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Med School Yr 2 > 5 - GAD > Flashcards

5 - GAD Flashcards

1
Q

is anxiety normal?

A

yes from an evolutionary view point - adaptive function
* alerts orgnaism to threats to survival
* prepares for fight/flight

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2
Q

when may anxiety be abnormal?

A
  • disproportionate to stimulus
  • triggered by harmless situations
  • can’t be controlled
  • impairs functioning
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3
Q

to have an operational diagnoses, what criteria must be met?

A
  • pt must exprience a certain no of symptoms for at least a minimum specified period
  • symptoms must cause - distress + be associated with impairment in everyday function
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4
Q

what are the assesment criteria of GAD?

A
  • persistent fear + worry
    at least 3 of:
  • poor concentration
  • restlessness
  • fatigue
  • muscle tension
  • initial insomnia

symptoms last for >6months

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5
Q

what is initial insomnia?

A

trouble getting to sleep

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6
Q

what is terminal insomia?

A

waking up early + unable to get back to sleep

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7
Q

what type of insomnia is more common in GAD?

A

initial insomnia

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8
Q

what type of insomnia is more common in depression?

A

terminal insomnia

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9
Q

when diagnosing GAD, what must you exclude?

A
  • alcohol or street drug misuse
  • hyperthyroidism
  • phaeochromocytoma
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10
Q

what is phaeochromocytoma?

A
  • benign tumour of adrenal medulla
  • leads to hypertension + anxiety due to release of catecholamines into circulation
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11
Q

symptoms of GAD can be split into?

A

psychological
physical
behavioural

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12
Q

what are the psychological symptoms of GAD?

A
  • constant worries + intrusive thoughts
  • feeling or apprehension + dread
  • poor concentration
  • depersonalisation + derealisation
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13
Q

what are some physical symptoms of GAD?

A
  • tremor, sweatiness, palpatations
  • muscular tension + tension headache
  • hyperventilation
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14
Q

chest pain is ‘atypical’ in GAD - what does this mean?

A
  • sharp + stabbing rather than crushing
  • left sided rather than central
  • won’t radiate
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15
Q

how can GAD lead to parasthesiae in hands, feet and lips?

A
  • hyperventilation
  • leads to respiratory alkalosis
  • causes changes in Cl- + Ca2+ channels in peripheral nerves
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16
Q

what are some of the behavioural symptoms of GAD?

A
  • putting things off because of anxiety
  • avoidance
  • self medication through drugs and alcohol
17
Q

is GAD more common in women or men?

A

women

18
Q

what is the median age of onset of GAD?

A

30 years

19
Q

what genetic factors can contribute to GAD?

A
  • first degree relative
  • risk genes
  • overactive amygdala
20
Q

what environmental factors can contribute to GAD?

A
  • parental rejection or over-control
  • childhood trauama
  • major life stress, eg. physical illness
21
Q

what is the main inhibitory neurotransmitter in the CNS?

A

GABA - 1/3 synapses

22
Q

how is GABA synthesised?

A

decarboxylation of amino acid glutamic acid

23
Q

GABA has a major role in the regulation of what?

A
  • neuronal excitability and muscle tone
24
Q

GABA is the endogenous agonist at what two main receptors?

A

GABA A - multiple ligand binding sites - more important in brain
GABA B - more important in muscles and used clinically as a muscle relaxant

25
Q

what is the arrangement of the GABA A receptor?

A
  • five subunits arranged around a central chloride channel
  • commonent mammamilian structure is - alpha x2, beta x2, gamma x1
26
Q

what happens when GABA binds to a GABA A receptor?

A
  • binds to binding pocket between alpha and beta subunits
  • causes Cl- to flow into neuron
  • leads to hyperpolarisation - reduced change of AP
27
Q

if GAD is not severe, what may a doctor suggest?

A

simple lifestyle changes before adopting ‘formal’ treatment:
* exercise
* work/life balance
* avoid caffeine and other drugs
* avoid excess alcohol

28
Q

what is the NICE guidance for GAD care?

A
  1. recognition and diagnosis GAD
  2. offer treatment in primary care
  3. non-response - reveiw and offer alternative
  4. review and offer referral to secondary care
  5. care specialist mental health services
29
Q

what psychological treatments may be offered for GAD?

A
  • counselling
  • CBT
  • mindfulness
30
Q

what is the aim of CBT?

A

identify unhelpful patterns of thinking and replace them with more realistic and balanced ones

31
Q

what are the NICE recommendations around CBT?

A

12-15 hour long sessions of CBT over 4 months

32
Q

which is more effective for GAD treatment - psychological vs pharmacological?

A

similarly effective - pt choice is crucial

33
Q
A

Med School Yr 2 (96 decks)

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