Anxiety Flashcards
What is the main problem with using citalopram?
Prolongation of QT interval —> increase the risk of arrhythmias.
Name the physical symptoms of anxiety
Muscle tension - headaches, pain and dizziness.
Hyperventilation - dizziness, tingling fingers and toes.
Sympathetic overactivity - tachycardia, hypertension, ectopic beats, sweating, pallor, dry mouth, butterflies and nausea.
Name the psychological symptoms of anxiety
CNS - poor concentration, poor memory, derealisation.
Mood - fear, panic, worry, on edge, irritable.
Thoughts - danger, not coping, loosing control, worry about worry.
What are the unhelpful behaviours in anxiety?
Attempts at coping (caffeine, smoking, alcohol, drugs), avoidance, safety behaviours, reassurance.
Name the main types of anxiety disorders
Generalised anxiety disorder, panic disorder, phobias, health anxiety, insomnia, PTSD, OCD, acute stress reaction, adjustment disorders.
General investigations for anxiety?
Bloods - FBC, TSH
GAD-7 & PHQ-9
Collateral history
Treatments for anxiety?
Education, relaxation techniques, sleep hygiene and exercise.
CBT.
SSRIs e.g. sertraline, fluoxetine.
Benzodiazepines e.g. diazepam, lorazepam.
Beta blockers e.g. propranolol.
What is a phobia?
Marked and persistent fear/anxiety that is triggered by a specific object or situation, which aren’t currently dangerous, that leads to avoidance of that object/situation.
What are the types of phobia?
Agoraphobia, social phobia, specific phobia.
Management of phobia?
CBT - graded exposure (desensitisation).
What is generalised anxiety disorder?
Anxiety which is generalised and persistent but not restricted to or predominating in any particular environmental circumstance (free floating).
What is panic disorder?
Recurrent attacks of severe anxiety/panic which aren’t restricted to any particular situation/circumstance, so are therefore unpredictable.
What is PTSD?
Post traumatic stress disorder - delayed and/or extended response to a stressful event/situation of an exceptionally threatening/catastrophic nature.
What is OCD?
Obsessive compulsive disorder - recurrent intrusive thoughts (obsessions) that cause anxiety leading to repetitive behaviours (compulsions) that neutralise anxiety.
What is acrophobia?
Fear of heights.
What is tocophobia?
Fear of childbirth.
What are the clinical features of GAD?
Apprehension, motor tension and autonomic overactivity that is present for most days for several weeks-months. Free floating anxiety.
What is the main risk factor for GAD?
Chronic environmental stress.
Management for GAD?
Sleep hygiene and relaxation techniques.
CBT.
SSRIs e.g. sertraline or SNRIs e.g. venlafaxine.
Clinical features for panic disorder?
Sudden onset of palpitations, chest pain, depersonalisation, derealisation and fear. Only lasts minutes.
Aetiology of panic disorder?
Inappropriately learned response to normal physiological symptoms, selective attention to body symptoms and avoidance of anxiety provoking situations reinforces behaviour.
Management of panic disorder?
CBT, SSRIs, TCAs e.g. imipramine, clomipramine.
Is social phobia more common in males or females?
Equally common in males and females.
Phobic anxiety often coexists with what other psychiatric condition?
Depression.
How do phobias occur?
Classical conditioning - association of a conditioned stimulus with an unconditioned response.
How are phobias maintained?
Operant conditioning - punishment and negative reinforcement.
Define agoraphobia
Fear of open spaces, crowds and difficult immediate escape to a safe space. Examples: fear of leaving home, entering shops or travelling alone.
Define social phobia
Fear of scrutiny by other people in small groups, leading to avoidance of social situations.
Define specific phobia
Phobias restricted to highly specific situations. Examples: fear of animals, heights, thunder, darkness, flying, closed spaces, public toilets, foods, dentists, blood and exposure to diseases.
OCD is equally common in males and females. True or false?
True.
Average age of OCD onset?
Childhood/early adulthood.
Management of OCD?
CBT - exposure and response prevention.
SSRIs.
Clomipramine.
Give examples of stressful events that could cause PTSD
Natural/man-made disaster, combat, serious accident, witnessing violet death, victim of torture/terrorism/rape.
Clinical features of PTSD?
Repeated reliving of trauma in flashback or dreams, emotional blunting, detachment, anhedonia, avoidance, hyperarousal with hypervigilance, insomnia, anxiety and depression.
Management of PTSD?
Eye movement desensitisation reprocessing (EMDR).
Trauma-focussed CBT intervention (narrative exposure therapy).
SSRIs e.g. sertraline.
Define the acute stress reaction
Transient disorder of significant severity in response to exceptional physical and/or mental stress. Usually subsides within hours/days.
Define adjustment disorder
Subjective distress and emotional disturbance arising in the period of adaptation to a significant life change or consequence of a stressful event.
Define dissociative disorders
Partial/complete loss of normal integration between past memories, awareness of identity and immediate sensations, and control of body movements.
What are the 3 common features of PTSD?
Re-experiencing, avoidance, hyperarousal.
If SSRIs have shown to be ineffective in a patient with GAD, what is the next step?
Try a SNRI such as duloxetine or venlafaxine.
Benzodiazepines vs barbiturates
Benzodiazepines increase the frequency of chloride channels. Barbiturates increase the duration of chloride channel opening.
What is the first line pharmacological therapy for GAD?
SSRIs e.g. sertraline.
Acute stress disorder vs PTSD
Acute stress disorder is an acute stress reaction that occurs in the 4 weeks after a traumatic event, as opposed to PTSD which is diagnosed after 4 weeks.
What is the first line treatment for acute stress disorders?
Trauma focused CBT.
When is an abnormal grief reaction more likely to occur?
Sudden and unexpected death, little support, problematic relationship before death.
What is delayed grief?
When more than 2 weeks passes before grieving begins.
Are pseudo-hallucinations part of normal grieving?
Yes.
What is the first-line medication for panic disorder?
SSRIs
