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RB Y3 2 Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

1
Q

biological symptoms of anxiety (that you wouldnt expect)

A
  • muscle tension or aches and pains
  • feeling of choking
  • palpitations
  • chest pain
  • nause or abdominal distress
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2
Q

derealization

A
  • Psychosensory feelings of detachment or estrangement from surroundings
  • Objects appear altered/unreal
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3
Q

depersonalization

A
  • Parts of the body experienced as being changed, unreal, remote, automatized
  • feeling that the self is distant or not reall there
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4
Q

what differentiates depersonalisation from psychosis

A

there is insight into the subjective nature

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5
Q

what is meta worry

A

worry about everything, eg worrying about worrying

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6
Q

what is there often a preference for in anxiety

A

order and routine

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7
Q

what are 4 symptoms in children that are indicative of anxiety

A

thumb sucking

nail biting

bed wetting

food fads

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8
Q

what is the first thing that the brain does when stimuli arrives

A

amygdala acts as the emotional filter to decide whether it needs a stress or fear response

later there is modification by a cortically processed signal

–> act first think later

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9
Q

where is the amygdala located

A

set of neurons in the medial temporal lobe

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10
Q

which system is the amygdala part of

A

the limbic (emotional system)

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11
Q

what happens when teh amygdala perceives something as dangerous

A
  • Stimulus information sent to amygdala – stress or fear??
  • Yes - distress signal to hypothalamus, which communicates with the rest of the body (so you have the energy to fight or flee)
  • Hypothalamus controls ANS, activates sympathetic nervous system via adrenal glands release of adrenaline (epinephrine) into blood stream
  • Then the hypothalamus activates HPA axis (hypothalamus, pituitary gland and adrenal glands). This aims to suppress the sympathetic nervous system
  • If the brain continues to perceive something as dangerous, the hypothalamus releases CRH… cortisol is released from adrenal cortex.
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12
Q

what does acute stress do to cortisol levels then

A

raises them

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13
Q

how much cortisol and catecholamines are released due to stress

A

dose dependent

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14
Q

is release of exxcess cortisol harmful?

A

yes it is neurotoxic to some extent, damages the hippocampus

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15
Q

what must be first eliminated in the presentation of anxiety

A

substance misuse, medication misuse, hyperthyroidism etc

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16
Q

which group of symptoms are pertinent in GAD

A

physical symptoms! medically unexplained

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17
Q

what are 3 severity criteria GAD must fulfil

A

long lasting, most days for at least 6 months

not controllable

causing significant distress or impairment in function

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18
Q

is there a genetic predisposition for GAD

A

yes

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19
Q

what type of things can trigger GAD

A
  • Stress: work, noise, hostile home
  • Events: divorce, death, moving house etc.
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20
Q

are females or males more affected by GAD

A

females

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21
Q

management of GAD

A
  • Symptom control: listen and reason
  • Regular (non-obsessive) exercise
  • Mediation
  • CBT and relaxation
  • pharmacotherapy
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22
Q

which pharmacological agents are used for GAD

A

SSRI/SNRI

pregabalin (anticonvulsant)

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23
Q

do benzodiazpines have a role in the management of anxiety

A

short term use, they have no long term benefits

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24
Q

what is the essential feature of panic disoder

A

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

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25
Q

what cues panic disorder attacks

A

they are not restricted to a particular set of circumstances and are unpredictable!

26
Q

which phobia is panic disorder often seen with

A

agoraphobia - 60%

27
Q

where do patients with panic disorder often present to

A

cardiology ward, present with palpitations, chest pain, dizziness etc

28
Q

what should be suspected if someone presents with panic/anxiety later in life

A

underlying depression

29
Q

are comobridities common with panic disorder

A

yes - drugs, depression, alcohol, other anxiety disorders

30
Q

what has been shown to trigger panic attacks in susceptible individuals

A

lactate build up and increased CO2 (re breathing air, hypoventilation)

31
Q

which area of the brain has a role in the triggering of panic attacks

A

parahippocampal gyrus

32
Q

management of panic attacks

A

CBT

SSRIs, SNRIs, TCA

33
Q

when have most phobias presented by

A

20s - early onset

34
Q

what type of behaviour do phobias lead to

A

avoidance behaviour, they are only anxious in specific situations

35
Q

what happens to the person with a phobia if they expect to see what they are scared of

A

anticipatory anxiety

36
Q

do patients with phobias have insight into their fear being irrational?

A

yes

37
Q

what type of behaviour is typical of avoidance behaviour

A

alcohol use

getting others to do stuff for them

avodiing situation, eg online shoppingin agoraphobia

38
Q

what is agoraphobia

A

A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes

39
Q

what is a specific phobia

A

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

40
Q

in specific phobia, does exposure to the phobic stimulus always provoke immediate anxiety response?

A

yes

41
Q

what is the mainstay of psychotherapy for specific phobia

A

behavioural therapy based on graded exposure/systematic desensitisation to phobia

42
Q

are people with social anxiety disorder scared of small or big groups

A

small groups - feat of being scrutinised/unfamiliar people

often fine in large groups as can hide

43
Q

what is there a common fear of with social anxiety

A

micturition or defaecation

vomiting

often there is blushing or shaking

44
Q

what imapct can social anxiety disorder have on soemones life

A

poor school performance, poor employment history

45
Q

what is behavioural inhibition

A

a consistent tendency to react to novel situations with fear and withdrawal to safety

46
Q

what is behavioural inhibition a good predictor of if seen in children

A

anxiety disorders

47
Q

what is seen in the brain during phobia attack

A

increased bilateral activation of amygdala and increased rCBF to amygdala and other limbic areas

48
Q

OCD: what are obsessions

A

stereotyped, puposeles,s words ideas or phrases that come into the mind

49
Q

are the obsessions in OCD recognised as the patients own thoughts or someone elses

A

recognised as their own thoughts

50
Q

OCD: how do the obssessive thoughts seem to the patients

A

unpleasant, resisted and egodystonic

51
Q

OCD: what are compulsions

A

senseless, repeated rituals or sterotyped behaviours

not enjoyable or functional !

52
Q

do patients believe there are consequences to not doing compulsions in OCD

A

often viewed as neutralizing - eg this wont happen if i do this

53
Q

do patients resist compulsions in OCD

A

often they do, but if they are longstanding the patients often give up on resisting

54
Q

how long must OCD symptoms be present for for diagnosis

A

minimum 2 weeks, this is more of a diagnosis of exclusion as they are normally present for much longer

must be present for most days a week

55
Q

can obsessions be different things each time in OCD

A

they must be repetitive

56
Q

when is peak onset of OCD in males and females

A

males - 14

females - 24

57
Q

is depression associated with OCD

A

most patients experience at least one major depresive episode

58
Q

is there co morbidity in COD

A

significant co-morbidity with schizophrenia, tourettes and other tic disorders, body dysmorphic disorder (spend a lot of time worrying about flaws in appearance), eating disorders and trichotillomania (pulling out hair).

59
Q

management of OCD

A

CBT , response prevention

SSRI

clomipramine

60
Q

what dose of SSRI is required for CBT

A

a higher than normal dose

RB Y3 2 Psychiatry (12 decks)

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