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Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Features of pathological anxiety

A

Autonomy: no or minimal environmental trigger
Intensity: exceeds patient’s capacity to bear the discomfort
Duration: symptoms are persistent
Behaviour: anxiety impairs functioning and/or results in disabling behaviours – avoidance or safety behaviours

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2
Q

Constant vs episodic anxiety disorders

A

Constant: GAD

Episodic:
OCD
PTSD
Phobias
Panic disorder
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3
Q

Psychological symptoms of anxiety

A 
Worrying thoughts
Irritability
Sensitivity to noise
Restlessness
Fearful anticipation
Poor concentration
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4
Q

Sleep symptoms of anxiety

A 
Difficulty falling asleep
Night terrors (PTSD)
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5
Q

Physical symptoms of anxiety

A 
Muscle tension - tremors, aches
Autonomic arousal: 
Dry mouth
Diarrhoea
Difficulty breathing
Palpitations
Chest discomfort
Frequent and urgent micturition

Consequences of hyperventilation:
Dizziness
Tingling numbness

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6
Q

ICD10 criteria of GAD

A

Generalised and persistent somatic (physical) and psychological symptoms of anxiety on most days for at LEAST SEVERAL WEEKS at a time and usually several months

Anxiety symptoms usually involve elements of
Apprehension
Motor tension
Autonomic overactivity

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7
Q

ICD 10 criteria for panic disorder (episodic paroxysmal anxiety)

A

Several attacks within one month
In circumstances with no objective danger
Not confined to known or predictable situations
With comparative freedom from anxiety symptoms between attacks

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8
Q

Agoraphobia (ICD 10?)

A

Psychological and autonomic symptoms primarily manifestations of anxiety and not secondary to other symptoms, such as depression or delusions.

Anxiety must be restricted to at least two of the following: crowds, public places, travelling alone, travelling away from the home

Avoidance of the phobic situation must be a prominent feature.

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9
Q

ICD10 criteria of social phobia

A

Psychological, behavioural or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms such as delusions or obsessional thoughts
The anxiety must be restricted to or predominate in particular social situations
The phobic situation is avoided whenever possible

Common anxiety symptoms are:
Blushing or shaking
Fear of vomiting
Urgency or fear of micturition

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10
Q

ICD 10 of specific phobias

A

Psychological or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms such as delusions or obsessional thoughts
The anxiety must be restricted to the presence of the particular phobic object or situation
The phobic situation is avoided whenever possible

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11
Q

What are obsessions

A

thoughts, ideas or images, which are:
acknowledged as excessive or unreasonable.
Repetitive
Intrusive and resisted by the patient (although the resistance may diminish in chronic OCD)
Unpleasant – i.e. the thought gives no pleasure
Originate in the mind of the patient and are not imposed by outside persons or influences (i.e. not thought insertion)
Cause distress
Interfere with functioning

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12
Q

What are compulsions?

A

Physical act:
Acknowledged as excessive or unreasonable
Repetitive
Intrusive and resisted by the patient, causing mounting anxiety
Unpleasant – i.e. the act itself gives no pleasure, but may relieve tension or anxiety.
The desire to carry out the act originates in the mind of the patient and are not imposed by outside persons or influences ie not a made act arising from psychosis.
Causes distress and interferes with functioning, usually due to wasting time.
Magical thinking can occur – eg. “if I touch this door frame five times, no harm will come to my family”

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13
Q

Which physical conditions can present with symptoms of anxiety?

A

Thyroid dysfunction
Phaeochromocytoma
Acidosis (eg. DKA)
Hyper or Hypothermia

Hypoxia (eg. CHF, angina, anaemia, COPD)
Seizures
Arrhythmias such as SVT
Alcohol/opiate withdrawal
Drug intoxication (caffeine, cocaine, amphetamines)
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14
Q

Consider the comorbid psychiatric disorders in anxiety

A

Presence of depressive symptoms - Are these causing the anxiety or resulting from it?
Drug / alcohol misuse - significantly complicates treatment
Personality disorders
Anxiety symptoms secondary to organic pathology

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15
Q

What is the effect of anxiety on the person’s life?

A

Avoidance and Safety behaviours to avoid triggers for anxiety.
Unfortunately, these behaviours feed into the anxiety and worsen the illness

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16
Q

Step 1 of anxiety management (all suspected cases)

A

Psychoeducation and active monitoring

17
Q

Step 2 of anxiety management (no improvement after education and monitoring)

A

Guided self-help and low-intensity psychological interventions (primary care psychological services: IAPT)

18
Q

Step 3 of anxiety management (inadequate response to step 2 or marked functional impairment)

A 
High intensity psych intervention (CBT)
Or 
DRUG treatment (primary care)
19
Q

Step 4 of anxiety management (complex/refractory, very marked functional impairment)

A

Referral to secondary care - complex drug or psychological treatment regimes; input from multi-agency team

20
Q

Educate a patient on his/her anxiety

A

Definition and nature of illness
Explaining cycle of anxiety for this diagnosis
Precipitating and maintaining factors
Treatment (medications and psychological)
CBT approach
Social interventions
Prognosis

21
Q

Implementation of psychoeducation and guided self-help

A

Psychoeducation usually with support of trained professionals (involves patient, family, carers)

Guided self-help: done by patient through access to resources (books, computers etc)
Usually guided by a trained person for efficacy

22
Q

What is eye movement desensitisation processing?

A 
For PTSD (NICE)
During the therapy, the original trauma is deliberately re-experienced in as much detail as possible, e.g. by the patient narrating or imagining every step that happened.  While doing this, they fix their eyes on the therapist's finger as it quickly passes from side to side in front of them.
23
Q

What are the pharmacological treatments of anxiety

A 
All antidepressants (SSRIs, SNRIs, TCAs)
Warn about possible initial increase in anxiety

Sometimes beta blocker is used for heart rate and autonomic arousal

in severe cases - short term (<4 weeks) benzodiazepines (ADDICTIVE):
lorazepam (short half-life)
diazepam (longer half-life) - not used anymore

In very severe cases, antipsychotics

24
Q

Acute Stress Reaction

A

Brief (3 days - 1 month) after severely stressful event (eg. vehicle crash or violent crime)

Symptoms
Anxiety and depression
Numbness, detachment, poor concentration, derealisation, insomnia, restlessness, anger, autonomic symptoms​
Avoidance of talking or thinking about the event
Acohol excess is common

25
Q

Prognosis of acute stress reaction

A

Majority get better without formal diagnosis.
Those who get formally diagnosed, 78% develops PTSD.
The reasons are - no support network, thus more mental health problems. Also more serious trauma

26
Q

Management of acute stress reaction

A 
Reduce emotional response - talk to family/therapist
Encourage recall (debriefing)
Learn effective coping skills
Anxiolytics if very severe
Hypnotics for sleep disturbance
27
Q

who is affected by adjustment disorder

A

Psychological reaction to adapting to a new set of circumstances, e.g. new job/home, divorce, etc.

Starts within 3 months and must be proportionate to the stressful event

in response to bereavement, the onset of terminal illness or sexual assault

28
Q

Symptoms of adjustment disorder

A

Anxiety, depression, irritability
Palpitations and tremor

Occasional outbursts of dramatic or aggressive behaviour
Sometimes abuse of alcohol or drugs
Social functioning impaired
Onset more gradual than acute stress reaction, and it takes a more prolonged course

29
Q

Management of adjustment disorder

A

If possible, help resolve the change of circumstances e.g. support to make changes at work
Prevent avoidance and denial
Encourage problem-solving to seek solutions
Relieve anxiety by encouraging to talk and express associated feelings

Can refer to talking therapy in primary care - CBT

30
Q

Prognosis of adjustment disorder

A

Most last a few months
A few last a few years
Adults generally do well
Adolescents with an adjustment disorder have an increased risk of developing psychiatric illness in adult life

31
Q

When is bereavement a medical issue?

A

If it lasts >6 months
Affects the person’s relationships or ability to function.

Certain symptoms can indicate abnormal bereavement:
Guilt about unrelated things
Thoughts of death (except thinking that one would be better off dead etc)
Preoccupation with worthlessness
Significant psychomotor retardation
Prolonged and serious functional impairment
Hallucinatory experiences (other than the deceased person)

32
Q

What are the normal symptoms in someone going through bereavement

A

poor energy
low mood
Anhedonia

disturbed sleep and appetite
Even symptoms of anxiety

Should gradually resolve within 3 months

33
Q

What is classified as PTSD?

A

Onset of symptoms following trauma, with a latency period of few weeks to months.
Lasts longer than 6 months after trauma (otherwise it would be normal reaction)

34
Q

Which trauma has a very high prevalence for PTSD?

A

45% in domestic violence

Otherwise usually 5-10% in different traumas

35
Q

Symptoms of PTSD

A

Core triad:
Hyperarousal (anxiety, insomnia, irritable, poor concentration)
Re-experiencing (flashbacks, dreams)
Avoidance (or reminders, detachment, numbness, anhedonia)

Depressive & guilt symptoms common
Substance use as a coping strategy common
Symptoms may begin quickly after, rarely >6 months after

36
Q

Management of PTSD

A

Psychological treatment:
psychoeducation
Trauma-focused CBT
Eye Movement Desensitization and Reprocessing (EMDR)

Social:
educate family
avoid alcohol
support reintegration into environment

Biological:
antidepressants (eg. SSRIs)

37
Q

Prognosis of PTSD

A

50% recover in 1st year
Poorer Prognosis if co-morbid mental illness, long duration, history of psychiatric illness, family history of mental illness, poor social support or pre-morbid functioning or outstanding compensation claims

Psychiatry (15 decks)

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