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Psychiatry > 2: Anxiety Disorders > Flashcards

2: Anxiety Disorders Flashcards

1
Q

Define generalised anxiety disorder (GAD)

A

At least 6-months of excessive anxiety and worry, with apprehension and tension about everyday life events

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2
Q

What is the time-frame for GAD

A

6-months

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3
Q

What gender is GAD most common

A

Female (2:1)

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4
Q

What is the genetic concordance of GAD

A

5-10%

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5
Q

What model describes aetiology of GAD

A

Triple vulnerability model

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6
Q

Describe the triple vulnerability model

A
  1. Biological
  2. Psychological
  3. Social
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7
Q

What biological factors contribute to GAD

A
  • High cortisol

- Genetic

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8
Q

What psychological factors contribute to GAD

A
  • Lack of perceived control: trauma, insecure attachment

- Parenting: over-protective, lack of warmth

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9
Q

What social factors contribute to GAD

A

Trauma

Marital problems

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10
Q

What are two risk factors for GAD

A

Stressful life events

Difficult marital relationships

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11
Q

What is the ICD-10 diagnostic criteria for GAD

A

Requires at least 4 of the following, one must be autonomic symptoms:

  1. Psychological - excessive worrying
  2. Autonomic - sweating, palpitations, dry-mouth
  3. Physical - breathing difficulties, nausea, abdominal distress
  4. General - tingling, numbness
  5. Muscle tension - restlessness, feeling on edge
  6. Other: exaggerated response to minor surprises, insomnia, concentration difficulties
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12
Q

What is the investigation for GAD

A

Suspect GAD in people who present to GP with:

  1. Repeatedly present with excessive worrying
  2. Present with wide-range somatic symptoms
  3. Chronic physical health problems
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13
Q

What is first-line management for GAD

A
  • Eduction

- Low-intensity psychosocial education

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14
Q

What are three low-intensity psychosocial interventions

A
  • Non-facilitate self-help
  • Guided self-help
  • Psychoeducational groups
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15
Q

What is second-line for GAD

A

High-intensity psychosocial intervention

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16
Q

What high-intensity psychosocial interventions are used

A
  • CBT

- Applied relaxation

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17
Q

What is first-line medication for GAD

A

SSRI

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18
Q

What should young people be warned of when starting SSRI

A

Increase risk of suicide

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19
Q

Explain monitoring of young people on SSRIs

A

See them weekly for the first-month

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20
Q

If SSRI ineffective, what should be done

A

Alternative SSRI or SNRI

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21
Q

What is an alternative to SSRI or SNRI

A

Pregabalin

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22
Q

Explain benzodiezapines for GAD

A

Benzodiazepines can be used in short-term crisis for anxiety, but should not be used long-term

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23
Q

What is fourth-line for GAD

A

Combination medication and high-intensity psychoeducation

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24
Q

Define a panic attack

A

Period of intense anxiety reaching peak-intensity at 10-minutes. Usually do not persist beyond 20-30 minutes. Can be spontaneous or precipitated

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25
Q

How long do panic attacks usually last

A

20-30min

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26
Q

What can cause panic attack

A

Spontaneous or situational

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27
Q

Define panic disorder

A

Recurrent tendency to experience panic attacks, not secondary to medical conditions, substance mis-use or psychiatric disorder

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28
Q

What is the problem with panic disorder

A

Individual fears about having another panic attack, which can lead to them avoid a particular situation

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29
Q

In which gender is panic disorder more common

A

Females (2:1)

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30
Q

When is panic disorder most common

A

15-25 or 45-55

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31
Q

What are 5 risk factors for panic disorder

A
  • Living in a city
  • Widow
  • Early parental loss
  • Limited education
  • Sexual or physical abuse
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32
Q

What disorders are associated with panic disorder

A
  1. Agraphobia (75%)
  2. Depression (70%)
  3. Other anxiety disorders (50%)
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33
Q

What is a mnemonic to remember clinical presentation of panic attacks

A

STUDENTS FEAR 3C’s

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34
Q

Explain clinical presentation of panic attacks

A 
Sweating
Trembling 
Unsteadiness
Derealisation
Elevated HR, palpitations
Nausea 
Tingling

FEAR of dying

Choking (Globus hystericus)
Chest pain
Chills

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35
Q

What is fear of dying called

A

Angor Amnii

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36
Q

What is choking due to psychological causes referred to as

A

Globus hystericus

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37
Q

Explain diagnosis of panic disorder

A

If individual presents to A+E with panic attack - need to exclude underlying physical causes (eg. MI, AF). Can distinguish panic disorder from the history

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38
Q

What is first-line for panic disorder

A

Low-intensity psychoeducational interventions

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39
Q

What are two low-intensity psychosocial interventions

A

Individual non-facilitated self-help
Individual facilitated self-help

Monitor 4-8W and use panic sub scale to measure effectiveness

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40
Q

What is a high-intensity psychological intervention

A

CBT

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41
Q

What pharmacological intervention is first-line for panic disorder

A

SSRI

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42
Q

What is second-line medication for panic disorder if SSRIs are ineffective

A

TCA: imipramine, clomipramine

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43
Q

When are TCAs indicated for panic disorder

A

If no improvement on SSRIs after 12W

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44
Q

What is fourth-line for panic disorder

A

Pharmacological and CBT

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45
Q

Define specific phobic disorder

A

Excessive unreasonable fear caused by presence of anticipation of a specific event

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46
Q

In which gender is phobic disorder more common

A

Female (4:1)

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47
Q

What is the life-time prevalence of phobic disorder

A

5%

48
Q

What is genetic concordance of phobic disorder

A

25%

49
Q

What are two theories of phobic disorder

A

Learning theory: due to operant or classical conditioning

Psychoanalytical theory: unresolved subconscious conflict manifests as phobias

50
Q

Explain clinical presentation of specific phobic disorder

A

Sudden increase in anxiety in exposure of anticipation of specific event. This can lead to avoidance which impacts person’s life

51
Q

Define agoraphobia

A

Fear of being alone in spaces where unable to escape

52
Q

What is problem with agoraphobia

A

Often leads to individuals not leaving their house, can become overly dependent

53
Q

What is claustrophobia

A

fear enclosed spaces

54
Q

What is acrophobia

A

fear heights

55
Q

what is first-line for specific phobic disorders

A

behavioural therapies

56
Q

what behavioural therapy is indicated for phobic disorder

A

Wolpe’s systematic desensitisation

57
Q

what is wolpe’s systemic desensitisation

A

Based on classical conditioning - aims to remove fear response and substitute relaxation

58
Q

what are other types of behavioural therapy

A
  • Flooding
  • Graded-exposure
  • Relaxation
59
Q

what is second-line for specific phobic disorder

A

CBT

60
Q

what is the risk with specific phobic disorder

A

Increases risk other mental-health conditions

61
Q

what is social anxiety disorder referred to as in the ICD-10

A

social phobia disorder

62
Q

define social phobia

A

fear of scrutiny by others leading to avoidance of social situations

63
Q

what are severe social phobia’s usually associated with

A

low self-esteem and fear of criticism

64
Q

explain how social phobia presents

A

in social situations individual develops blushing, sweating, tremor - individuals often believe these are the primary problems and results in avoidance of social situations

65
Q

when is SAD more common

A

25-35 years-old

66
Q

in which gender is SAD more common

A

Female

67
Q

explain clinical presentation of SAD

A

Blushing, Tremor, Sweating during social interaction which is worse when noticed by others

68
Q

what two questions should someone with SAD ask

A
  1. Do you get fearful or embarrassed in social situations

2. Do you find yourself avoiding social situation s

69
Q

what scoring system is used as a screening tool for social anxiety disorder

A

mini-SPIN (social phobia inventory)

70
Q

what score on the mini-SPIN indicates social anxiety disorder

A

> 6

71
Q

what should happen is someone scores more than 6 on the social-anxiety disorder

A

refer for full comprehensive assessment of social anxiety disorder

72
Q

what comprehensive assessments are used for social anxiety

A

SPIN: social-anxiety phobia inventory

LSAS: liebowitz social anxiety scale

73
Q

what is first-line for SAD

A

CBT for SAD

74
Q

what two CBT models exist for SAD

A
  • Heimberg

- Clark and Wells

75
Q

what is second-line for SAD

A

self-help CBT

76
Q

what is third-line for SAD

A

pharmacological interventions

77
Q

what SSRIs are used for SAD

A

Sertraline or Escitalopram

78
Q

what is fourth-line for SAD

A

Psychodynamic psychotherapy

79
Q

Define OCD

A

Recurrent obsessional thought and compulsive act

80
Q

Define obsessive thoughts

A

Idea, Image or impulse that enters patient’s mind again and again in a stereotyped form. Often distressing and patient tries to resist them

81
Q

Define compulsive acts

A

Stereotyped behaviours repeated again and again. They are not enjoyable or useful. Function is to prevent some perceived harm patient feels will happen I they do not perform them.

82
Q

What happens if compulsive event is resisted

A

If resisted anxiety worsens

83
Q

In which age-group is OCD more common

A

20-years

84
Q

In which gender is OCD. more common

A

Female

85
Q

What is genetic concordance for OCD

A

57%

86
Q

What is neurobiological correlate for OCD

A

Increased matter in orbitofrontal cortex and anterior cingulate gyrus

87
Q

What is the brief definition of obsessions

A

Intrusive thoughts

88
Q

What is a brief definition of compulsions

A

Repetitive actions used to minimise obsessions

89
Q

What does ICD-1O state must be present for diagnosis of OCD

A
  • Occupies significant amount of time: more than one hour a day
  • Causes social or occupational impairment
90
Q

What are the 6 screening questions for OCD

A
  1. Do you clean or wash a lot
  2. Do you get upset by mess or when things aren’t in a certain order
  3. Do you check things a lot
  4. Do you take a long time to finish daily activities
  5. Are there thoughts bothering you, that you can’t get rid of
  6. Do these symptoms trouble you
91
Q

What formal classification system is used for OCD

A

Yale-Brown obsessive-compulsive scale (Y-BOCS)

92
Q

How is mild functional impairment in OCD managed

A

IAPT

Exposure-Response Prevention Therapy

93
Q

How is moderate impairment in OCD managed

A

ERP therapy

SSRIs (or TCA)

94
Q

What is an alternative for moderate functional impairment in OCD

A

TCA

95
Q

What is indicated for severe functional impairment in OCD

A

Refer to secondary-care, Give ERP and SSRI whilst waiting

96
Q

What can SSRIs in the first trimester of pregnancy cause

A

Congenital heart defects

97
Q

What can SSRIs after 20-weeks cause

A

Persistent pulmonary HTN of the new-born

98
Q

Define acute stress reaction

A

Transient disorder lasting hours-days as an Immediate response (within 1h) to an exceptional stress

99
Q

Define acute stress disorder

A

Onsets in 4W of stress and persisted from 3d-4W

100
Q

Define adjustment disorder

A

Onsets in 1 month of psychological stress, does not persist beyond 6-months. Symptoms cause marked distress of impaired functioning

101
Q

Define post-traumatic stress disorder

A

Onsets within 6-months of a stress and persistent for at least 1-month. Cause clinically significant distress and impairment in social, occupational or other area of functioning

102
Q

What gender is more likely impaired by PTSD

A

Male (4:1)

103
Q

what causes PTSD

A

Stressful life events that are threatening or catastrophic in nature

104
Q

what is type I trauma

A

Single, dangerous, overwhelming event

105
Q

what is type II trauma

A

Repeated ordeal stressors

106
Q

what is the most common type of trauma causing PTSD

A

Sexual abuse

107
Q

what other traumas can cause PTSD

A

Physical abuse
War
Natural accidents

108
Q

What are 4 risk factors for PTSD

A

Initial severe reaction
Lack of support
Psychiatric co-morbidities
Low socio-economic status

109
Q

What is the triad of symptoms in PTSD

A
  1. Hyper-arousal
  2. Re-experiencing
  3. Avoidance
110
Q

Give 5 symptoms of hyper arousal

A 
Hyper-Vigilant 
Sleep disturbance 
Heightened startle reflex 
Sleep disturbance 
Irritable 
Poor concentration
111
Q

What are 2 symptoms of avoidance

A

Avoid memories, thoughts and feelings

Avoid external reminders

112
Q

What are 4 symptoms of re-experiencing

A

Flashbacks
Recurring, intrusive dreams
Distress related to external causes

113
Q

If symptoms have persisted less than four-weeks what is recommended in PTSD

A

Observation

114
Q

What is NOT recommended for PTSD

A

Single-session de brief

115
Q

What are other interventions that can be offered for PTSD

A

Eye-movement desensitisation and reprocessing

116
Q

Explain eye movement desensitisation and reprocessing

A

Individual recalls the trauma in as much details as possible, whilst focusing eyes in therapists finger

117
Q

What medication is licensced for PTSD

A

SSRI: paroxetine and mertazapine

Psychiatry (13 decks)

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