Anxiety Flashcards
Give examples of the biological symptoms of anxiety.
- Sweating, hot flushes or cold chills
- Trembling
- Muscle tension/aches/pains
- Numbness or tingling sensations
- Feeling dizzy, unsteady, faint or lightheaded
- Dry mouth (not due to medication or dehydration)
- Feeling of choking
- Lump in the throat, or difficulty in swallowing
- Difficulty breathing
- Palpitations
- Chest pain
- Nausea /churning in stomach
Give examples of the cognitive symptoms caused by anxiety
- Fear of losing control
- Difficulty concentrating, “mind going blank”
- Feeling that objects are unreal - derealization
- Feeling that the self is distant - depersonalisation
- Hypervigilance (internal and external)
- Racing thoughts
- Meta-worry
- Health anxiety
- Preference for order and routine
What behavioural symptoms indicate anxiety?
- Avoidance of situations
- Exaggerated response to minor surprises/startled
- Difficulty sleeping due to worrying
- Excessive use of alcohol/drugs
- Restlessness/ irritability
Acute stress increases cortisol levels. TRUE/FALSE?
TRUE
When is anxiety considered pathological?
- when anxiety is more extreme than “normal”
- when anxiety presents in certain situations that are not “normally” anxiety provoking
Give examples of types of anxiety disorder?
Generalised Anxiety Disorder Panic Disorder Agoraphobia Social Phobia Specific Phobia Obsessive Compulsive Disorder
What is meant by Generalised Anxiety Disorder?
- generalised and persistent anxiety
- not in any particular circumstance or environment
- long-lasting (most days for at least 6 months)
- not controllable
- causing significant distress / impairment in function
What symptoms of anxiety are typically found in Generalised Anxiety Disorder?
- restlessness
- easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance
Who normally gets Generalised Anxiety Disorder?
Typical age of onset between 20-40
2:1 female:male ratio
What percentage of patient’s with Generalised Anxiety disorder also have other co-morbid psychiatric disorders (e.g. depression, substance abuse etc)
90%
How is generalised anxiety disorder treated?
- Cognitive Behavioural Therapy
- SSRIs / SNRIs
- Pregabalin
- Benzodiazepines (short term only)
What is CBT and how does it work?
- Talking therapy
- identifying individual’s automatic thoughts, cognitive biases and schemas
- Help the individual understand why their thoughts are pathological/harmful and perpetuate the anxiety
What is panic disorder?
- recurrent attacks of severe anxiety
- not restricted to any particular situation
- unpredictable
What symptoms and thoughts are experienced in a panic disorder?
palpitations
chest pain
choking sensations
dizziness
feelings of unreality (depersonalization or derealization)
Secondary fear of dying/losing control/going mad
Many patients with panic disorder also have agoraphobia. TRUE/FALSE?
TRUE
50-67%
When is the typical onset of panic disorder?
Late adolescence to mid-30’s
How many people have recovered or improved at 10 year follow up of a panic disorder?
1/3 unchanged or worse
1/3 modest improvement
1/3 well
How are panic disorders treated?
Cognitive Behavioural Therapy
SSRIs / SNRIs / Tricyclics
Benzodiazepines (short term only)
When do phobias typically present?
- Agoraphobia = 20-30s
- Social and Specific phobias = early adolescence - early 20’s
Do patients with a phobia recognise their fear is irrational?
Yes
What is agoraphobia?
cluster of phobias:
- fears of leaving home
- entering shops
- crowds
- public places
- Travelling alone in trains, buses or planes
Sometimes patients with agoraphobia can avoid their stimulus so much that they experience very little anxiety. TRUE/FALSE?
TRUE
What are the signs of agoraphobia in relation to shopping?
others do shopping (for or with the patient)
go shopping to 24 hour store at night (when quiet)
Internet shopping!
Why do patients with agoraphobia often drink alcohol?
- to overcome fear and allow them to go out and do tasks they wouldn’t previously do
Give examples of specific phobias
flying, heights, animals or insects, receiving an injection or seeing blood
How are specific phobias treated?
Behavioural Therapy – exposure
Graded exposure / systematic desensitisation
Add in CBT if necessary
SSRIs / SNRIs if required
What is social phobia/social anxiety disorder?
- persistent fear where person is exposed to unfamiliar people or to scrutiny by others
- fears that he or she will act in a way that will be embarrassing and humiliating
Social phobia can cause problems with poor school performance. TRUE/FALSE?
TRUE
school refusal causes poorer results
may cause poor employment
How is social phobia treated?
Cognitive Behavioural Therapy
SSRIs / SNRIs
Benzodiazepines (short term only)
What type of thoughts are typical of OCD?
Ego-dystonic
=> thoughts that are distressing/ unacceptable or inconsistent with one’s self-concept.
What is meant by the “compulsive acts” involved in OCD?
- Repeated rituals or stereotyped behaviours
- Not enjoyable/ pointless acts
- Often viewed as “neutralising” aka will stop something bad from happening
How is OCD diagnosed?
Obsessive symptoms/ compulsive acts present most days for at least 2 weeks
AND these are source of distress and interference with activities
Name some of the common obsessions associated with OCD?
Contamination
Fear of Harm
Concern with order/symmetry
Name some of the common compulsive acts of OCD?
Checking
cleaning/washing
repeating acts
When is the typical onset of OCD?
mean age of onset – 20
peak incidence for males – 13-15
peak incidence for females – 24-25
What percantage of OCD patients experience at least 1 depressive episode?
60-90%
What comorbidities (other psychiatric conditions) can accompany OCD?
schizophrenia
Tourettes and other tic disorders
Body dysmorphic disorder
Eating disorders
How is OCD treated?
Cognitive Behavioural Therapy
Including response prevention
SSRIs / Clomipramine
HOw do benzodiazepines help to treat anxiety
Bind to GABA-A receptor Allow Chlordie ion influx Membrane hyperpolarisation => NO AP generated and neurons dont fire
What problems can occur with benzodiazepines if they are used for longer than 2 weeks?
- Sedation and psychomotor impairment
- withdrawal problems
- Dependency and abuse
- Alcohol interaction
- Can worsen co-morbid depression
What type of medication is first line in OCD?
SSRI
OCD is highly comorbid with other disorders. TRUE/FALSE?
TRUE
What is the difference between obsessive thoughts and mental compulsions?
Mental compulsions involve patient role-playing their compulsion in their head
=> i.e. counting to certain number, imagining they are completing a task etc
