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?

18
Q

what is the median age of onset of GAD?

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
what is the arrangement of the GABA A receptor?
* five subunits arranged around a central chloride channel * commonent mammamilian structure is - alpha x2, beta x2, gamma x1
26
what happens when GABA binds to a GABA A receptor?
* binds to binding pocket between alpha and beta subunits * causes Cl- to flow into neuron * leads to hyperpolarisation - reduced change of AP
27
if GAD is not severe, what may a doctor suggest?
simple lifestyle changes before adopting 'formal' treatment: * exercise * work/life balance * avoid caffeine and other drugs * avoid excess alcohol
28
what is the NICE guidance for GAD care?
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
what psychological treatments may be offered for GAD?
* counselling * CBT * mindfulness
30
what is the aim of CBT?
identify unhelpful patterns of thinking and replace them with more realistic and balanced ones
31
what are the NICE recommendations around CBT?
12-15 hour long sessions of CBT over 4 months
32
which is more effective for GAD treatment - psychological vs pharmacological?
similarly effective - pt choice is crucial
33