Anxiety and Coping

Mechanisms

Phil Copeman and Alex Hammant

& some practice exam questions

What are the psychological

symptoms of General Anxiety

Disorder?Worry

Interrupted sleep

Poor concentration

Increased sensitivity to noise

Criteria for diagnosis of GAD

Anxiety and worry occuring more days than not for at least 6 months associated with at least 3 of these 6 symptoms:

Restlessness

Easily fatigued

Difficulty concentrating

Irritability

Muscle Tension

Sleep Disturbance

Name 4 broad methods of treating anxiety

Pharmacological treatments

Relaxation-mindfulness

CBT

Thought Diary (emotions with physical symptoms)

Name 3 ways in which people with GAD

might perceive events

Selective attention (to negative features)

Magnification (of importance of undesirable events)

Overgeneralisation (drawing broad negative conclusions)

What are the 4 classes of effects of stress?

Affective

Behavioural

Cognitive

Physiological

What are the possible ‘physiological’ effects

of stress on in-patients on the ward?

Slower wound healing

More post-surgery complications

Longer in-patient stay

More staff time per day

More analgesia use

Less satisfaction with treatment (poor adherence)

What are the possible ‘physiological’ effects of

stress on in-patients after discharge?

Longer recovery

More service

Less use of rehabilitation services

Increased risk of co-morbidity and early mortality

What are the 3 stages of the

physiological response to

stress?1. Alarm – fight or flight

2. Resistance – conservation response to return to homeostasis

3. Exhaustion – depletion of resources

Describe the physiology behind the stress response

Hypothalamus

Anterior Pituitary gland

Adrenal gland

ACTH (Adrenocorticotrophic hormone)

Adrenaline and Cortisol

What are the physical symptoms of GAD?

Dizziness, irritability

Tachypneoa, Breathlessness

Palpitations

Chest pain

Raised BP

Abdominal pain

Sweating

Increased muscle tension and trembling

What are the 3 dimensions in which

stressors can impact a person?

Chronicity

Magnitude

Inclusiveness

What is the transactional model of stress?

The stimulus events are indirectly related to the stress experience

Stimulus Event(a potential

stressor)

PrimaryAppraisal

(event demands)

SecondaryAppraisal(oneself)

Response(Coping)

Health-RelatedOutcome(Stress)

What were those three intervening processes again?

Primary appraisal: hello, hello what’s all this then? Is this something that could do me down?

Secondary appraisal: am I a strong independent man/woman and therefore able to handle these threats/threats?

Coping: activities – thought or behavioural – brought about to handle the event.

How can ‘coping’ be hierarchically ordered?1. Activities: anything one does in order to manage

stress e.g. doing research or getting smashed.

2. Strategies: coping activities which can be made up into meaningful groups e.g. making a plan

3. Dimensions: strategies which themselves can be separated into either problem-focussed coping or emotion focussed coping

When is problem focussed coping most effective?

When the stressor is amenable to change

When is emotion focused coping most effective?

When the stressor can not be changed

Some practice questions

A 73 year old man attends the movement disorder clinic for his regular check-up. He was diagnosed with Parkinson’s disease 8 years ago, but has noticed that his movement is getting harder on his current medication. The neurologist decides to change his medication to levodopa. Which of the following drugs is co-administered with Levodopa to prevent the peripheral breakdown of levodopa by dopa-decarboxylase?

a) Benserazideb) Entacaponec) Orphenadrined) Rasagilinee) Tolcapone

A 53 year old man has suffered a spinal cord injury resulting from a vascular insufficiency occurring at the T3 level. He has UMN signs in both legs and bilateral loss of pain and temperature sensation below the level of the lesion. Which lesion of the spinal cord is most likely to result in these symptoms?

a) Anteriorb) Centralc) Hemicordd) Posteriore) Transverse

A 47 year old woman visits her optician as she is suffering from visual loss. Her field of vision is shown below:  

Where is the most likely site of a lesion in her visual pathway?

a) Optic chiasmb) Optic nervec) Optic radiation (occipital lobe)d) Optic radiation (temporal lobe)e) Optic tract

A 67 year old man who had suffered a recent stroke is brought to the stroke rehabilitation centre for his physiotherapy session. His main problem is that whilst his lower limbs function normally, his hands and wrist are functional and his cranial nerve exam is normal, his arms and torso are immobile and have reduced sensation. What is the most likely type of stroke that this man has suffered?

a) Lacunar infarctb) Partial anterior circulation infarctc) Posterior circulation infarctd) Total anterior circulation infarcte) Watershed infarct

A 12 year old boy was hit by a car whilst out playing. He was taken to the Emergency Department and given an urgent CT scan:

What type of haemorrhage does the CT show

a) Extraduralb) Intraparenchymalc) Intraventriculard) Subarachnoide) Subdural

a) Actionb) Contemplationc) Maintenanced) Precontemplatione) Preparation

A 43 year-old man attends his GP for a check-up. He has a history of alcohol dependency but proudly announces that he went to his first support group (alcoholics anonymous) meeting last night and that he has stopped socialising with his usual ‘drinking buddies.’  At what stage of the transtheoretical model of behaviour change is the patient?

a) Paracetamolb) Diclofenacc) Codeined) Co-codamole) Naproxen

A 34 year old woman visits the GP as she has been suffering with painful lower limbs. She has been taking Nurofen plus (ibuprofen + caffeine) to no effect and would like to add something else to see if that would work. What of the following drugs would give her the strongest analgesic combination, when added to her current intake?

a) Angiogramb) CTc) DWId) PETe) TI-MRI

A 34 year old woman visits the GP as she has been suffering with painful lower limbs. She has been taking Nurofen plus (ibuprofen + caffeine) to no effect and would like to add something else to see if that would work. What of the following drugs would give her the strongest analgesic combination, when added to her current intake?

a) ACE-3b) AMTc) CAMCOGd) DemTecte) MMSE

An 87 year old man is visited by his general practitioner (GP) following concerns raised by the local occupational therapist. He tells the GP that he was asked a huge number of questions by the occupational therapist when she saw him, but he couldn’t remember why. Which of the following assessment schedules is generally used by occupational therapists to assess cognitive function?

a) 5HT reuptake blockerb) NA reuptake blockerc) α1 adrenoreceptor antagonistd) H1 receptor antagoniste) M1 receptor antagonist

A 39 year old man who has been receiving amitriptyline for treatment of neuropathic pain visits his GP as he is concerned about how sleepy he feels all the time since starting the drugs, and it is beginning to affect his work. Which mechanism could account for his symptoms?

a) Blackb) Dark greyc) Light – mid greyd) Mid greye) White-light grey

A 49 year old woman is brought into the emergency department by her daughter. The daughter states that whilst they were out shopping her mother had suddenly complained about an excruciating headache and then collapsed. An emergency CT scan is ordered by the attending doctor. What colour is acute blood in a CT scan?

a) ACAb) MCAc) Middle Meningeal Arteryd) Posterior Cerebral Arterye) Superior cerebellar Artery

The CT scan shows a region of infarct. The infarct corresponds to which arterial supply?

a) Amygdalab) Caudate Nucleusc) Hippocampusd) Insulae) Mammillary Bodies

A 67 year old woman is being treated for dementia. In order to determine whether the patient has Alzheimer’s or Dementia with Lewy bodies, an MRI scan is ordered. Degeneration of which structure would enable you to differentiate between DLB and Alzheimer’s?

a) Extraduralb) Intraparenchymalc) Intraventriculard) Subarachnoide) Subdural

A 72 year old man with a history of Parkinson’s disease presents with right-sided weakness one week after a fall.

What type of haemorrhage does the CT show?

a) Inferior sagittal sinusb) Sigmoid sinusc) Straight sinusd) Superior sagittal sinuse) Transverse sinus

A 52 year old woman is brought to the emergency department after becoming disoriented and uncoordinated whilst at a garden party. She complained of a severe headache and nausea and was found to be hypertensive and have papilloedema. MRI showed the presence of a large sinus thrombosis, cerebral oedema and bilateral infarcts in the thalamus.  Where is the thrombus most likely to be located?

a) Inferior sagittal sinusb) Sigmoid sinusc) Straight sinusd) Superior sagittal sinuse) Transverse sinus

A 52 year old woman is brought to the emergency department after becoming disoriented and uncoordinated whilst at a garden party. She complained of a severe headache and nausea and was found to be hypertensive and have papilloedema. MRI showed the presence of a large sinus thrombosis, cerebral oedema and bilateral infarcts in the thalamus.  Where is the thrombus most likely to be located?

a) Foramen lacerumb) Foramen magnumc) Hypoglossal formaend) Internal auditory meatuse) Jugular foramen

A 73 year old man visits his general practitioner as he is having difficulty swallowing food. He has had recurring headaches for the last month and more recently has had a few bouts of vomiting. The GP notices that his voice is hoarse and gravelly and that he is unable to lift his right shoulder. An MRI scan showed the presence of a tumour in the base of skull, occluding one of the foramen. Which foramen is most likely to be occluded by the tumour?