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Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

1
Q

What is anxiety?

A

Emotional response to a threat

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2
Q

What is depression?

A

Emotional response to loss

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3
Q

What are the two broad temporal forms anxiety can take?

A

Chronic

Episodic

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4
Q

What are the three chronic forms of chronic anxiety?

A

Generalised anxiety disorder
PTSD
OCD

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5
Q

What is generalised anxiety disorder?

A

Persistent anxiety

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6
Q

What sex is more affected by GAD?

A

Women

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7
Q

What are the three categories of symptoms seen in GAD?

A

Somatic
Behavioural
Psychological

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8
Q

What are some somatic symptoms of GAD?

A 
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'
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9
Q

What are some behavioural symptoms of GAD?

A 
Trigger avoidance
Withdrawal
DSH
Self medication- Alcohol/drugs
Reassurance seeking
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10
Q

What are some psychological symptoms of GAD?

A 
Fearful anticipation or dread 
Irritability 
Worrying/repetitive/intrusive thoughts 
Poor concentration 
Memory issues
Hypervigilance 
Depersonalization/detachment
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11
Q

How do you treat GAD?

A 
Listen to them
Exercise
Meditation
CBT
Anxiolytics- Paroxetine
Pharma- SSRI, BB, Bzd, Venlafaxine
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12
Q

What is the course of GAD?

A

Generally resolves or lessens >50YO

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13
Q

What is PTSD?

A

Protracted response to stressful event or situation of exceptionally threatening nature. Will affect anyone in that situation.

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14
Q

WHat things can prolong the course of PTSD?

A

Personality, previous unresolved traumas, other psychiatric illness

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15
Q

What are some symptoms of PTSD?

A 
Flashbacks
Insomnia with nightmares
Emotional blunting/numbness
Extreme anxiety at triggers
Avoidance of triggers
Emotional detachment from others
Hypervigilance
Extreme startle response
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16
Q

What can flashbacks trigger in PTSD?

A

Intrusive memories

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17
Q

What does emotional blunting/numbness alternate with in PTSD?

A

Extreme anxiety

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18
Q

What does extreme anxiety alternate with in PTSD?

A

Emotional blunting/numbness

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19
Q

What are some complications of PTSD?

A

Depression

Substance misuse

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20
Q

What is the treatment of acute PTSD?

A

Watch and wait

2/3 resolve in a year

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21
Q

How do you treat chronic PTSD?

A

Antidepressants- Paroxetine and Olanzapine

Psychotherapy

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22
Q

What antidepressants are used in PTSD?

A

Paroxetine

Olanzapine

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23
Q

What is the progression of PTSD?

A

Acute stress reaction (48h)
Acute stress disorder (4w)
Acute PTSD (3m)
Chronic PTSD (>3m)

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24
Q

How long does the acute stress reaction last for?

A

48h

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25
Q

How long does an acute stress disorder last for?

A

4w

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26
Q

How long does acute PTSD last for?

A

3m

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27
Q

How long does it need to be for chronic PTSD?

A

> 3m

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28
Q

What are some symptoms of OCD?

A

Obsessional ruminations
Compulsive rituals- Some need to be repeated a certain number of times
Constant and non-reassurable worry
Thought-action fusion

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29
Q

What are obsessional ruminations?

A

Time consuming and intrusive so as to interfere with daily life.
Often out of character thoughts such as violence or sexual

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30
Q

What are compulsive rituals?

A

Time consuming and intrusive so as to interfere with daily life.
Some need to be repeated a certain number of times.

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31
Q

What is thought-action fusing?

A

Thinking something = doing it

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32
Q

What is primary OCD?

A

OCD with no underlying cause?

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33
Q

What is secondary OCD?

A

OCD with underlying cause?

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34
Q

What conditions can cause OCD?

A

Depression
Tourette’s
Basal Ganglia Dysfunction- Parkinson’s, Huntington’s and Trauma

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35
Q

What are some symptoms of mild OCD?

A 
Over-conscientiousness
Tidiness
Punctuality
Inflexibility
Perfectionist
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36
Q

What can precipitate mild OCD?

A

Stress

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37
Q

Is there a genetic link to OCD?

A

Probably yes

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38
Q

What basal ganglia dysfunction can cause secondary OCD?

A

Parkinson’s
Huntington’s
Trauma

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39
Q

How do serotonin/5-HT levels vary in OCD?

A

Low

40
Q

How do you psychologically treat OCD?

A

CBT
Thought stopping
COmpulsion prevention

41
Q

What is thought blocking?

A

Use sudden intrusion such as snapping and elastic band to interrupt thoughts

42
Q

How does compulsion prevention work?

A

Exposure to obsessional stimuli

Prevent doing compulsive behaviour

43
Q

What are some pharmacological treatments of OCD?

A

SSRI- Fluoxetine

TCA- Clomipramine

44
Q

How does SSRI dose differ in OCD from depression?

A

Much higher in OCD

45
Q

What is psychosurgery used for?

A

Occasionally for severe chronic OCD

46
Q

What are the two forms of episodic anxiety?

A

Panic disorders

Phobias

47
Q

What is a phobia?

A

Irrational fear response to specific trigger

48
Q

What are the symptoms of phobias?

A

Same as GAD but only in response to trigger

49
Q

What is the pathology of phobias?

A

Conditioning- Negative event associated with cue
Imagines threat- Ghost stories etc
Genetics

50
Q

What are some common phobias?

A

Agoraphobia
Social phobias
Simple phobias- arachnophobia

51
Q

What are simple phobias?

A

Arachnophobia etc

52
Q

WHat are simple phobias?

A

Particular object as a trigger

53
Q

What are complex phobias?

A

Phobia of a particular situation

54
Q

What are some examples of complex phobias?

A

Agoraphobia

Social phobias

55
Q

What is agoraphobia?

A

Fear of open places/being away from home

56
Q

What is a social phobia?

A

Fear of social situations

57
Q

What are panic disorders?

A

Anxiety onset with no specific trigger

58
Q

What are some symptoms of panic disorders?

A

Multiple panic attacks

59
Q

What are some symptoms of panic attacks?

A

Sudden onset
Reaches maximum on a few minutes
Think they’re about to die

60
Q

What condition does a panic attack mimic?

A

MI but no raised Troponin T and GTN does not help

61
Q

What can cause the symptoms of a panic attack?

A

Overactive sympathetic NS
Hyperventilation
Increased muscle tone

62
Q

How do you treat panic attacks?

A

Paroxetine

CBT

63
Q

What are some natural forms of anxiety?

A

Acute stress reaction
Adjustment disorder
Normal grief

64
Q

What is an acute stress reaction?

A

Response to a stressful situation that can last several days. Generally severe response but in proportion to stimuli.

65
Q

How can acute stress reactions progress?

A

Resolve in a few days or progress to adjustment disorder

66
Q

What are some symptoms of an acute stress reaction?

A

Feel dazed/numb

Inability to comprehend situation

67
Q

How do you treat an acute stress reaction?

A

Reassure them

68
Q

What is an adjustment disorder?

A

Normally follows on from acute stress reaction.

Low mood joins initial shock but not bad enough to be anxiety disorder or depression.

69
Q

How long can an adjustment disorder last for?

A

Upto 6 months

70
Q

How do you treat an adjustment disorder?

A

Supportive counselling

71
Q

What is a specific form of adjustment disorder?

A

Pathological/abnormal grief

72
Q

What is pathological grief?

A

Excessive or prolonged grief or absence of grief with denial

73
Q

What are some symptoms of pathological grief?

A 
Grief
Insomnia
Dreams of the dead person
Anger
Inability to deal with personal effects
74
Q

How do you treat pathological grief?

A

Guided mourning

75
Q

What are the three stages of normal grief?

A

Shock and disbelief
Emotions
Acceptance and resolution

76
Q

How long does normal grief last?

A

Up to a year?

77
Q

What is the general first line treatment for anxiety?

A

CBT

SSRI

78
Q

What is the generalised second line treatment for anxiety?

A

SNRI

TCA

79
Q

What are some psychological treatments for anxiety?

A 
Talking it through
Relaxation
Anxiety management/phobia training
Biofeedback
Behavioural therapies
CBT
80
Q

How does anxiety management work?

A

Give verbal/mental cues to show link with symptoms

Relaxation/distraction/reassurance to dispel anxiety

81
Q

What is an example of biofeedback and what is it use for?

A

Skin resistance

To show not relaxed

82
Q

What are behavioural therapies?

A

Change behaviour and therefore symptoms

83
Q

What is an example of behavioural therapies?

A

Graded exposure/systematic desensitization

84
Q

How does Graded exposure/systematic desensitization work?

A

Rank stimuli
Gradually expose to least threatening stimuli
Progress up ladder

85
Q

How does CBT work?

A

ID mental cues

Change way of thinking

86
Q

What are some pharmacological treatments for anxiety?

A

Reduce anxiety inducing drugs- alcohol and caffeine
Bzd
SSRI
BB

87
Q

What are SSRI and BB used for in anxiety?

A

Symptomatic treatment

88
Q

Who should not get propranolol?

A

The young

89
Q

Where do Bzd work?

A

Centrally

90
Q

Give some examples of Bzd

A

Diazepam
Alprazolam
Chlordiazepoxide

91
Q

What are some side effects of Bzd?

A

Sedation- Do NOT drive
Memory impairment
Dependence
Withdrawal syndrome

92
Q

What should you not do while on Bzd?

A

Do NOT drive!!!

93
Q

How long can Bzd dependence take to form?

A

4-6 weeks in those with dependent personality

94
Q

How should Bzd be given?

A

PRN

95
Q

What are some symptoms with Bzd withdrawal syndrome?

A 
Insomnia
Anxiety
Tremulousness
Muscle twitchings
 Perceptual distortions
Hallucinations (which may be visual)
Hypersensitivities (light, sound, touch)
Convulsions

Psychiatry (22 decks)

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