ANXIETY Flashcards
Anxiety
Feeling of worry or unease about the future, with psychological and physical symptoms.
Excessive or persistent = sign of an anxiety disorder.
What are the 3 types of Anxiety?
- Generalised anxiety disorder
- Panic disorder
- Social anxiety
Psychological symptoms
- Restlessness
- Worry
- Fear
- Difficulty concentrating
- Irritability
Physical symptoms
- Palpitation
- Muscle aches + tension
- Trembling or shaking
- Excessive sweating
- Shortness of breath
- Insomnia
What are the symptoms of GAD?
Symptoms for at least 6 months
* Excessive worry about a number of issues
* Preoccupation/seeking reassurance for somatic symptoms or chornic physical health problem
* Over-arousal and irritability
* Insomnia + poor conc
How long should symptoms be present for to have GAD (and cause clinically significant distress, impairment in social, occupational or other important areas of functioning)
at least 6 months
Non-drug treatment for GAD
CBT
Pharmacological therapy for GAD
- SSRI - sertraline
- Alternative SSRI/SNRI (venlafaxine, duloxetine)
- Pregabalin
- Benzos for short term use only in severe anxiety state
Do not use antipsychotics
What to do if pt has GAD + comorbid depressive or other anxiety disorder
treat primary disorder first i.e. the one that is more severe and in which is it more likely that treatment will improve overall functioning
Symptoms of panic disorder
- Panic attack followed by 1 month of peristent worry about recurrence
- Worrying thoughts and fearful anticipation
- Unforseen abrupt surge of intense fear (panic attack)
- Poor memory
Psychological therapy for panic disorder
Offer individualised Cognitive Behavioural Therapy (CBT)
- Over 1-2 hours for each session
- Max 4 months of treatment
- Integrate with structured self help materials - groups and exercise
- If not effective, add in pharmacotherapy
Drug treatment for panic disorder
Less evidence for longer duration of positive effects
Treatment choice:
- First line: Any licensed SSRI
- Second line: Imipramine or
Clomipramine
- If treatment successfully used for 6 months dose can be tapered and stopped
DO NOT USE benzodiazepines, antipsychotics. sedating antihistamines
What are the symptoms of Social anxiety/phobia?
At least 6 months
- Persistent and overwhelming fear of social situations that is
out of proportion
- Excessive worrying before, during and after
Psychological
treatment for Social anxiety/phobia disorder
Offer individualised cognitive pehavioural therapy (CBT)
- Clark and Wells model
- Heimberg model
- Those who decline CBT may be offered CBT-based self help
- Combine CBT with pharmacological approaches if partial/limited response
- Psychodynamic therapy last
Pharmacological treatment of social anxiety/phobia disorder
- First line: SSRI - Sertraline/ Escitalopram
- Second line: Alternative SSRI or SNRI - venlafaxine/ fluvoxamine
- Third line: Mono-amine oxidase inhibitor (MAOI) - moclobemide/phenelzine
DO NOT USE benzodiazepines, TCA’s, antipsychotics, St john’s wort or anticonvulsants
