anxiety Flashcards

1
Q

what is generalised anxiety disorder (GAD)

A

excessive anxiety occurring most days for at least 6 months

the anxiety is hard to control and is about a number of events

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2
Q

what symptoms are associated with the anxiety/worry in GAD

A
restlessness
easily fatigued 
difficulty concentrating 
irritability 
muscle tension 
sleep disturbance

3+ of these for most days in past 6 months

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3
Q

what is GAD-7

A
screening tool used to grade anxiety 
0-5 = mild 
6-10 = moderate 
11-15 = moderately severe 
15-21 = severe
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4
Q

what are alternate causes of anxiety to consider before diagnosing GAD

A

medication induced anxiety
hyperthyroidism
cardiac problems

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5
Q

how do patients with GAD normally present

A

worry

frequent health concerns

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6
Q

step one of GAD management

A

identify and assess the level of distress, functional impairment, number/severity/duration of symptoms
educate patient
active monitoring
treat any primary disorder first e.g. depression

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7
Q

step two of GAD management

A

low intensity psychological interventions - individual guided CBT and self-help
direct to psychoeducational groups

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8
Q

step three of GAD management

A

for people with marked functional impairment or who haven’t responded to step 2
high intensity intervention - (121 CBT), applied relaxation
SSRIs (sertraline is first line)
can use betablockers like propranolol for physical symptoms

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9
Q

what can you use if sertraline is ineffective in step three

A

use another SSRI - fluoxetine
swap to a SNRI - venlafaxine or duloxetine
pregabalin as last resort - has potential for abuse

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10
Q

what drugs should you not use for GAD in primary care

A

benzodiazepines (except short term during a crisis)

anti-psychotics

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11
Q

what is step 4 of GAD treatment

A

if it is still not responding this is a severe anxiety disorder and the patient needs to be referred
they could be at risk of self-harm/suicide, comorbidity, self-neglect
need a specialist review - community mental health team (CMHT)

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12
Q

what is panic disorder

A

recurring panic attacks with 1+ months of persistent worry/change in behaviour related to the attacks

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13
Q

what is a panic attack

A

an abrupt sensation of intense fear/discomfort

usually last a few minutes

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14
Q

what symptoms may be experienced in a panic attack

A
at least 4 of:
palpitations 
sweating 
tight throat/choking 
SOB
chest pain/discomfort 
nausea/vomiting
dizziness, fainting, instability 
derealization 
fear of losing control 
numbness/tingling
chills/hot flushes 
fear of dying
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15
Q

how do you manage panic disorder

A

mild/moderate - CBT/self-help/exercise

moderate/severe - CBT/psychological therapy and medications

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16
Q

what medications are used in panic disorder

A

SSRIs are first line (except fluoxetine)

imipramine or clomipramine if SSRIs arent working (TCAs)

17
Q

what is social anxiety disorder

A

persistent fear of social or performance situations
exposure to situation causes anxiety +/- panic attack
patient recognises fear is unreasonable
avoidance of situations
lasts 6+ months
not attributable to anything else

18
Q

what are features of social anxiety disorder

A

fear of social or performance situations
anxiety + panick attacks related to this
patient knows the fear is excessive
avoidance of situations
interruption of normal routine
the fear/anxiety/avoidance lasts >6months

19
Q

how can you manage social anxiety

A

CBT
sertraline or escitalopram if not responding to CBT
continue for 6 months once treatment is effective