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m4 psych > 5. Anxiety, Phobia & Stress-Related Disorders > Flashcards

5. Anxiety, Phobia & Stress-Related Disorders Flashcards

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1
Q

What is Generalised Anxiety Disorder?

A

A sensation of persistent worry and apprehension about common day problems and events, associated with chest, abdomen, mental state, general symptoms

  • “free-floating” anxiety
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2
Q

Common signs and symptoms of GAD

A

Autonomic
- Palpitations
- Tachycardia
- Diaphoresis
- Dry mouth
- Tremors

Chest/Abdo:
- Chest pain
- SOB
- Nausea
- Stomach churning
- Choking sensations

Mental
- Giddiness
- Derealisation/Depersonalisation
- Fear of losing control and going crazy
- Feelings of death

General
- Numbness/tingling
- Muscle aches
- Restlessness
- Feeling on edge
- Feeling hot or cold

Others
- Persistent irritability
- Poor sleep
- Poor concentration

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3
Q

DSM-5 Criteria for GAD

A

Individuals must have had experienced excessive anxiety and worries for most everyday events for at least 6 months in duration.
- excessive worries are difficult to control
- cause functional impairment
- associated with at least 3 of the following symptoms:
1. Restlessness
2. Easily tired
3. Attentional and concentration difficulties
4. Muscle tension
5. Sleep difficulties

MR TICS
Muscle tensions
Restlessness
Tired
Irritable
Concentration poor
Sleep difficulties

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4
Q

Differential diagnosis of GAD

A

Panic disorder
Panic disorder with agoraphobia
Substance-induced anxiety
Hyperventilation syndrome
Stress-related disorder
Phobia
Mixed anxiety and depression

CHECK: Hyperthyroidism

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5
Q

Management of GAD

A

SSRIs (1st line)
CBT

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6
Q

Panic attack, Panic disorder and agoraphobia (comorbid)

A

Single attack = Panic attack
-> multiple build up of stress to hit threshold for panic attack
-> activates sympathetic drive
Recurrent and frequent panic attacks over a period of time (episodic) with symptom-free periods between attacks = panic disorder

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7
Q

Common sign and symptoms of panic disorder

A

Autonomic
- Palpitations
- Tachycardia
- Diaphoresis
- Dry mouth
- Tremors
- Feeling hot and cold

Chest/Abdo:
- Chest pain
- SOB
- Nausea
- Stomach churning
- Choking sensations

Mental
- Giddiness
- Derealisation/Depersonalisation
- Fear of losing control and going crazy
- Feelings of death

General
- Numbness/tingling
- Muscle aches
- Restlessness
- Feeling on edge

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8
Q

DSM-5 diagnostic criteria for panic disorder

A

Sudden onset of intense fear that peaks within mins
+ following symptoms might occur:

Physical symptoms
1. Palpitations
2. Diaphoresis
3. Tremors
4. SOB
5. Chest pain
6. Choking sensations
7. Abdominal discomfort
8. Dizziness
9. Feeling hot or cold

Mental symptoms
1. Derealisation
2. Depersonalisation
3. Feelings of losing control and going crazy
4. Feelings of death

At least one of the attacks must be followed by at least 1 month of either:
1. Persistent concerns about having additional attacks or
2. Marked changes in behaviour in relation to the attacks

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9
Q

For panic disorder, at least one of the panic attacks must be followed by at least 1 month of either:

A
  1. Persistent concerns about having additional attacks or
  2. Marked changes in behaviour in relation to the attacks -> avoidant behaviour
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10
Q

DSM-5 diagnostic criteria for agoraphobia

A

Significant anxiety and fear in at least 2 of the following situations:
+ preoccupation of worries that escape might be difficult / help not available

  1. Being alone outside of home
  2. Being in a crowd
  3. Bring in enclosed space
  4. Being in open spaces
  5. Using public transport modalities

+ affected functioning for at least 6 months
+/- panic disorder

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11
Q

Management of panic disorder

A

SSRIs (1st line)
CBT (2nd line)
*effect of CBT is as efficacious as SSRI

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12
Q

What is social phobia / social anxiety disorder?

A

Marked fear brought about by social situations (eg. being the focus of attention or fear of behaving in a manner that will be embarrassing), leading to avoidance of being the focus of attention

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13
Q

DSM-5 diagnostic criteria for social phobia

A

Significant anxiety about 1 or more social situations -> worry about being evaluated negatively by others -> tend to avoid these situations

*lasted for at least 6 months + functional impairment

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14
Q

Management for social phobia

A

SSRIs
- paroxetine
- continued for at least 6 months after recovery
CBT

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15
Q

DSM-5 diagnostic criteria for Specific Phobia

A
  1. Significant anxiety about a particular object or situation
  2. Encounters with the object or situation always cause marked anxiety
  3. The specified object or situation is avoided
  4. The anxieties and worries are excessively out of proportion in consideration of the actual threat posed

At least 6 months + functional impairment

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16
Q

Pathophysiology of OCD

A

Lesion in the orbital-frontal cortex and basal ganglia

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17
Q

What is an obsession?

A

Obsessions are persistent, intrusive thoughts, recognised to be the patient’s own, which cause the patient significant distress.

These thoughts can be doubts, images or ruminations.

The patient attempts to ignore or suppress these thoughts.

18
Q

What is a compulsion?

A

Repetitive behaviours or mental acts usually associated with an obsession; they serve to reduce the distress caused by the obsessions

Carrying out the compulsive act should not be pleasurable to the patient

19
Q

DSM-5 diagnostic criteria for OCD

A

Presence of (a) obsessions and (b) compulsions that have caused functional impairment

Obsessions must be:
1. repetitive thoughts, urges or images that are experienced recurrently, found to be intrusive and result in significant anxiety
2. efforts made to try to suppress these thoughts, urges or imagines with other thoughts or actions

Compulsions must be:
1. repetitive behaviours or mental acts that the individual feels obliged to perform as a response to the underlying obsessive thoughts
2. performed in order to reduce the anxiety experienced, or to prevent some dreadful event from happening

20
Q

Questionnaire for OCD

A

Yale-brown obsessive compulsive scale

21
Q

OCD spectrum disorder (to be assessed when taking an OCD history)

A
  1. body dysmorphic disorder
  2. hoarding disorder
  3. trichotillomania
22
Q

Management of OCD

A

SSRIs (2-3x higher than dose for treating depression)
TCA: clomipramine
- trial of at least 1 SSRI found to be ineffective
- SSRI is poorly tolerated
- patient’s preference
- previous good response to clomipramine

Psychotherapy
- Behaviour therapy: Exposure response-prevention therapy***
- Danger ideation reduction therapy for contamination themes

Social
- Psychoeducation

23
Q

Poor prognostic factors for OCD

A
  • male
  • childhood onset
  • strong conviction about the rationality of obsession
  • comorbid depression
  • comorbid tic disorder
  • inability to resist compulsions
  • bizarre compulsions
  • long duration of untreated illness
  • need for hospitalisation
  • presence of overvalued ideas
24
Q

DSM-5 diagnostic criteria for hoarding disorder

A
  • Difficulties disposing items, regardless of actual value
  • Pre-occupied with needing to save the items, and the distress associated with disposing
  • Leads to accumulation of items that clutter person living space and functional impairment
25
Q

DSM-5 diagnostic criteria for Acute Stress Reaction

A

The following symptoms must be fulfilled within a duration of 3 days to 1 month after experiencing the traumatic event:

  1. Exposure to a severe or threatened death, serious injury or sexual violence
  2. Intrusive symptoms: repetitive, intrusive, distressing memories of the traumatic event
  3. Negative mood: inability to experience positive emotions
  4. Dissociative symptoms
  5. Avoidance symptoms
  6. Hyperarousal symptoms: sleep difficulties, irritable mood, on edge, issues with concentration, easily getting startled
26
Q

DSM-5 diagnostic criteria for Adjustment disorder

A

Behavioural or emotional symptoms that have occurred within 3 months from the onset of the stressor (major change in life situation)

Symptoms cause functional impairments + out of proportion in terms of severity and intensity to what is normally expected of the stressors

Should resolve within 6 months after removal of stressors

27
Q

Post-traumatic stress disorder

A

Acute stress disorder could become PTSD if symptoms persist for more than 1 month

  • Develops within 6 months after traumatic event

Symptoms include:
- Re-experiencing (ie. flashbacks)
- Avoidance
- Hyperarousal
- Emotional numbing/detachment

28
Q

DSM-5 diagnostic criteria for PTSD

A
  1. Repetitive, intrusive, and distressing memories of the traumatic events
  2. Marked efforts to avoid distressing memories and external reminders
  3. Dissociative amnesia towards important aspects of the traumatic event

+ marked impairment

29
Q

Management of autonomic hyperarousal

A

Beta blockers

30
Q

Operant conditioning

A

Organisms learn by operating on the environment
- Positive reinforcer will strengthen response
- Negative reinforcer will strengthen removing/avoiding stimulus

31
Q

Risk factors for PTSD

A
  • Recent stressful life events
  • Childhood trauma
  • Inadequate family support
  • Low premorbid intelligence
  • Female
  • Previous exposure to trauma/psychiatric disorders
32
Q

Management for PTSD

A

Pharmacotherapy: SSRIs
- Paroxetine, sertraline, fluoxetine

Psychotherapy
- Trauma-focused CBT
- Eye movement desensitisation and reprogramming

33
Q

Acute treatment of panic attack

A

Benzodiazepines

34
Q

Specific phobia most typically develops during which age period?

A

Childhood
- children are unable to discern the risks of the object/animal

35
Q

Management of agoraphobia

A

Graded exposure to MRT train without coping avoidance

36
Q

Should debriefing be done for patients who witnessed a traumatic event?

A

No, its ineffective or harmful

37
Q

Treatment for specific phobia

A

Psychotherapy with systemised desensitisation

38
Q

Meaning of ‘free floating anxiety’

A

No specific triggers for the anxiety

39
Q

During hyperventilation, what phenomenon can be observed?

A

Carpopedal spasms

40
Q

What are signs and symptoms of carpopedal spasms?

A

Peri-oral numbness
Acral numbness
Cramping of hands and legs Forced adduction of thumb Flexion of metacarpophalangeal joint and wrists
Extension of fingers on bilateral hands

41
Q

Favourable prognostic factors in OCD

A
  • good premorbid social and occupation status
  • episodic symptoms
  • less avoidant symptoms

m4 psych (18 decks)

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