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PSYCHIATRY > Anxiety > Flashcards

Anxiety Flashcards

1
Q

S+S:

Mood and thought

What is depersonalisation?

What is derealisation?

A 
Tension
Agitation
Fear of loss of control 
Dread
Irritability 
Lack of concentration

Periods of feeling disconnected or detached from one’s body and thoughts

An alteration in the perception or experience of the external world so that it seems unreal.

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2
Q

S+S - Physical symptoms:

What is somatization?

GI symptoms? - 4

What is Globus Pharyngeus?

A

The physical (or body) expression of stress and emotions through the mind-body connection.

Bowel and bladder changes
Butterflies in stomach
Nausea
Lack of appetite

Feeling like there is a lump in their throat when in fact there is nothing there.

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3
Q

S+S - Panic attacks:

Physical signs? - 4

What is angor animi?

How long does it last?

Hyperventilation:

  • You get tetany with it. What is it?
  • What else do you get? - 3
  • What type of metabolic disturbance can happen very acutely>
A

Palpitations
Sweating
Trembling
Hyperventilation

The fear of dying - common in panic attacks

Involuntary contraction of muscles, which may be caused by disorders that increase the action potential frequency of muscle cells or the nerves that innervate them.

Tingling
Paraesthesia
Chest pain

Respiratory alkalosis

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4
Q

Risk Factors:

What sex is at a higher risk for most anxiety disorders except OCD and social anxiety disorder?

What’s the age of onset for most anxiety disorders?

What’s the age of onset for GAD?

What screening tool can be used to evaluate the severity of the anxiety?

A

FH

Females

Teens and 20s but may be untreated for yrs

40s and 50s

GAD7 Anxiety Screening Tool

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5
Q

Generalised Anxiety Disorder (GAD):

2 keywords to define

GAD is not situational. What does this mean?

How long must it last for?

It is the most common anxiety disorder. Which sex is it more common in?

A

Generalised
Persistent

Not triggered by anything specific like a phobia

6 months

Females

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6
Q

Generalised Anxiety Disorder (GAD) - Management:

Psychological:

  • First-line - 1
  • Low-intensity - 2
  • High intensity - 2 - who is this offered to? - 2
A

Psychoeducation for patients and families

6 weeks of self-help CBT or group psychoeducation

12 wks of weekly CBT or applied relaxation
Those with marked functional impairment or failure to improve on lower steps - drug Rx can also be alternative

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7
Q

Generalised Anxiety Disorder (GAD) - Management:

Biological - an alternative for those who need high-intensity psychological intervention:

  • First-line
  • Second-line
  • Third-line - also used to treat nerve pain - P

How long will the drugs take to begin working?

What may happen before they start working?

What warnings should be given to the patient?

A

SSRI

Alternative SSRI or SNRI

Pregabalin

1 wk

Increased anxiety or agitation

Suicide risk
Warn against sudden cessation due to withdrawal effects

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8
Q

Generalised Anxiety Disorder (GAD) - Management:

Social interventions:

A

Peer support groups

Support with returning to work or training if needed

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9
Q

Panic disorder - S+S:

Define

How many attacks typically happen in a month?

How may people with panic attacks interpret their symptoms?

What may panic disorder lead to that starts with A?

A

Episodic and recurrent panic attacks which are not situational

Several

A physical health problem

Agoraphobia - now situational fear - they don’t fear being with people unlike a social phobia

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10
Q

Agoraphobia:

What is it?

What percentage of those with the panic disorder does it present in?

A

Fear of public places and fear that they will find it hard to escape from such places and/or have a panic attack.

50%

Rx IS THE SAME FOR BOTH

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11
Q

Panic disorder and agoraphobia - Management:

What type of Rx is done in primary care?

When is a secondary referral needed?

A

Psychological and biological

Failed at least 2 Rx

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12
Q

Panic disorder and agoraphobia - Management:

Psychological:

First-line

Second-line

Third-line

What specifically can be done for agoraphobia?

A

Psychoeducation for patient and family - including those presenting at A&E - CAN JUST BE SOME INFORMATION TO TAKE AWAY WITH THEM

CBT - Self-help or computerised

Individual CBT - 7-14 weekly sessions

Graded exposure therapy

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13
Q

Panic disorder and agoraphobia - Management:

Biological:

First-line

Second-line

How long should the drugs be used for if found to be effective with manageable side effects?

When are benzo’s needed?

A

SSRI - allow 12 wks for effect to be seen - counsel as always about side effects

TCA (imipramine or clomipramine)

6 months

Emergencies - A&E

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14
Q

Panic disorder and agoraphobia - Management:

Social Rx - 1

A

Peer support groups

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15
Q

Social anxiety disorder (social phobia):

What is it?

What sort of sign could you see? - eye

Psychological symptoms - 2

How may this present with children?

A

Fear and avoidance of meeting people and daily activities such as speaking by telephone, going to the shops, eating and drinking in company.

Poor eye contact

Low self-esteem and fear of criticism

Selective mutism

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16
Q

Social anxiety disorder (social phobia) - Management:

Psychological therapy before meds. CBT is done first. What is involved in the individual CBT?

Clark and Wells Modelis used for adults in CBT. What is it?

What type of CBT is useful in young people?

What is an alternative to individual CBT?

A

Individual CBT - involves psychoeducation and graded exposure either during sessions or as homework.

Video feedback to correct negative self-imagery, and shifting from self-focused to externally-focused attention.

Group CBT - useful in children and young people

Self-help CBT
Psychodynamic therapy

17
Q

Social anxiety disorder (social phobia) - Management:

Biological:

  • First-line
  • Second-line
  • Third-line

In who should drugs be avoided in?

A

SSRI - sertraline

A different SSRI or venlafaxine (SNRI)

MAOIs - moclobemide

Children and young people

18
Q

Social anxiety disorder (social phobia) - Management:

Social - what difficult social situations which may be contributing to the condition, should be addressed?

SPIN is used for initial assessment and to monitor Rx response. What does it stand for?

How should appointments be planned?

What should be done if you find the person is also depressed?

A

Bullying in school
Family problems

Social Phobia Inventory

Offer clinic at less busy times
Private waiting areas if possible
Home-based appointments and Rx

Treat that first

19
Q

Simple or specific phobia:

What is it?

What does the person do to compensate?

Management:

What is done in CBT?

A

Anxiety which is situational (specific to objects or situations)

Anticipatory avoidance and anxiety - panic attacks may occur

Graded exposure therapy and anxiety management

20
Q

OCD:

What does it stand for?

What type of thoughts do they have?

What does it mean by compulsive acts?

What may co-exist with it? - 3

A

Obsessive compulsive disorder

Obsessional thoughts (e.g. around contamination, security)

Repetitive behaviours which provide temporary relief but don’t give pleasure

Depression, substance misuse or eating disorders

21
Q

OCD - Management:

Psychological:

In their CBT, they undergo ERP. What does it stand for and mean?

Low-intensity CBT is 1st line for mild disease:
- What type is used? - 2

What is alternative to SSRI’s as the 1st line in moderate disease?

What combo can be done for severe disease?

A

Exposure and response prevention

Subjects confront the stimuli for their obsessions and are encouraged to resist acting out their compulsions (e.g. touching something ‘dirty’ and not washing their hands).

Self-help CBT
Group CBT

High-intensity individual CBT

Combo of CBT and SSRIs

22
Q

OCD - Management:

Biological:

First-line?

When should meds only be used in children?

When should the dose be increased if there is no response?

How long should it be continued for if there is a response?

A

SSRIs - fluoxetine, paroxetine, sertraline

Only if Rx fails, and monitor carefully due to the risk of suicidality.

4-6 wks

23
Q

OCD - Management:

Biological:

  • Second line
  • Third line

What can be used for suicidal or severely incapacitated patients?

A

Switch to another SSRI or clomipramine (TCA) but try adding CBT to SSRI

Antipsychotic

ECT

24
Q

OCD - Management:

Social:

Who might need support in adult patients?

What support is needed for employment?

MDT approach - What does an OT and social worker do?

A

Children especially if it is affecting the patient’s ability to care for them.

Support regarding return to work and benefits if employment is affected

OT can help return to normal activities
Social workers - advice on childcare and benefits

25
Q

PTSD:

What does it stand for?

What is it?

When does it present?

Risk factors

A

Post-traumatic stress disorder

Psychological distress following an extreme traumatic event, often involving a threat to life or physical integrity.
(e.g. assault, trauma, rape - can also be after childbirth)

6 months after the event

Females
Refugees
First responders

26
Q

PTSD:

Key features mneumonic HARD:

Other features - what might they do to certain aspects of the event?

What does PTSD lead to?

Co-morbid conditions?

A

Hyperarousal/hypervigilance - autonomic arousal leading to:

  • poor sleep
  • irritability
  • angry outbursts
  • extreme startle response
  • poor concentration

Avoidance of reminders of events - certain people or places

Re-living - flashbacks, dreams or vivid memories of events, accompanied by distress

They forget or blank out them

Functional and/or social impairment

Substance abuse, depression, anxiety

27
Q

PTSD - Management:

Trauma-focused CBT - what does this include?

****Eye movement desensitisation and reprocessing (EMDR) is used. What is it?

A

Psychoeducation
Anxiety and anger management
Breathing techniques
Exposure to triggers in a controlled environment (ERP_
—————————–
During EMDR therapy sessions, you relive traumatic or triggering experiences in brief doses while the therapist directs your eye movements.

EMDR is thought to be effective because recalling distressing events is often less emotionally upsetting when your attention is diverted. This allows you to be exposed to the memories or thoughts without having a strong psychological response.

28
Q

PTSD - Management:

If preferred, meds can be used instead.

What meds can be used if mild?

What meds can be used if severe?

When should BZDs be used?

A

SSRI (sertraline) or SNRI (venlafaxine)

Antipsychotics (risperidone)

ONLY IN EMERGENCIES

29
Q

Acute Stress Disorder:

What is it?

Onset?

Symptoms?

Management - 2

A

PTSD-like symptoms within 1 month following extreme stress (e.g. car accident, assault) with onset typically in minutes to days.

Dissociation and PTSD symptoms (hypervigilance, avoidance, intrusive thoughts, low mood)

Trauma-focused CBT or active monitoring

30
Q

Adjustment disorder:

Why is it different from PTSD and acute stress disorder?

A

They have impaired functioning without meeting the full diagnostic criteria for those or other mental disorders.

31
Q

Benzodiazepines - Anxiolytics:

Lorazepam has a rapid-onset and is short-acting. What else can it do if given IV?

An example which begins with O

Diazepam - what is the difference between this and lorazepam? - what else can it do if given IV/PR?

A

Lorazepam - anticonvulsants

(Oxazepam) has a rapid-onset and is short-acting

Diazepam - Anticonvulsants

32
Q

Benzodiazepines - Sedatives:

Nitrazepam - onset? how long does it last?

Temazepam - onset? how long does it last?

A

Rapid onset - long-acting

Slow onset - short-acting

33
Q

Benzodiazepines - Others:

Midazolam is rapid-onset and short-acting sedative.

  • When is it used? - 3
  • By what route is it an anticonvulsant? - 2

Chlordiazepoxide - what type of withdrawal is it used in?

A

Procedures
ICU
Palliative care

Alcohol withdrawal

34
Q

Benzodiazepines:

Side effects - 2

What situations are they used for?

A

Tolerance and dependency
Drowsiness and weakness

Severe, disabling anxiety or insomnia

PSYCHIATRY (20 decks)

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