Anxiety Flashcards
what are Sx of anxiety
sweating tremor SOB dizziness heart racing seeking reassurance lump in the throat (globus hystericus) feeling like you're chocking
what acts as the emotional filter of the brain for assessing whether sensory material needs a stress or fear response
amygdala
via the thalamus
what are the types of anxiety disorders
Generalised Anxiety Disorder (GAD) Panic Disorder Agoraphobia Social Phobia Specific Phobia
what is the definition of GAD
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”
what are the Sx of GAD
persistent nervousness trembling muscular tensions disturbed sleep sweating lightheaded palpitations dizziness epigastric discomfort
what requirements need to be met to call it GAD
long-lasting (most days for at least 6 months)
not controllable
causing significant distress / impairment in function
what is the definition of panic disorder
recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable
Sx of a panic attack
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
what is the definition of a panic attack
discrete periods of intense fear along with physical and psychological anxiety symptoms that come on quickly i.e. within a few mins
what is agoraphobia
extreme or irrational fear of open or public places.
can include leaving home, entering shops/crowds, travelling on public transport
what can trigger a panic attack (physiologically)
susceptible individuals by infusions of lactate
re-breathing air (increased CO2)
what is seen on a PET whilst someone is going through a panic attack
increased metabolism anterior pole of temporal lobe – parahippocampal gyrus
what features are seen in phobias
fear recognised as irrational
typified by avoidance and anticipatory anxiety
what is the definition of a specific phobia
a marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
what happens in specific phobia when the stimulus is seen
invariably provokes an immediate anxiety response, akin to a panic attack
what features are important in a specific phobia
person recognises that the fear is excessive or unreasonable
what is a social phobia or social anxiety disorder
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
what does someone with SAD often worry about
that he/she will act in a way that will be embarrassing and humiliating
what Sx are seen in SAD
common anxiety Sx
- blushing or shaking
- fear of vomiting
- urgency or fear of micturition or defaecation
what is seen on a CT scan of someone with SAD
Increased bilateral activation of the amygdala and increased rCBF to the amygdala
what characterises heath anxiety
excessive or disproportionate preoccupations with having or acquiring a serious illness
what is extinction principle
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
what is Tx using the extinction principle called
graded exposure
what is flooding Tx
full exposure to the feared stimulus an staying with it until fear reduces
what is the cognitive triangle
thoughts produce emotions >> emotions create behaviour >> behaviour reinforces thoughts
what is the principle of CBT
asking patients to question/test their thoughts, to influence emotions and behaviours
what are the psychological Tx for PTSD
EMDR
trauma focused CBT
what are the medical Tx options for PTSD
1st line - SSRI = paroxetine, fluoxetine, sertraline
2nd line - SNRI or Benzodiazepines = Phenelzine, Clonaxepam
3rd line - Anticonvulsant = gabapentin, pregabalin
what is the psychological Tx for OCD
Exposure and Response Prevention (ERP) ≥ 20 hours
CBT (with heavy emphasis on exposure)
what is the medication options for OCD
1st line = clompiramine or fluoxetine (TCA or SSRI)
2nd line = risperidone, Aripiprazole (anti-psychotic drugs)
3rd line = lamotrigine
Tx pathway for OCD
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
what is the psychological Tx of GAD
guided self -help (if mild)
CBT
relaxation
what are the medication options for Tx of GAD
1st - SSRI (sertraline)
2nd - SNRI (Venlafaxine, duloxetine)
3rd - Pregabalin
what is the psychological Tx of social phobia
CBT with emphasis on exposure
cognitive restructuring
social skills training
what are the medication options for social phobias
1st line: SSRIs
2nd line: SNRIs (Venlafaxine, phenelzine)
3rd line: Benzodiazepines (bromazepam, clonazepam) or Anticonvulsants (gabapentin, pregabalin)
what are the psychological Tx options for specific phobia
exposure therapy
- graded exposure
- flooding
what are the medication Tx options for specific phobia
1st - SSRI only if anxiety is moderate/severe and they haven’t responded to behavioural therapy
what are the psychological options for Tx of panic disorder (with or without agoraphobia)
CBT
Graded
what are the medication Tx of panic disorder (with or without agoraphobia)
1st line: SSRIs
2nd line: TCAs (Clomipramine, Imipramine) or Venlafaxine
3rd line: Anticonvulsants (Gabapentin, valproate)
how long are patients treated for
GAD (≥ 18 months) Panic disorder (≥ 6 months) Social phobia (≥ 6 months) PTSD (≥ 12 months) OCD (≥ 12 months)
