Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry (Y4) > 1- Mental health conditions (Anxiety disorders 1/2) > Flashcards

1- Mental health conditions (Anxiety disorders 1/2) Flashcards

1
Q

define neuroses

A

Is a collective term for psychiatric disorders characterized by distress, that are non-organic, have a discrete onset and where delusions and hallucinations are absent.
- Functional and not an organic illness
- Not psychotic
o Patients are distressed, but no delusions
- Synonymous with anxiety disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

classification of neuroses

A
  • Paroxysmal or episodic anxiety
  • Continuous or generalised anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common symptoms of neuroses

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

clinical features of neuroses

A

Clinical features
- Common symptoms (see above)
- Associated cognitions inc worries or fears that are inappropriate or excessive
- Associated behaviour inc avoidance or escape from the situation that causes anxiety
- Depressive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Conditions associated with anxiety

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

anxiety

A
  • Anxiety is an unpleasant emotional state involving subjective fear and somatic symptoms.
  • Every human experiences anxiety, but if these anxieties become excessive or inappropriate they are described as an illness.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The Yerkes–Dodson law

A

states that anxiety
can actually be beneficial up to a plateau of
optimal functioning. Beyond this level of
anxiety however, performance deteriorates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The most common anxiety disorders, in order of prevalence are:

A

o Specific phobia
o Social phobia
o Generalized anxiety disorder
o Agoraphobia
o Panic disorder
o OCD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Anxiety disorders can be split into

A
  • Specific phobias
  • GAD and panic disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

aetiology of anxiety

A
  • Positive / re-entry feedback loops
  • Trait anxiety: a stable characteristic arising from a multitude of genetic and environmental factors, particularly adaptive responses to experiences of potential threat during development
  • State anxiety simply the state of feeling anxious. This is not rocket science (we’re all familiar with the experience of anxiety), but like any illness, the disorder is identified when these symptoms become severe and persistent enough to cause significant distress and functional impairment.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

langs three system model

A

basis of many CBD models

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Padeskys anxiety equation

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Neurotic and stress-related disorders (ICD-10 classification) are split into:

A

Split into:
Phobic anxiety disorders
o Specific phobia
o Agoraphobia
o Social phobia

Other anxiety disorders:
o Panic disorder,
o Generalised anxiety disorders
o Mixed anxiety
o Depressive disorder

Obsessive-compulsive disorder: predominantly obsessional thoughts, predominantly compulsive thoughts, mixed

Reaction to severe stress and adjustment disorders
o Acute stress reaction
o Post-traumatic stress disorder
o Adjustment disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

define GAD

A

Generalized anxiety disorder (GAD) is a syndrome of ongoing, uncontrollable, widespread worry about many events or thoughts that the patient recognizes as excessive and inappropriate. Symptoms must be present on most days for at least 6 months duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Type 1 vs Type 2 GAD

A
  • Type 1- specific content of worries change/ varies
  • Type 2- worries about worries

Often maintained by the belief that worry is useful e.g. it motivates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

prevalence of GAD

A

o GAD has a prevalence of 2–4% in the general population.
o It is more common in F at a ratio of 2:1.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

risk factors for GAD

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of GAD

A

biospychosocial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Difference between GAD and stress

A

Stress is typically caused by an external trigger
- Trigger can be short term, such as a work deadline or a fight with love one
- Can experience mental and physical symptoms
 Irritability
 Anger
 Fatigue
 Muscle pain
 Difficulty sleeping

Anxiety is defined as persistent, excessive worries that don’t go away even in the absence of a stressor
- Can lead to identical set of symptoms as stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Differential diagnosis for GAD

A
  • Other neurotic disorders: panic disorders, specific phobias, OCD, PTSD
  • Depression
  • Schizophrenia
  • personality disorder
  • Excess caffeine or alcohol
  • Withdrawal from drugs

Organic
o Anaemia
o Hyperthyroid
o Phaeochromocytoma
o Hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

presentation of GAD

A

Symptoms concerning chest and abdomen
 Difficulty breathing
 Feeling of choking
 Chest pain or discomfort
 Nausea
 Abdominal distress or pain
 Loose motions.

Symptoms concerning the brain and mind
 Feeling dizzy or light headed
 Fear of dying
 Fear of losing control
 Derealization and depersonalization.

General symptoms
 Hot flushes or cold chills
􏰀 Numbness or tingling
 Headache.

Symptoms of tension
 Muscle tension, aches or pains
􏰀 Restlessness
 Feeling on edge
 Difficulty swallowing
 Sensation of lump in throat.

Non-specific symptoms
 Being startled
 Concentration difficulty and mind blanks
 Persistent irritability
 Sleep problems.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnosis/investigations for GAD

A

1) Screening tool e.g. GAD 2/7
2) Full history / ICD-10
3) MSE
4) Physical exam
5) Investigations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

GAD-2/7

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MSE for GAD

A
25
Q

ICD-10 for GAD

A
26
Q

general management of GAD

A

Psychological therapies address the problem (for instance by helping the patient to break some of the positive feedback loops described above), and medications reduce the intensity of state anxiety to better enable the person to engage with psychology.

Psychological treatment most important
- Often both approaches are essential.
- Treatment is effective but takes time and significant effort because the patient is required to go against their innate self-protective impulses (such as avoidance).

General management
- Self help methods
- Exercise
- Support groups

27
Q

stepwise approach to anxiety

A

The stepwise treatment algorithm, depending on severity, is as follows:18
1. Psychoeducation, sleep hygiene, and self-guided cognitive-based therapy (CBT) relaxation techniques: it may be helpful to acknowledge that these can appear basic/low intensity, but emphasise their evidenced effectiveness for mild/moderate anxiety if done regularly.
2. CBT: identifying then gradually unlearning the maladaptive patterns of thought/behaviour which are perpetuating symptoms. A CBT practitioner may employ techniques such as exposure therapy (allows extinction of erroneously learned fears) and applied relaxation.
3. Pharmacological(equal 1st line with CBT). SSRI (e.g. escitalopram or sertraline), SNRI (e.g. duloxetine or venlafaxine) or atypical antidepressant (e.g. Mirtazapine) with the choice depending on side-effect profile.
o Pre-gabalin (addictive)
o Buspirone (seratonergic)
o Benzodiazepines (tranquilisers)
o B blockers for symptoms

28
Q

DO NOT GIVE BENZODIAZEPINES FOR MORE THAN

A

4 WEEKS

29
Q

Anxiety (GAD) history taking

A
30
Q

define phobia

A

is an intense, irrational fear of an object, situation, place or person that is recognized as excessive (out of proportion to the threat) or unreasonable.

31
Q

types of phobia

A

1) Agoraphobia
2) Social phobia
3) Specific phobia

32
Q

prevalence of phobias

A

specific phobias most common

33
Q

phobia pathophysiology and risk factors

A
  • Biological: Tachycardia is the usual autonomic response, however in phobias of blood, injection and injury, a vasovagal response (bradycardia) is produced, commonly leading to fainting (syncope). For a complete list of biological symptoms see GAD, Section 5.2.
  • Psychological: Include unpleasant anticipatory anxiety, inability to relax, urge to avoid the feared situation and, at extremes, a fear of dying.
  • Agoraphobia is strongly linked to panic disorder. Indeed the ICD-10 divides agoraphobia into: agoraphobia with panic disorder and agoraphobia without panic disorder.
34
Q

define agoraphobia

A

Agoraphobia literally means a ‘fear of the marketplace’. It is a fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack.

35
Q

Pathophysiology of agoraphobia

A

Maintained by avoidance which prevents deconditioning and sets up a vicious cycle of anxiety.

36
Q

management of agoraphobia

A
  • CBT with graduated exposure
  • SSRIs
37
Q

graduated exposure therapy

A

Graduated exposure is the process of exposing the patient slowly and methodically to more and more raw aspects of those experiences.

38
Q

social phobia def

A

A fear of social situations which may lead to humiliation, criticism or embarrassment- lies a fear of negative evaluation by others

39
Q

pathophysiology of social phobia (social anxiety disorder)

A

Uncertain aetiology. Usually begins in late adolescence, an age at which people are concerned about the impression they make on others.

40
Q

presentation of social phobia

A
  • Can lead to avoidance of feared situation (counter-productive, use of safety behaviours, anticipatory anxiety, and unhelpful ‘post mortems’ following social encounters
41
Q

management of social phobia

A
  • CBT with graduated exposure to feared situations e.g. to feared situations
  • Pharmacological intervention e.g. SSRIs (escitalopram or sertraline), SNRIs (venlafaxine) or if no response to these, a MAOI (moclobemide)
42
Q

specific phobia def

A

A fear restricted to a specific object or situation (excluding agoraphobia and social phobia).

43
Q

speciifc phobias pathophysiology

A

Conditioning event in early life, i.e. a frightening experience. Possibly a role for learned behaviour, e.g. from parents

44
Q

management of specific phobias

A
  • Exposure therapy either using self-help methods or through CBT
  • Benzodiazepines for short erm e.g. if a patient needs a CT scan and they are claustrophobic
45
Q

diagnosis/investigations of phobias

A

1) history
2) ICD-10 criteria
3) MSE
4) Risk assessment
5) Investigations

46
Q

history taking for phobia

A
  • ‘What situations cause you anxiety or embarrassment?’ (specific phobia)
  • ‘Do you get symptoms in situations from which escape would be difficult?’, ‘Do you get symptoms in places or situations where help may not be available?’, ‘Do you get symptoms while being in a crowd or travelling on public transport?’ (agoraphobia)
  • ‘Do you ever worry about what people think of you? Does this worry ever lead to you avoiding certain situations?’ (social phobia)
  • ‘Do you avoid any situation because you know you will feel panicky?’ (anticipatory anxiety)
47
Q

ICD criteria for phobias

A
48
Q

MSE for phobias

A
49
Q

risk assessment for phobias

A

suicie and self harm

50
Q

investigations for phobias

A
  • Questionnaires e.g. social phobia inventory and Liebowitz social anxiety scale
51
Q

Panic disorders characterised by

A

recurrent, episodic, severe panic attacks, which are unpredictable and not restricted to any particular situation or circumstance.

52
Q

panic disorders prevalence

A
  • 1%
  • More common in women
  • Onset most common in late adolescence
53
Q

pathophysiology and risk factors of panic disorders

A

Biological
o Genetics – very heritable
o Neurochemical- post synaptic hypersensitivity to serotonin and adrenaline
o Sympathetic nervous system- fear or worry stimulates the NS -> increased cardiac output which can lead to further anxiety

Cognitive
o Misinterpretation of somatic symptoms (e.g.. feat that palpitations will lead to a heart attack)

Environmental
o Presence of life stressors can lead to panic disorder

54
Q

panic disorder presentation

A

Presentation
Panic symptoms usually peak within 10 minutes and rarely persist beyond an hour.
* Shortness of breath
* Chest pain
* Excessive sweating
* Palpitations or tachycardia
* Dizziness or feeling faint
* Trembling or shaking
* Intense feeling of terror
* Nausea
* Tingling or numbness in fingers or toes
* Derealisation/depersonalisation
* Dry mouth
* Chills or hot flashes
* Visual disturbances
* Fear of dying
* Fear of losing control or impending doom

55
Q

diagnosis/investigations for panic disroders

A

1) History
2) ICD-10
3) MSE
4) investigations

56
Q

history for panic disorders

A

o ‘Are you generally anxious or are there periods where you are anxiety-free?’ (episodic)
o ‘Can you predict when these attacks will come on?’ (unpredictable)
o ‘Have you ever been so frightened that you felt your heart was pounding and that you might die?’ (intense fear and anxiety)
o ‘Are you worried about your health or any other specific things?’ (major life stressors)

57
Q

ICD-10 panic disoders

A
58
Q

MSE for panic disorders

A
  • MSE- same as GAD, may be more intense e.g. hyperventilation and restlessness

- MSE- same as GAD, may be more intense e.g. hyperventilation and restle

59
Q

investigations for panic disorders

A

o Bloods: FBC (infection, anaemia), FTFs (hyperthyroidism), glucose (hypoglycaemia)
o ECG: may show sinus tachycardia
o Questionnaires: GAD-2, GAD-7, Becks anxiety inventory, hospital anxiety and depression scale

Psychiatry (Y4) (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions