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Psychiatry SB > Anxiety > Flashcards

Anxiety Flashcards

1
Q

what are Sx of anxiety

A 
sweating
tremor
SOB
dizziness
heart racing 
seeking reassurance
lump in the throat (globus hystericus)
feeling like you're chocking
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2
Q

what acts as the emotional filter of the brain for assessing whether sensory material needs a stress or fear response

A

amygdala

via the thalamus

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3
Q

what are the types of anxiety disorders

A 
Generalised Anxiety Disorder (GAD)
Panic Disorder
Agoraphobia
Social Phobia
Specific Phobia
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4
Q

what is the definition of GAD

A

Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances

i.e. it is “free-floating”

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5
Q

what are the Sx of GAD

A 
persistent nervousness
trembling
muscular tensions
disturbed sleep 
sweating 
lightheaded
palpitations
dizziness
epigastric discomfort
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6
Q

what requirements need to be met to call it GAD

A

long-lasting (most days for at least 6 months)

not controllable

causing significant distress / impairment in function

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7
Q

what is the definition of panic disorder

A

recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable

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8
Q

Sx of a panic attack

A 
sudden onset of palpitations
chest pain
choking sensation
dizziness
feeling of unreality (depersonalisation and derealisation)

fear of dying, losing control or going mad during the attacks

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9
Q

what is the definition of a panic attack

A

discrete periods of intense fear along with physical and psychological anxiety symptoms that come on quickly i.e. within a few mins

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10
Q

what is agoraphobia

A

extreme or irrational fear of open or public places.

can include leaving home, entering shops/crowds, travelling on public transport

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11
Q

what can trigger a panic attack (physiologically)

A

susceptible individuals by infusions of lactate

re-breathing air (increased CO2)

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12
Q

what is seen on a PET whilst someone is going through a panic attack

A

increased metabolism anterior pole of temporal lobe – parahippocampal gyrus

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13
Q

what features are seen in phobias

A

fear recognised as irrational

typified by avoidance and anticipatory anxiety

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14
Q

what is the definition of a specific phobia

A

a marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation

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15
Q

what happens in specific phobia when the stimulus is seen

A

invariably provokes an immediate anxiety response, akin to a panic attack

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16
Q

what features are important in a specific phobia

A

person recognises that the fear is excessive or unreasonable

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17
Q

what is a social phobia or social anxiety disorder

A

a persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others

18
Q

what does someone with SAD often worry about

A

that he/she will act in a way that will be embarrassing and humiliating

19
Q

what Sx are seen in SAD

A

common anxiety Sx

  • blushing or shaking
  • fear of vomiting
  • urgency or fear of micturition or defaecation
20
Q

what is seen on a CT scan of someone with SAD

A

Increased bilateral activation of the amygdala and increased rCBF to the amygdala

21
Q

what characterises heath anxiety

A

excessive or disproportionate preoccupations with having or acquiring a serious illness

22
Q

what is extinction principle

A

If we have exposure to the stimulus but the anxiety is manageable and we don’t avoid it, we slowly learn that the stimulus doesn’t signal fear and the anxiety lessens

23
Q

what is Tx using the extinction principle called

A

graded exposure

24
Q

what is flooding Tx

A

full exposure to the feared stimulus an staying with it until fear reduces

25
Q

what is the cognitive triangle

A 
thoughts produce emotions 
>>
emotions create behaviour
>>
behaviour reinforces thoughts
26
Q

what is the principle of CBT

A

asking patients to question/test their thoughts, to influence emotions and behaviours

27
Q

what are the psychological Tx for PTSD

A

EMDR

trauma focused CBT

28
Q

what are the medical Tx options for PTSD

A

1st line - SSRI = paroxetine, fluoxetine, sertraline

2nd line - SNRI or Benzodiazepines = Phenelzine, Clonaxepam

3rd line - Anticonvulsant = gabapentin, pregabalin

29
Q

what is the psychological Tx for OCD

A

Exposure and Response Prevention (ERP) ≥ 20 hours

CBT (with heavy emphasis on exposure)

30
Q

what is the medication options for OCD

A

1st line = clompiramine or fluoxetine (TCA or SSRI)

2nd line = risperidone, Aripiprazole (anti-psychotic drugs)

3rd line = lamotrigine

31
Q

Tx pathway for OCD

A

mild Sx = brief CBT + ERP < 10 hours

moderate = intensive CBT + ERP > 10 therapist hours OR course of SSRI

severe =
1st line CBT + ERP + SSRI
2nd line different SSRI or clomipramine
3rd line add antipsychotic to SSRI or clomipramine

32
Q

what is the psychological Tx of GAD

A

guided self -help (if mild)
CBT
relaxation

33
Q

what are the medication options for Tx of GAD

A

1st - SSRI (sertraline)
2nd - SNRI (Venlafaxine, duloxetine)
3rd - Pregabalin

34
Q

what is the psychological Tx of social phobia

A

CBT with emphasis on exposure
cognitive restructuring
social skills training

35
Q

what are the medication options for social phobias

A

1st line: SSRIs
2nd line: SNRIs (Venlafaxine, phenelzine)
3rd line: Benzodiazepines (bromazepam, clonazepam) or Anticonvulsants (gabapentin, pregabalin)

36
Q

what are the psychological Tx options for specific phobia

A

exposure therapy

  • graded exposure
  • flooding
37
Q

what are the medication Tx options for specific phobia

A

1st - SSRI only if anxiety is moderate/severe and they haven’t responded to behavioural therapy

38
Q

what are the psychological options for Tx of panic disorder (with or without agoraphobia)

A

CBT

Graded

39
Q

what are the medication Tx of panic disorder (with or without agoraphobia)

A

1st line: SSRIs
2nd line: TCAs (Clomipramine, Imipramine) or Venlafaxine
3rd line: Anticonvulsants (Gabapentin, valproate)

40
Q

how long are patients treated for

A 
GAD (≥ 18 months)
Panic disorder (≥ 6 months)
Social phobia (≥ 6 months)
PTSD (≥ 12 months)
OCD (≥ 12 months)

Psychiatry SB (23 decks)

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