: sanderheesakkers1995 • 2 year ago
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COURSE 5 – ANXIETY AND RELATED DISORDERSTASK 1: ANXIETY AND HYPERVENTILATION
Anxiety = an innate, adaptive mechanism that readies human beings for action and
protects them from anticipated threat (alarm system).
DSM: axis I disorders (other) and axis II disorders (personality and developmental
disorders).
Source: Schmidt, et al (2014)
Anxiety disorders = disorders that share features of excessive fear and anxiety and
related behavioural disturbances
- Separation Anxiety Disorder (fear or anxiety concerning separation from
those to whom the individual is attached)
- Selective Mutism (consistent failure to speak in specific social situation
despite speaking in other situations)
- Specific Phobia (fear or anxiety about a specific object or situation)
- Social Anxiety Disorder (Social Phobia) (fear or anxiety about one or more
social situations in which the individual is exposed to possible scrutiny by
others)
- Panic Disorder (recurrent unexpected panic attacks)
- Agoraphobia (marked fear or anxiety about two (or more) of the following five
situations: public transportation, open spaces, enclosed spaces, in line/crowd
or being alone outside)
- Generalized Anxiety Disorder (excessive anxiety and worry (apprehensive
expectation) about a number of events or activities)
- Substance/Medication-Induced Anxiety Disorder (panic attacks or anxiety
is predominant in the clinical picture and during or soon after intoxication or
withdrawal)
- Anxiety Disorder Due to Another Medical Condition (panic attacks or
anxiety is predominant in the clinical picture and a direct consequence of
another condition)
- Other Specified Anxiety Disorder (do not meet the full criteria for any of the
disorders in the anxiety disorders diagnostic class and clinician communicates
the specific reason for this)
- Unspecified Anxiety Disorder (do not meet the full criteria for any of the
disorders in the anxiety disorders diagnostic class and the clinician does not
communicate the specific reason for this).
Source: DSM-V
1. What is a panic disorder? (DSM)
Diagnostic criteria:
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of
intense fear or intense discomfort that reaches a peak within minutes, and
during which time four (or more) of the following symptoms occur:
Note: The abrupt surge can occur from a calm state or an anxious state.
1. Palpitations, pounding heart, or accelerated heart rate;
2. Sweating;
3. Trembling or shaking;
1
, 4. Sensations of shortness of breath or smothering;
5. Feelings of choking;
6. Chest pain or discomfort;
7. Nausea or abdominal distress;
8. Feeling dizzy, unsteady, light-headed, or faint;
9. Chills or heat sensations;
10. Paresthesias (numbness or tingling sensations);
11. Derealization (feelings of unreality) or depersonalization (being
detached from one-self);
12. Fear of losing control or “going crazy.”
13. Fear of dying.
Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache,
uncontrollable screaming or crying) may be seen. Such symptoms should not
count as one of the four required symptoms.
B. At least one of the attacks has been followed by 1 month (or more) of one /
both of the following:
1. Persistent concern or worry about additional panic attacks or their
consequences (e.g. losing control, having a heart attack, ‘going
crazy’);
2. A significant maladaptive change in behaviour related to the attacks
(e.g. behaviours designed to avoid having panic attacks, such as
avoidance of exercise or unfamiliar situations);
C. The disturbance is not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition (e.g.,
hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder (e.g., the
panic attacks do not occur only in response to feared social situations, as in
social anxiety disorder: in response to circumscribed phobic objects or
situations, as in specific phobia: in response to obsessions, as in obsessive-
compulsive disorder: in response to reminders of traumatic events, as in
posttraumatic stress disorder: or in response to separation from attachment
figures, as in separation anxiety disorder).
Source: DSM-V
Panic = an intense fight or flight emotional arousal (can be the result of a
malfunctioning “alarm system,” and will sometimes manifest in an overwhelming
emotional experience called a panic attack)
Panic attack = a discrete period of intense fear or discomfort that reaches a peak
within minutes and is accompanied by four or more somatic and/or cognitive
symptoms (e.g., sweating, fear of dying)
DSM-V: panic attack has at least 4 symptoms occurring simultaneously:
1. heart palpitations and chest pain
2. lightheadedness
3. nausea
4. heat sensations or chills
5. shortness of breath
6. tingling
7. sweating
2
, 8. feelings of unreality
9. shaking
10. subjective or cognitive symptoms (include fear of dying and fear of losing
control).
Panic disorder (PD) = anxiety condition
- Essential feature: presence of recurrent, unexpected panic attacks along
with significant panic-related worry (different forms: e.g. persistent fears
and concerns about having additional panic attacks, worry about
consequences of panic attacks)
- Panic attacks cannot arise solely from the direct physical effects of a
substance (e.g., caffeine intoxication) or from a medical condition (e.g.
hyperthyroidism)
- Cannot be caused by some other mental disorder (e.g., social anxiety
disorder, obsessive-compulsive disorder)
- Associated with significant disability and impairment, particularly when the
condition is combined with substantial avoidance behaviors wherein the
individual also receives an AG (agoraphobia) diagnosis
o Impairment across physical, occupational and social functioning
Panic attacks alone are not sufficient to warrant a PD-diagnosis (estimated 28%
of people will experience a panic attack in their lifetime, yet less than 5% develop
PD).
DSM-v: three types of panic attacks
1. Unexpected, spontaneous or uncued attacks (occur out of the blue and
are not associated with a particular situation or internal cue);
a. Central to PD;
2. Situationally bound or cued attacks (almost always occur upon
exposure to or in anticipation of a particular situation)
3. Situationally predisposed attacks (linked to a particular situation but do
not always occur)
→ uncued attacks are central and required for PD diagnosis, but many patients
also experience situationally bound and disposed attacks as well (typically present a
mixture of different types of panic attacks)
Individuals with PD display characteristic concerns about the implications or
consequences of the panic attacks (indication of undiagnosed, life-threatening
illness; indication of going crazy, losing control, emotional weakness).
DSM-IV: agoraphobia is secondary to a panic disorder (panic-related consequence)
DSM-V: agoraphobia is distinct from panic disorder (PD diagnosis, AG diagnosis or
diagnosis of comorbid PD and AG)
Differential diagnosis of panic:
- Other anxiety disorders (83% of patients with anxiety disorder have had at
least one panic attack)
- Substance-induced panic (intoxication or withdrawal)
- Panic due to general medical condition (acute medical crisis)
- Comorbidity with axis I disorders (e.g. anxiety, mood and substance use
disorders).
Source: Schmidt, et al. (2014)
3
, 2. What is a generalized anxiety disorder (GAD)? (DSM)
Diagnostic criteria:
A. Excessive anxiety and worry (apprehensive expectation), occurring more days
than not for at least 6 months, about a number of events or activities (such as
work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following 6
symptoms (with at least some symptoms having been present for more days
than not for the past 6 months):
a. Note: only 1 item is required in children.
1. Restlessness or feeling keyed up or on edge;
2. Being easily fatigued;
3. Difficulty concentrating or mind going blank;
4. Irritability;
5. Muscle tension;
6. Sleep disturbance (difficulty falling or staying asleep, or restless,
unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress
or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition (e.g.,
hyperthyroidism).
F. The disturbance is not better explained by another mental disorder (e.g.,
anxiety or worry about having panic attacks in panic disorder, negative
evaluation in social anxiety disorder [social phobia], contamination or other
obsessions in obsessive-compulsive disorder, separation from attachment
figures in separation anxiety disorder, reminders of traumatic events in
posttraumatic stress disorder, gaining weight in anorexia nervosa, physical
complaints in somatic symptom disorder, perceived appearance flaws in body
dysmorphic disorder, having a serious illness in illness anxiety disorder, or the
content of delusional beliefs in schizophrenia or delusional disorder).
Source: DSM-V.
Anxious people are highly aroused and alert, and generally in a state of
‘overpreparedness’. With anxiety patients, an anxiety-producing situation is not
necessary to produce hyperarousal🡪 rather, the hyperarousal seems to be chronic.
Research: Heart rate for patients with agoraphobia was consistently higher at each
walk than that of the control subjects (leaving safety of clinic). However, heart rate
decreased or habituated in both groups over the 7 walks. The only difference in the
slope of this change was in the very last walk, when our patients with agoraphobia
showed a marked increase in heart rate that was significantly different from the
continuing habituation shown by the control subjects. Perhaps: the patients knew it
was their last walk and reacted with the final exam effect.
Data shows no difference between the 2 groups in their heart rate during the
supposedly frightening (for the patients) walk, relative to what their heart rate
happened to be on that day as measured during resting baseline procedures (if heart
rate was high at baseline 🡪 high during walk). The test does not seem to be specific
for changes in anxiety associated with panic disorder with agoraphobia, as measured
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