Anxiety and mood disorders

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What is fear

emotional response to real or perceived imminent threats

What is anxiety

anticipation of future threats

What is the onset of anxiety disorder

• has an early onset - teens or early twenties

• most occur more frequently in girls than in boys

  • approximately 2:1 ratio

When is an anxiety disorder diagnosed

diagnosed only when he symptoms are not attributable to the physiological effects of a substance/medication or to another medical condition

What are the comorbidity and specificity rates for anxiety disorder

high comorbidity and specificity

What is a specific phobias

fearful or anxious about or avoidant of specific objects or situations

• e.g. animal, natural environment, situational

What is social anxiety disorder

fearful/anxious/avoidant of social interactions and situations that involves the possibility of being scrutinised

• e.g. meeting unfamiliar people, performing in front of others

What is generalised anxiety disorder (GAD)

persistent and excessive anxiety and worry about various domains, including work and school performance

Describe the characteristics of an anxiety disorder

• persistent rather than short-term fear or anxiety

  • typically lasting 6 months or more

• excessive (i.e. overestimation of danger)

• affects every day functioning and cannot be controlled

Symptoms of anxiety disorder - somatic/physical

• Poor sleep

• Goosebumps

• Tense muscles/muscle aches

• Increased heart rate

• Accelerated or deepened respiration

• Dilated pupils

• Decreased salivation

Symptoms of anxiety disorder - affective/emotional

• irritability

• sense of dread

• terror

• restlessness

Symptoms of an anxiety disorder - cognitive

• poor concentration

• anticipation of harm

• exaggeration of danger

• hyper vigilance

Symptoms of an anxiety disorder - behavioural

• escape

• avoidance

• aggression

• freezing

What is a panic disorder

• recurrent unexpected panic attacks

  • i.e. intense fear and/or discomfort

• persistently concerned or worries about having more panic attacks

• maladaptive behavioural changes because of the panic attacks

  • e.g. avoidance of exercise or of unfamiliar locations

Describe the statistics of people with a panic disorder

• 40% of young adults have occasional panic attacks

  • especially during times of intense stress

• 10% of first degree-relatives also have panic disorder

  • twin studies: 30-40% heritability

What are some of the neurotransmitters involved in the panic disorder

• norepinephrine is poorly regulated especially in the brain stem (locus coeruleus), serotonin, gamma-aminobutyric (GABA), and cholecystokinin (CCK) also implicated

What goes on when someone has a panic disorder

• your brain misinterprets the situation

  • thinks it is a life-or-death scenario, and releases adrenaline into the body

• fight or flight

  • feelings of intense fear, sweat, increasing your heart-rate, causing palpitations, nausea, and excess energy

• snowball effect

  • you can realise you’ve began to lose control of your body, your stress levels increase

  • may start to feel detached from yourself or the situation, choking, difficulty breathing, and fear of ‘going crazy’

• blood flow changes

• your amygdala flips out

• your nervous system sends a signal to your parasympathetic system

Interventions for panic disorder

• Cognitive-behavioural therapy (CBT): identifying and challenging irrational thoughts and beliefs that contribute to panic attacks

• Cognitive restructuring

  • Identifying and challenging negative thought patterns

• Exposure therapy

  • Gradual exposure to feared situations or sensations to reduce anxiety

• Relaxation techniques

  • E.g. breathing and progressive muscle relaxation

Interventions for panic disorder - medication

• selective serotonin reuptake inhibitors (SSRIs)

• serotonin-norepinephrine reuptake inhibitors (SNRIs)

• benzodiazepines

Mindfulness-based interventions for panic disorder

virtual reality therapy

What is a mood disorder

any group of conditions of mental and behavioural disorder where the main underlying characteristic is a disturbance in the person’s mood

• also known as an affective disorder

• e.g. bipolar and related disorders, depressive disorder

Symptoms for mood disorder

• changes in sleep patterns

  • insomnia or hypersomina

• changes in appetite

  • significant weight loss or gain

• fatigue and low energy

  • feeling tired and lacking the energy to perform regular activities

• difficulty concentrating

  • trouble focusing on tasks

• feelings of hopelessness or worthlessness

  • persistent negative thoughts about oneself

• loss of interest or pleasure (anhedonia)

  • a diminished interest in perviously enjoyed activities

• irritability or agitation

What is bipolar 1 disorder

• alternations between manic and other mood episodes

• depressive episodes may also occur

• tends to be chronic

What is the onset for Bipolar 1 disorder

average age onset is 18 years, but can begin in childhood

What is bipolar 2 disorder

• characterised by recurring episodes of major depression and hypomania

• tends to be chronic

What is the onset of bipolar 2 disorder

• average age on onset is 22 years

• can being in childhood (10 to 13% of cases progress to bipolar 1 disorder)

What is cyclothymic disorder

chronic mood disturbances with periods of hypomania and mild depression that lasts for at least two years but do not meet the criteria for bipolar 1 or 2 disorders

What is major depressive disorder

• pervasive depressed mood, loss of interest, and enjoyment (e.g. withdrawal from friends), feeling tired, poor concentration (e.g. missed school)

• discrete episodes of at least 2 weeks duration (changes in affect, cognition)

What is dysthymic/persistent depressive disorder

chronic mood disturbances continues for at least 2 years in adults or 1 year in children

What is disruptive mood dysregulation disorder

• characterised by severe and recurrent temper outbursts (verbal and/or behavioural) that are out of proportion (in intensity or duration) to the situation

• inconsistent with developmental level

What can affect depression / mood disorders

• Genetic influences

 

• Neurobiological influences;

  • Low levels of serotonin

  • Elevated cortisol

  • Disturbed sleep and circadian rhythms

 

• Stress is strongly related to mood disorders

• Negative coping styles – a tendency to interpret life events negatively

• Engaging in more cognitive errors:

  • Arbitrary inference – overemphasise the negative

  • Overgeneralisation – generalise negatives to all aspects of a situation

Interventions that help with depression / bipolar / mood disorder

Cognitive-behavioural therapy (CBT):

• MDD: helps identify and challenge negative thought patterns, develop healthier cognitive patterns, and acquire coping skills

• Bipolar disorders: adapted to address the cognitive and behavioural aspects of bipolar disorder, providing psychoeducation, mood tracking, and strategies for managing mood swings

• Interpersonal therapy (IPT): improving interpersonal relationships (can focus on social and interpersonal triggers)

• Mindfulness-based cognitive therapy (MBCT) and dialectical behaviour therapy (DBT): cognitive-behavioural techniques and mindfulness strategies

• Electroconvulsive therapy (ECT): electrical currents are passed through the brain to induce controlled seizures

  • Can be used for severe and treatment-resistant mood disorders, particularly major depressive disorder and bipolar disorder

• Antidepressant medications: selective serotonin reuptake inhibitors (SSRIs); serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Mood stabilisers: lithium (bipolar disorder) - seems to a number of neurotransmitter systems, including serotonin, dopamine, and glutamate

  • It appears to be more effective in reducing the symptoms of mania than the symptoms of depression; but it can have serious side effects

• Antipsychotic medications may be used in combination with mood stabilisers for bipolar disorder