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AKT - Lizzie Bain > 3. Anxiety Disorders > Flashcards

3. Anxiety Disorders Flashcards

1
Q

What are the treatments for social anxiety disorder?

A

Self help
Psychological therapy - individual CBT (first line)
Medication - SSRI such as sertraline or escitalopram

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2
Q

What are the 2 types of PTSD?

A
  1. Simple PTSD - response to single traumatic event
  2. Complex PTSD - response to being exposed to repeated or multiple traumatic events over life e.g. slavery, genocide, DV, repeated childhood sexual/physical abuse.
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3
Q

What are the risk factors for PTSD?

A
  • refugees/asylum
  • first responders
  • Military (increased length service, lower rank)
  • prev psych disorder
  • female
  • chronic disease
  • postnatal
  • over avoidance of risk
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4
Q

what are the symptoms of PTSD?

A

* re-experiencing
- Flashbacks - as if event happening again
- nightmares
- reminders of the event provoke distress
* hyperarousal or emotional numbing (spectrum)
- hypervigilance
- exaggerated startle response
- irritable, difficulty concentrating
- sleep difficulty
- difficulty feeling emotion, detached from others
- giving up hobbies
- amnesia of main events
- negative self perception
* avoidance or rumination behaviour
-avoid people or situations that remind of event
- suppress memories
- why me?

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5
Q

What is the stepwise management for PTSD?

A
  • 1st month - watchful waiting, unless severe symptoms then specialist referral
  • treat PTSD before other co-morbid conditions e.g depression, alcoholism
  • assess suicide/self harm risk
  • if symptoms continue after 1 month of event - refer to specialist

Under specialist:
* trauma focussed CBT 1st line if within 3 months (CBT main focus in children)
* EMDR 1st line if >3 months from event
* Treatment can be effective at anytime after the event.
* Drug treatment 2nd line: venlafaxine or SSRI (sertraline, paroxetine)
* Short term benzo for insomnia

immediate debriefing is ineffective, can be harmful

depression will usually lift as the PTSD is treated.

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6
Q

When to diagnose GAD?

A
  • excessive worry about several aspects of everyday life, or general worry about no particular circumstance
  • with symptoms of physiological arousal:
  • muscle tension/restlessness, headaches, back pain
  • sympathetic overactivity - GI disturbance, palps, trembling,dry mouth, irritability
  • difficulty concentrating
  • sleep - difficulty falling or staying asleep
  • symptoms persist several months
  • distress or impairment of social life/work/education.

Can use GAD-7

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7
Q

What is Step 1 in the management of GAD?

A
  • educate on diagnosis
  • active monitoring
  • manage comorbid conditions e.g depression/physical
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8
Q

What is step 2 in the management of GAD?

if symptoms not improved with education and active monitoring

A

Offer a low intensity psychological intervention:
* Individual self help (based on CBT principles) - written/electronic for person to work through over 6 weeks.
* Individual guided self-help -as above but telephone therapist led
* Psychoeducational groups - CBT principles with therapist.

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8
Q

What is Step 3 in the management of GAD?

or if severe impairment

if not improved with step 2

A

Offer either:
* Individual high intensity psychological intervention - CBT or applied relaxation (12 weeks) (1st line if pregnant)
* Drug treatment - sertraline 1st line. If sertraline not effective, alternative SSRI - paroxetine or escitalopram, Or SNRI - duloxetine or venlofaxine.
* Pregabalin if cannot tolerate SSRI or SNRI
* Do not offer benzo unless short term in a crisis

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9
Q

What is step 4 in the management of GAD?

complex, treatment failed, very marked impairment
or high risk self harm

A
  • specialist referral
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10
Q

What are the options for a pregnant woman taking SSRI/SNRI/pregabalin for GAD?

A
  • discuss risk benefits - relapse vs fetal risks
  • currently no data that pregabalin causes malformations/ miscarriage/ fetal growth changes. There are risks with SSRI/SNRI (PPHN, withdrawal, unknown if teratogenic)
  • option to switch to psych intervention
  • lowest effective dose
  • perinatal mental health specialist referral if uncertain/changing medication/starting medication
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11
Q

How soon should I review someone under the age of 30 receiving an SSRI/SNRI?

A

within 1 week

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12
Q

How soon should I review someone with GAD?

A

after 4-6 weeks of treatment.

(Unless under 30 and started SSRI/SNRI. Or they are High Risk)

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13
Q

How long should someone with GAD continue medication for if it is effective?

A

at least a year to reduce the risk of relapse

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14
Q

What are the features of social anxiety disorder?

A
  • excessive fear of humiliation or embarrassment
  • physical autonomic symptoms - palps, sweating, dry mouth, nausea, shaking
  • Fear is followed by avoidance
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15
Q

How should OCD be classified?

A
  • mild, moderate or severe
  • recommend the use of the Y-BOCS scale
  • ‘severe’ OCD would be someone who spends > 3 hours a day on their obsessions/compulsions, has severe interference/distress and has very little control/resistance
16
Q

What is an obsession in OCD?

A

unwanted intrusive thought, image or urge that repeatedly enters the person’s mind

17
Q

What is a compulsion in OCD?

A

Compulsions are repetitive behaviours or mental acts that the person feels driven to perform.

overt -checking that a door is locked, covert mental act- repeating a certain phrase in one’s mind.

18
Q

When should someone with OCD be referred?

A
  • severe OCD
  • high risk
  • initial treatments not helped
  • Age <18
19
Q

How should OCD with mild functional impairment be managed?

A

referal to NHS talking therapies for low intensity CBT with Exposure Response Prevention (ERP)

Move to moderate management if not helped.

20
Q

How should OCD with moderate functional impairment be managed?

A

Offer choice:
Intensive CBT with ERP or SSRI (escitalopram, fluoxetine, paroxetine, sertraline)
Clomipramine is an alternative to SSRI if person prefers or SSRI contraindicated - high toxicity in overdose

refer to psych if unsure or treatment not helped.

compared to depression, the SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response

fluoxetine for Body dysmorphic disorder

continue meds for 12 months after remission.

21
Q

How are children under age 18 with OCD managed by CAMHS?

A

guided self help (mild)

CBT incl ERP involving family and carers (if mod/severe)

22
Q

How long should an SSRI be continued for panic disorder?

A
  • the minimum duration is least 6 months after the optimal dose is reached.

AKT - Lizzie Bain (55 decks)

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