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Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

1
Q

What is the stress response?

A

Exposure to stress results in instantaneous and concurrent biological responses to asses the danger and organise an appropriate response

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2
Q

What is the role of the amygdala in the stress response?

A

Acts as the emotional filter to assess if sensory material via thalamus requires a stress/fear response, then goes to cortex for decision

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3
Q

Describe what happens chemically in the stress response.

A

Acute stress causes dose-dependent increase in catelcholamines and cortisol
Cortisol acts to mediate and shut down the stress response through negative feedback acting on the pituitary, hypothalamus, hippocampus and amygdala

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4
Q

What sites of the brain are responsible for stimulation of cortisol release?

A

Hypothalamus
Pituitary
Hippocampus
Amygdala

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5
Q

List 7 types of anxiety disorder

A 
Generalised anxiety disorder
Panic disorder
Agoraphobia 
Social phobia
Specific phobia
OCD
PTSD
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6
Q

Describe GAD

A

Generalised, persistent, free-floating - not specific to environmental circumstances

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7
Q

Describe presentation of GAD

A

Typically presents with physical symptoms
Restlessness/on edge
Irritability
Easily fatigued
Mind blank
Muscle tension
Sleep disturbance
Fear that something bad is going to happen
Lasts almost every day for approx. 6 months

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8
Q

What is typical age of onset of GAD

A

20-40

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9
Q

WHat is female to male ratio of GAD

A

2:1 F:M

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10
Q

50% of GAD are co-morbid with other psychiatric disorders. True/false?

A

False - 90% co-morbid

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11
Q

What is management of GAD?

A

CBT
SSRIs/SNRIs
Pregabalin
Benzodiazepines (short term only for acute anxiety)

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12
Q

What is CBT based on and how does it help the individual?

A

Based on identifying individuals automatic thoughts, cognitive biases and schemas
Help the individual identify thoughts, assumptions, misinterpretations and behaviours that perpetuate the anxiety

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13
Q

What is panic disorder?

A

Recurrent attacks of severe anxiety or panic which are not restricted to any particular situation so are unpredictable

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14
Q

What are dominant symptoms of panic disorder?

A

Sudden onset physical symptoms e.g. palpitations, chest pain, choking sensations, dizziness
Feelings of unreality
Secondary fear of dying, losing control or going mad

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15
Q

GAD and panic disorder can be due to the direct physiological effects of a substance or medical condition e.g. hyperthyroidism or caffeine. True/false?

A

False - they are NOT due to these

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16
Q

Approximately what percentage of patients with panic disorder have agoraphobia?

A

50-70%

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17
Q

What is typical age of onset of panic disorder?

A

Adolescence - mid 30s

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18
Q

WHat is usual course of panic disorder?

A

Chronic - fluctuates

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19
Q

Lifetime prevalence of GAD is approx. 3%/9% and lifetime prevalence of panic disorder is approx. 3%/9%.

A

GAD - 9%

Panic disorder - 3%

20
Q

The following are what kind of symptoms of anxiety?

Sweating, hot flushes, cold chills
Trembling 
Muscle tension 
Numbness/tingling
Dizzy/faint
Dry mouth 
Feeling of choking
Lump in throat 
Difficulty breathing 
Palpitations
Chest pain 
Nausea/abdominal distress
A

Physical/biological symptoms

21
Q

The following are what kind of symptoms of anxiety?

Fear of losing control/going crazy
Feeling on edge 
Difficulty concentrating 
Derealisation 
Depersonalisation 
Hyper vigilance
Racing thoughts
Meta-worry (worrying about worrying) 
Health anxiety
Beliefs about needing to worry 
Preference for order and routine
A

Cognitive symptoms

22
Q

The following are what kind of symptoms of anxiety?

Avoidance
Exaggerated response to minor surprises 
Difficulty in getting to sleep 
Excessive use of alcohol/drugs
Restlessness
Irritability
Checking behaviours
A

Behavioural symptoms

23
Q

What type of anxiety disorder has higher prevalence in cardiology clinic than in general population?

A

Panic disorder

24
Q

What are two mechanisms of inducing panic attacks that people with panic disorder are more susceptible to panic attacks with?

A

Infusing lactate

Re-breathing CO2

25
Q

Where in the brain shows increased metabolism on PET scan during a panic attack?

A

In parahippocampal gyrus in the anterior pole of the temporal lobe

26
Q

What is the treatment for panic disorder?

A

CBT
SSRIs/SNRIs/Tricyclics
Benzodiazepines for short term

27
Q

What are the 3 types of phobias?

A

Agoraphobia
Social phobias
Specific phobias

28
Q

What are the approximate ages of onset for agoraphobia and social and specific phobias?

A

Agoraphobia - most by 20s and early 30s

Social and specific phobias - most by early adolescence and early 20s

29
Q

In phobias the patient recognises their fear as rational. True/false?

A

False - patient can recognise their fear is irrational

30
Q

What is agoraphobia?

A

Fear of being around people, in busy places, open places etc.

31
Q

Agoraphobia is strongly linked to avoidance. It can be primary but is more often secondary to other pathology like panic disorder or depression. True/false?

A

True

32
Q

What is the name of this anxiety disorder:
Marked and persistent fear that is excessive/unreasonable cued by presence or anticipation of a specific object or situation

A

Specific phobia

33
Q

What is the treatment of specific phobias?

A

Behavioural therapy - exposure grade/systematic desensitisation
Maybe CBT
SSRIs/SNRIs if required

34
Q

What is social phobia?

A

Persistent fear of one or more social situations
Fear of possible scrutiny, embarrassment and humiliation
Often occurs in relatively small social settings

35
Q

What are common social anxiety symptoms?

A

Blushing
Shaking
Fear of vomiting
Urgency/fear of micturition or defaecation

36
Q

What changes in the brain are there in social phobia/anxiety that are normalised on successful treatment?

A

Increased bilateral activation of the amygdala & increased regional cerebral blood flow to amygdala

37
Q

Which phobia can often present in toddlers/pre-school children?

A

Social phobia

38
Q

What is the treatment for social phobia?

A

CBT
SSRIs/SNRIs
Benzodiazepines (short term)

39
Q

How long must symptoms be present are for OCD diagnosis?

A

Obsessional Symptoms and compulsive acts must be present most days for at least 2 weeks

40
Q

What is the mean age of onset of OCD? And specific peak ages for males and females?

A

Mean: 20
Males: 13-15
Females: 24-25

41
Q

60-90% of patients with OCD experience at least 1 major depressive episode. True/false?

A

True

42
Q

OCD does not tend to occur with other psychiatric disorders such as schizophrenia, Tourette’s, body dystrophic disorder, eating disorders, trichtillomania. True or false?

A

False - high co-morbidity

43
Q

OCD thoughts are unpleasant, resisted and ego-dystonic. What does this mean?

A

Ego-dystonic means not in line with patients values/beliefs

44
Q

What is the treatment for OCD?

A

CBT

SSRIs/Clomipramine (TCA)

45
Q

What is the mechanism of action of benzodiazepines?

A

Binds to GABA-A receptor (inhibitory receptor) and enhances the effect of GABA. When GABA binds to GABA-A receptor the ion channel allows chloride ion influx, membrane hyperpolarises and this results in inhibitory postsynaptic action - basically stops neuronal excitability and benzos help that

46
Q

What problems are associated with benzodiazepines particularly if used over 2 weeks?

A 
Sedation and psychomotor impairment 
Withdrawal problems 
Dependency and abuse
Alcohol interaction 
Can worse co-morbid depression

Psychiatry (17 decks)

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