Anxiety Flashcards
How common is it?
25% Lifetime risk. GAD: 4.4.% Panic: 1.2% Phobias 1.9% (M:F 1:2) OCD 1-3% PTSD: 2.6% men; 3.3% women. Adjustment disorders, hospital: 12%. Mixed depression & anxiety 9.7%.
What causes it?
Anxiety is a normal emotional feeling, part of fight or flight. But it becomes a problem if: It interferes with our daily life, the response is out of proportion to the threat/more prolonged/ occurs without a threat and if the focus is on physiological response.
What risk factors are there?
Environmental stressors such as domestic violence, unemployment, separation, low socioeconomic status, and history of child abuse.
Genetic factors play a part, there is a fivefold increase risk of GAD in first degree relatives of people with GAD.
Substance dependence or exposure to organic solvents.
Cognitive styles of negative thinking can lead to excessive worry and are associated with development of GAD.
Chronic illness or painful disorders such as arthritis.
Neurophysiological factors do also play a role.
How does it present?
Psychological: “free floating anxiety”, worry, apprehension, fear, persistent nervousness, poor concentration, irritability.
Arousal: hypervigilance, restlessness, increased startle response, feeling keyed up.
Fears: patient or relative will become ill/have accident, fear of losing control, impending danger, unrealistic ideas of danger, negative thoughts, feeling they can’t cope, fear of dying.
Motor: Muscle tension, headaches, trembling, purposeless activity, weakness.
Autonomic: CVS e.g. Palpitations, tightness, pains. RESP e.g. Over breathing, difficulty inhaling. GI e.g. dry mouth, loose stools, epigastric discomfort, butterflies, choking, dysphagia. GUS e.g. frequent micturition. Neuro e.g. blurred vision, light headed, dizzy, nausea, numbness, tingling.
Others: Sweating, sleep disturbance, derealisation, depersonalisation, flushing, sweats.
Obsessions: Repetitive intrusive involuntary anxiety provoking thoughts/images/ideas. Recognised by patient as own.
Compulsions: Repeated stereotyped behaviours, associated with anxiety. Pt will have insight.
PTSD: Flashbacks, persisting background of a sense of “numbness”, emotional blunting, detachment from other people and surroundings, anhedonia, avoidance of activities reminiscent of the trauma.
Investigations?
Mainly history
GAD screening questionnaire
Treatment
SSRI e.g. fluoxetine, citalopram, sertraline
NaSSA e.g. mirtazapine
SNRI e.g. venlafaxine
Others: pregabalin, trazadone, buspirone,
Benzodiazepines – PRN only.
Conditions that would present similarly
Physical disorders: Heart disease (IHD, AF, heart failure, PE). Diabetes. Under or over active thyroid. Asthma or COPD. Drug & alcohol abuse or withdrawal. IBS. Tumours e.g. phaeochromocytoma.
Depression. Psychosis.
