Anxiety Flashcards
What is anxiety?
Emotional response to a threat
What is depression?
Emotional response to loss
What are the two broad temporal forms anxiety can take?
Chronic
Episodic
What are the three chronic forms of chronic anxiety?
Generalised anxiety disorder
PTSD
OCD
What is generalised anxiety disorder?
Persistent anxiety
What sex is more affected by GAD?
Women
What are the three categories of symptoms seen in GAD?
Somatic
Behavioural
Psychological
What are some somatic symptoms of GAD?
Headache Presyncope SOB -> Hyperventilation -> Paresthesia Tremors Palpitations and chest pain GI upset- N+V, diarrhoea, 'Butterflies' and dry mouth Urinary frequency/urgency Restlessness/insomnia Globus hystericus- 'Lump in throat'
What are some behavioural symptoms of GAD?
Trigger avoidance Withdrawal DSH Self medication- Alcohol/drugs Reassurance seeking
What are some psychological symptoms of GAD?
Fearful anticipation or dread Irritability Worrying/repetitive/intrusive thoughts Poor concentration Memory issues Hypervigilance Depersonalization/detachment
How do you treat GAD?
Listen to them Exercise Meditation CBT Anxiolytics- Paroxetine Pharma- SSRI, BB, Bzd, Venlafaxine
What is the course of GAD?
Generally resolves or lessens >50YO
What is PTSD?
Protracted response to stressful event or situation of exceptionally threatening nature. Will affect anyone in that situation.
WHat things can prolong the course of PTSD?
Personality, previous unresolved traumas, other psychiatric illness
What are some symptoms of PTSD?
Flashbacks Insomnia with nightmares Emotional blunting/numbness Extreme anxiety at triggers Avoidance of triggers Emotional detachment from others Hypervigilance Extreme startle response
What can flashbacks trigger in PTSD?
Intrusive memories
What does emotional blunting/numbness alternate with in PTSD?
Extreme anxiety
What does extreme anxiety alternate with in PTSD?
Emotional blunting/numbness
What are some complications of PTSD?
Depression
Substance misuse
What is the treatment of acute PTSD?
Watch and wait
2/3 resolve in a year
How do you treat chronic PTSD?
Antidepressants- Paroxetine and Olanzapine
Psychotherapy
What antidepressants are used in PTSD?
Paroxetine
Olanzapine
What is the progression of PTSD?
Acute stress reaction (48h)
Acute stress disorder (4w)
Acute PTSD (3m)
Chronic PTSD (>3m)
How long does the acute stress reaction last for?
48h
How long does an acute stress disorder last for?
4w
How long does acute PTSD last for?
3m
How long does it need to be for chronic PTSD?
> 3m
What are some symptoms of OCD?
Obsessional ruminations
Compulsive rituals- Some need to be repeated a certain number of times
Constant and non-reassurable worry
Thought-action fusion
What are obsessional ruminations?
Time consuming and intrusive so as to interfere with daily life.
Often out of character thoughts such as violence or sexual
What are compulsive rituals?
Time consuming and intrusive so as to interfere with daily life.
Some need to be repeated a certain number of times.
What is thought-action fusing?
Thinking something = doing it
What is primary OCD?
OCD with no underlying cause?
What is secondary OCD?
OCD with underlying cause?
What conditions can cause OCD?
Depression
Tourette’s
Basal Ganglia Dysfunction- Parkinson’s, Huntington’s and Trauma
What are some symptoms of mild OCD?
Over-conscientiousness Tidiness Punctuality Inflexibility Perfectionist
What can precipitate mild OCD?
Stress
Is there a genetic link to OCD?
Probably yes
What basal ganglia dysfunction can cause secondary OCD?
Parkinson’s
Huntington’s
Trauma
How do serotonin/5-HT levels vary in OCD?
Low
How do you psychologically treat OCD?
CBT
Thought stopping
COmpulsion prevention
What is thought blocking?
Use sudden intrusion such as snapping and elastic band to interrupt thoughts
How does compulsion prevention work?
Exposure to obsessional stimuli
Prevent doing compulsive behaviour
What are some pharmacological treatments of OCD?
SSRI- Fluoxetine
TCA- Clomipramine
How does SSRI dose differ in OCD from depression?
Much higher in OCD
What is psychosurgery used for?
Occasionally for severe chronic OCD
What are the two forms of episodic anxiety?
Panic disorders
Phobias
What is a phobia?
Irrational fear response to specific trigger
What are the symptoms of phobias?
Same as GAD but only in response to trigger
What is the pathology of phobias?
Conditioning- Negative event associated with cue
Imagines threat- Ghost stories etc
Genetics
What are some common phobias?
Agoraphobia
Social phobias
Simple phobias- arachnophobia
What are simple phobias?
Arachnophobia etc
WHat are simple phobias?
Particular object as a trigger
What are complex phobias?
Phobia of a particular situation
What are some examples of complex phobias?
Agoraphobia
Social phobias
What is agoraphobia?
Fear of open places/being away from home
What is a social phobia?
Fear of social situations
What are panic disorders?
Anxiety onset with no specific trigger
What are some symptoms of panic disorders?
Multiple panic attacks
What are some symptoms of panic attacks?
Sudden onset
Reaches maximum on a few minutes
Think they’re about to die
What condition does a panic attack mimic?
MI but no raised Troponin T and GTN does not help
What can cause the symptoms of a panic attack?
Overactive sympathetic NS
Hyperventilation
Increased muscle tone
How do you treat panic attacks?
Paroxetine
CBT
What are some natural forms of anxiety?
Acute stress reaction
Adjustment disorder
Normal grief
What is an acute stress reaction?
Response to a stressful situation that can last several days. Generally severe response but in proportion to stimuli.
How can acute stress reactions progress?
Resolve in a few days or progress to adjustment disorder
What are some symptoms of an acute stress reaction?
Feel dazed/numb
Inability to comprehend situation
How do you treat an acute stress reaction?
Reassure them
What is an adjustment disorder?
Normally follows on from acute stress reaction.
Low mood joins initial shock but not bad enough to be anxiety disorder or depression.
How long can an adjustment disorder last for?
Upto 6 months
How do you treat an adjustment disorder?
Supportive counselling
What is a specific form of adjustment disorder?
Pathological/abnormal grief
What is pathological grief?
Excessive or prolonged grief or absence of grief with denial
What are some symptoms of pathological grief?
Grief Insomnia Dreams of the dead person Anger Inability to deal with personal effects
How do you treat pathological grief?
Guided mourning
What are the three stages of normal grief?
Shock and disbelief
Emotions
Acceptance and resolution
How long does normal grief last?
Up to a year?
What is the general first line treatment for anxiety?
CBT
SSRI
What is the generalised second line treatment for anxiety?
SNRI
TCA
What are some psychological treatments for anxiety?
Talking it through Relaxation Anxiety management/phobia training Biofeedback Behavioural therapies CBT
How does anxiety management work?
Give verbal/mental cues to show link with symptoms
Relaxation/distraction/reassurance to dispel anxiety
What is an example of biofeedback and what is it use for?
Skin resistance
To show not relaxed
What are behavioural therapies?
Change behaviour and therefore symptoms
What is an example of behavioural therapies?
Graded exposure/systematic desensitization
How does Graded exposure/systematic desensitization work?
Rank stimuli
Gradually expose to least threatening stimuli
Progress up ladder
How does CBT work?
ID mental cues
Change way of thinking
What are some pharmacological treatments for anxiety?
Reduce anxiety inducing drugs- alcohol and caffeine
Bzd
SSRI
BB
What are SSRI and BB used for in anxiety?
Symptomatic treatment
Who should not get propranolol?
The young
Where do Bzd work?
Centrally
Give some examples of Bzd
Diazepam
Alprazolam
Chlordiazepoxide
What are some side effects of Bzd?
Sedation- Do NOT drive
Memory impairment
Dependence
Withdrawal syndrome
What should you not do while on Bzd?
Do NOT drive!!!
How long can Bzd dependence take to form?
4-6 weeks in those with dependent personality
How should Bzd be given?
PRN
What are some symptoms with Bzd withdrawal syndrome?
Insomnia Anxiety Tremulousness Muscle twitchings Perceptual distortions Hallucinations (which may be visual) Hypersensitivities (light, sound, touch) Convulsions