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PSYCHIATRY > Anxiety > Flashcards

Anxiety Flashcards

1
Q

List 5 physical symptoms of Anxiety.

A
  1. light headedness
  2. dry mouth
  3. palpitations
  4. lump in throat- difficult to breathe or swallow
  5. nausea or abd. pain

(chest pain, choking muscle ACHES)

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2
Q

What are 5 cognitive symptoms of Anxiety?

A
  1. fear of LOSING control
  2. mentally tense
  3. loss of concentration
  4. Derealization (objects feel unreal)
  5. Depersonalization

(racing thoughts. met-worry, hypervigilance)

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3
Q

What are 5 behavioural symptoms of Anxiety?

A
  • avoidance
  • EXAGGERATED response to MINOR surprises
  • unable to fall asleep (too worried)
  • excessive use of DRUGS/ ALCOHOL
  • irritable

(can’t relax)

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4
Q

What is the role of the Amygdala in the stress response?

A
  • acts as the EMOTIONAL filter of the brain for assessing whether sensory material (via the THALAMUS) requires a STRESS or FEAR response
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5
Q

What sites in the brain are responsible for the release of Cortisol by the Adrenal gland?

A
  • Pituitary
  • HYPOTHALAMUS
  • hippocampus
  • amgydala
  • —cortisol THROUGH NEGATIVE FEEDBACK will act on ALL these sites
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6
Q

When is anxiety considered as a disorder? (2)

A
  • when the symptoms of anxiety are MORE extreme than normal
  • when they occur in an otherwise not anxiety provoking situitation
  • a disorder when it causes SIGNIFICANT DISTRESS to social/occupational function
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7
Q

What does a pt with Generalized Anxiety Disorder experience? (3)

A
  • PERSISTANT and generalized anxiety (“free floating”)
  • typical anxiety symptoms
  • constant fear of loved one falling ill/getting in an accident
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8
Q

What is the criteria for GAD to be diagnosed?

A
  • should be LONG LASTING (most days for at least 6 months)
  • no control
  • impairs normal function
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9
Q

What are the physical symptoms seen with Generalized Anxiety D.O?

A
  • restlessness
  • easily fatigued
  • irritable and muscle TENSION
  • SLEEP disturbance
  • hard to concentrate
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10
Q

Which demographic group is predominantly affected by GAD?

A
  • 20-40 y.o FEMALE
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11
Q

90% of GAD cases have other co-morbidities. Name a few.

A
  • depression
  • substance abuse
  • other anxiety disorders
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12
Q

What is the treatment for GAD?

A
  • SSRIs is first line; esp. SERTALINE
  • CBT
  • Pregabalin
  • Benzodiazepines for short-term use during CRISISES
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13
Q

What occurs in CBT ?

A

-it is an evidence based PSYCHOLOGICAL treatment
- based on identifying the pt’s THOUGHTS, COGNITIVE biases and schemas
-

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14
Q

What are schemas?

A
  • an avalanche effect of how people with GAD have this tendency of having negative thoughts ONE after the OTHER.
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15
Q

How is a Panic disorder diff.?

A
  • RECURRENT, Unexpected attacks of SEVERE anxiety

- holds the same physical symptoms of anxiety ( dizziness, chest pain, palpitations, feelings of unreality )

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16
Q

What is common between GAD and Panic disorder?

A
  • similar symptoms

- both NOT due to substance misuse or other medical condition (hyperthyroidism, caffeine intoxic)

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17
Q

What are some ESSENTIAL clinical fts of Panic Disorder? (3)

A
  • 50-67% also have AGORAPHOBIA
  • onset late ADOLESCENCE-MID 30s
  • high prevalence in cardiology clinic
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18
Q

What are the co-morbidities of Panic disorder?

A
  • depression
  • drug and ALCOHOL misuse

-other anxiety d.os

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19
Q

How may panic attacks be triggered?

A
  • in susceptible individuals by INFUSIONS of lactate

- by re-breathing AIR (more CO2)

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20
Q

What is seen on the PET scan during panic attacks>

A
  • increased METABOLISM of the ANTERIOR pole of the TEMPORAL lobe
  • parahippocampal gryus
21
Q

How do you treat panic d.o?

A
  • SSRIs/SNRIs/TRICYCLICS
  • CBT

-BENZOs (for panic crisis)

22
Q

What are the 3 forms of phobias?

A
  1. Agoraphobia
  2. Social Phobia
  3. Specific Phobia
23
Q

At what age, do half the cases of agoraphobia present in patients?

A

50% presents by 20

75% BY EARLY 30s

24
Q

At what age do social phobias become more apparent?

A
  • 80% by early adolescence

- 75% by early 20s

25
Q

What is phobia typified with?

A
  • avoidance

- anticipatory ANXIETY

26
Q

What is Agoraphobia?

A
  • fears of leaving home
  • entering shops
  • crowd and public places
  • travelling alone in trains, buses or planes
27
Q

What is a key characteristic of agoraphobia?

A

AVOIDANCE of the the situation; to experience less anxiety

28
Q

Can Agorabphobia occur secondary to other pathology?

A
  • with depression
  • panic d.o
  • or just a primary d.o
29
Q

How may people avoid agoraphobic situations?

A
  • others do shopping for them
  • drink alcohol to overcome alone (before socializing)
  • shop at 24hr store at night
  • internet shopping
30
Q

What is a specific phobia?

A
  • the marked and PERSISTENT fear that is EXCESSIVE and unreasonable, cued by the anticipation of an object or situation
  • pure mention of the phobic stimulus provokes an immediate ANXIETY resp.
31
Q

Are people with phobias full aware of it?

A
  • they recognize that the fear is EXCESSIVE or UNREASONABLE
32
Q

How to treat phobias?

A
  • behavioural therapy (EXPOSURE)
  • —-graded exposure/ systematic desensitisation ——add in CBT
  • SSRIs/ SNRIs
33
Q

How different is SOCIAL phobia from the rest of the phobias?

A
  • the persistent fear of ONE or more social situations in which the person exposed to UNFAMILIAR people or to possible SCRUTINY by others
  • they feel humiliated or embarassed
34
Q

Where does social phobia usually kick in?

A
  • in small social setting

- they are fine in LARGE crowds

35
Q

How may the panic attack appear (for social phobia)?

A
  • shaking or blushing
  • fear of vomitting
  • urgency to DEFECATE or MICTURATE
36
Q

How may social phobia impact an individual?

A
  • poor school performance
  • poor EMPLOYMENT hx
  • school refusal
37
Q

What site in the brain is predominantly activated in social phobia?

A
  • bilateral activation of the AMYGDALA

- increased rCBF (regional cerebral blood flow) to the amygdala (and related LIMBIC areas)

38
Q

How to rx social phobias?

A
  • CBT
  • SSRIs/ SNRIs

-Benzos

39
Q

What is OCD? (2)

A

-d.o characterised by obsessive thoughts (intrusive, frequent ideas and impulses) and compulsive acts

40
Q

What is the MEAN age of onset for OCD?

A
  • 20 y.o
41
Q

What co-mordidities may OCD be a.w? (4)

A
  • schizo
  • tourettes
  • body dysmorphic d.o
  • eating d.o
  • trichtillomania
42
Q

How are thoughts and acts described as in OCD? (4)

A
  • ideas entering the mind in a stereotyped way (unpleasant, RESISTED, EGO-DYSTONIC)
  • repeated, non-functional acts
43
Q

Top 3 Most common obsessions in OCD?

A
  1. Contamination from DIRT, germs, viruses
  2. Fear of HARM
  3. excessive concern with SYMMETRY and order
44
Q

First line rx for OCD according to NICE guideline.

A

CBT (exposure-response therapy) and/or an SSRI and Clomipramine (TCA)

45
Q

What is the action of GABA on neurotransmission? (3)

A
  • GABA attaches to GABA-A receptor (inhibitory ionotropic R)
  • triggers CHLORIDE ion influx> membrane HYPERPOLARIZATION

> inhibitory post-synaptic potential

46
Q

What is the axn of benzos?

A
  • enhances the effect of GABA
47
Q

Potentiation of BZD site brings about what effects?

A
  • relaxation

- anti-convulsant efx

48
Q

What do antagonists cause at the BZD site?

A
  • anxiety and PRO-convulsants
49
Q

Why are benzos always intended for use of LESS than 2 weeks?

A 
>sedation (psychomotor impairment)
> dependence and abuse
> alcohol interaction
> may cause CO-morbid depression 
> withdrawal problems

PSYCHIATRY (32 decks)

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