Anxiety Flashcards
What is anxiety?
Excessive worry about a widespread variety of things + heightened tension
What is yerkes-dodson law?
Arousal performance is an inverted U shaped curve, optimal performance at medium arousal/anxiety
As arousal goes between medium - high, person becomes more anxious
What questions would you ask in an anxiety history?
Rate of onset? Duration? Severity? Spontaneous? or Stimulus? Other psychotic conditions?
What symptoms may be indicative of an anxiety disorder?
Psychological:
- Irritable
- Worry
- Early startles
- Impending doom
- Poor Concentration
GI - loose stools, butterfly’s, N&V
Genitourinary - increased micturition, erection failure
Neuromuscular - headaches, tremor
Cardioresp - Palpitations, tachycardia, chest pain, hyperventilate
What differentials would you consider for anxiety disorders?
Hyperthyroidism
Cardiac disorders
Salbutamol
Theophylline
Steroids
Caffeine
Psychiatric:
- Eating disorders
- Depression
- Schizophrenia
- OCD
- PTSD
- Somatoform disorders
What are the types of phobic anxiety disorder? Briefly describe these
Specific phobia - fear of a specific object or situation
Agoraphobia - fear of public spaces that you cannot escape from
Social phobia - fear of social situations in which you may become embarrassed or criticised
What is generalised anxiety disorder?
Syndrome of ongoing uncontrollable widespread worry about events/thoughts ongoing for most days for at least 6 months.
Patient realties thoughts are excessive and worries about being worried
What are the steps of managing generalised anxiety disorder?
Step 1 - psychoeducation and active monitoring
Step 2 - self help, group psychoeducation therapy
Step 3 - CBT +/- SSRI (1. sertraline 2. venlafaxine or duloxetine 3. pregabalin)
Step 4 - Highly specialist team combining psychological and pharmacological interventions
What are the risk factors for phobic anxiety disorder?
Prior bad experience Other anxiety disorder Mood disorder Substance misuse Family history
How is phobic anxiety disorder managed?
CBT + Graded Exposure + SSRI
Psychodynamic therapy can also be used
Benzodiazepines can be used in the short term
What is panic disorder?
Recurrent episodic severe panic attacks which are unpredicatable
How may panic disorder present?
Sense of dread Nausea Shaky Feel faint Wobbly legs Chest pain Rapid HR
How is panic disorder managed?
- Self help - education, support groups
- CBT +/- Sertraline
- TCA (imipramine) if no improvement after 12 weeks SSRI
- specialist services
What is PTSD?
Post-traumatic stress disorder
Intense prolonged delayed reaction following an exceptionally traumatic event - >1 month
How may patients with PTSD present?
Re-live the event - intrusive and involuntary flashbacks or vivid memories or nightmares
Avoidance - people or location, inability to recall trauma
Hyperarousal - irritability and outbursts, difficulty concentrating/sleeping, easily startled
Emotional numbing - detach from others, give up enjoyable activities, low mood
What is acute stress disorder and how is it managed?
Reaction (like PTSD) occurring within the first 4 weeks of an acutely stressful event
Watchful waiting
How are patients with PTSD managed?
Trauma focussed CBT
EMDR - eye movement desensitization and randomisation
- Sertraline or venlafaxine
Risperidone in severe cases
Benzodiazepines for short term agitation and sleep disturbance
What are the stages of bereavement?
Denial Anger Bargaining Depression Acceptance
What is atypical grief reaction? What are the risks for this?
- Delayed onset - >2wks
- Reaction more intense
- Prolonged - up to and beyond 12 months
Risks: women, sudden/unexpected, complex relationship, poor support
What is OCD?
Recurrent obsessional thoughts or compulsive acts or both
Describe the cycle seen in OCD
Obsessive though –> Anxiety –> Compulsion –> Temporary Relief
What differentials would you consider for OCD?
Eating disorders Anankastic personality disorder - OCPD Body dysmorphia Other anxieties Hypochondriacal Schizophrenia
What are obsessions (in OCD)?
Unwanted intrusive thoughts, images or urges that repeatedly enter the individuals mind
They are recognised as absurd
What are compulsions (in OCD)?
Repetitive behaviours or mental acts that the person feels driven to perform
Overt - observable by others
Covert = mental acts eg repeating a phrase
How is OCD managed?
CBT including exposure & response prevention therapy (ERP)
+/- SSRI depending on severity
Which SSRI is used for body dysmorphic disorder?
Fluoxetine
What is insomnia? What defines it as being chronic?
Trouble falling asleep, staying asleep or waking early
Chronic: 3 nights/week for 3 months
How is insomnia managed?
Sleep hygiene
Identify cause
1 prescription only of zopiclone
Diazepam if linking to daytime anxiety
?CBT referral
