Anxiety Flashcards
What are the differentials of palpitations?
- Hyperthyroidism
- Cardiac arrhythmia
- Anxiety
What are the criteria for Generalised Anxiety Disorder (GAD7)?
- Feeling, nervous, anxious or on edge
- Not able to sleep or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it is hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid, as if something awful might happen
Score each one from 0-3, from not at all to nearly every day
What is GAD?
Described as excessive worry about a number of different events associated with heightened tension.
What are potential physical/organic causes of anxiety symptoms?
- Hyperthyroidism
- Cardiac disease
- Medication induced - salbutamol, theophylline, corticosteroids, antidepressants
- Caffeine
What are the general symptoms of anxiety?
- Autonomic arousal: palpitations, sweating, tremor, dry mouth, tingling
- Chest + abdomen: breathing difficulty, feeling of choking, chest pain, nausea (churning in stomach)
- Feeling dizzy or fearful
- General symptoms: hot flushes, cold chills, numbness, restlessness, feeling tense or irritable
What is the DSM-5 criteria for GAD?
- Excessive anxiety present more days than not for 6 months
- Hard to control anxiety
- Adults ~3 or more symptoms, children ~1 or more - chronic fatigue, restlessness, irritability, difficulty concentrating + sleeping
- Impairment in important daily objectives
- NOT medication, drug abuse or condition
- NOT better explained by another mental disorder e.g. panic disorder
What are panic attack symptoms?
- Unpredictable recurrent episodes of severe anxiety
- Sudden onset, usually lasts few mins but can be hours
- May feel impending doom/feeling of being overwhelmed
- 4/13 symptoms - chest pain, sweating, palpitations, trembling, SOB, nausea, dizziness, chills, numbness, feelings of choking, feelings of detachment, fears of losing control and dying
- Can occur in depressive disorders, PTSD and substance abuse
What is panic disorder?
- Recurrent and unexpected panic attacks
- Persistent worry or change in behaviour because of the panic attacks
- NOT effects of substance
- NOT another disorder
- Can’t predict when another panic attack will happen
- Need to treat before avoidance where they avoid places previous panic attacks happened (temporary relief)
- Anticapatory anxiety (agoraphobia)
What is agoraphobia?
Fear of being in situations where escape might be hard or help will be difficult to get, includes: fears of leaving home, public places, crowds, travelling alone.
What is social phobia?
Fear of scrutiny by others in social situations.
What is obsessive compulsive disorder (OCD)?
- Obsessions: often fears of contamination, safety or security, symmetry +/or aggressive impulses, but are recognised as irrational and product of own mind by the patients
- Delusions: patient believes them to be true
- Compulsions/rituals
- If depression present - treat first as can help OCD
What is the management for mild GAD?
- Education on GAD
- Active monitoring with options for self-help strategies
- Lifestyle advice (diet, exercise, sleep hygiene, alcohol use and substances)
What is the management for GAD?
- Low intensity psychological interventions (individual self-help or groups)
- High intensity psych interventions (CBT or applied relaxation) or medication
- Medication: SSRI e.g. sertraline, paroxetine, escitalopram
- Highly specialised input e.g. multi-agency teams
What are the medications for GAD?
- 1st line: SSRI e.g. sertraline
- Can also prescribe beta blockers, benzodiazepine and busiprone (anxiolytic)
What are the indications for CBT?
- Depressive disorders
- Phobias
- GAD
- Panic disorder
- OCD
- Chronic pain
