Anxiety Flashcards
Generalised anxiety
Does not occur in discrete episodes and tends to last for hours, days or longer, and is of mild to moderate severity. It is not associated with a specific external threat or situation, but is rather excessive worry about many normal life events (e.g. job security, relationships, responsibilities)
Paroxysmal anxiety
Has an abrupt onset, occurs in discrete episodes and tends to be quite severe. May present as panic attacks, either as a response to a specific (real or imagined) threat, or not
Physical signs of anxiety (17)
- Tachycardia
- Palpitations
- Hypertension
- SOB
- Chest pain/discomfort
- Choking sensation
- Tremors, shaking
- Muscle tension
- Dry mouth
- Sweating
- Cold skin
- Nausea/vomiting
- Diarrhoea
- Abdominal discomfort (butterflies)
- Dizziness, light-headedness, syncope
- Mydriasis (pupil dilatation)
- Paraesthesia
Phobia
An intense, irrational fear of an object, activity or situation. Patients may go to extreme lengths to avoid their phobic stimulus
What three key features should you determine when considering the Ddx for anxiety?
- The rate of onset, severity and duration of the anxiety
- Whether the anxiety is in response to a specify threat or arises spontaneously
- Whether the anxiety only occurs in the context of a pre-existing psychiatric or medical condition
Agoraphobia
Fear of public places, including a fear of crowded spaces where an immediate escape is difficult. At the worst extreme, patients may become housebound
Often occurs with a past diagnosis of panic disorder - the patient fears having a panic attack somewhere where they would not be able to escape
Social phobia
Fear of social situations where they might be exposed to scrutiny by others that might lead to humiliation or embarrassment.
May be limited to an isolated fear (e.g. public speaking, eating in public, speaking to the opposite sex), or involve almost all social activities outside the home
Generalised anxiety disorder
Excessive worry about minor matters on most days for about 6months.
Three key elements in ICD-10:
- Apprehension
- Motor tension (restlessness, fidgeting, tension headaches, inability to relax)
- Autonomic overactivity
Panic disorder
Characterised by the presence of panic attacks that occur unpredictably and are not restricted to any particular situation on objective danger, with little anxiety symptoms in between attacks (except for anticipatory anxiety - the fear of having further attacks)
Ddx for a patient presenting with anxiety
Phobic disorders • Agoraphobia (with or without panic disorder) • Social phobia • Specific phobia Non-situational disorders • Generalized anxiety disorder • Panic disorder Reaction to stress • Acute stress reaction • Post-traumatic stress disorder • Adjustment disorder Obsessive-compulsive disorder Secondary to other psychiatric disorders (especially depression and psychosis) Secondary to a general medical condition Secondary to psychoactive substance use (especially alcohol use)
What percentage of patients with anxiety also have depressive symptoms?
65%
It is essential to decide which symptoms came first
Medical conditions associated with anxiety
Causing dyspnoea:
- Congestive cardiac failure
- Pulmonary embolism
- COPD
- Asthma
Causing increased sympathetic outflow:
- Hypoglycaemia
- Pheochromocytoma
Causing pain:
- Malignancies
Other:
- Cerebral trauma
- Cushing’s disease
- Hyperthyroidism
- Temporal lobe epilepsy
- Vitamin deficiencies
Substance intoxication associated with anxiety
Alcohol Amfetamines Caffeine Cannabis Cocaine Hallucinogens Inhalants Phencyclidine
Substance withdrawal associated with anxiety
Alcohol Benzodiazepines Caffeine Cocaine Nicotine Other sedatives and hypnotics Opiates
Prescribed drugs that can have a side-effect of anxiety
Antidepressants (e.g. SSRIs and tricyclics in first 2 weeks of use) Corticosteroids Sympathomimetics Thyroid hormones Compound analgesics containing caffeine Anticholinergics Antipsychotics (akathisia)
