Anxiety Flashcards
List some of the features of a panic attack
i. Discrete episode of short-lived, intense anxiety
ii. Abrupt onset and rapid build up
iii. Accompanied by strong autonomic symptoms
iv. Can believe you are having a heart attack, compounding the anxiety attack
Give the three elements of generalised anxiety disorder (ICD-10)
- Apprehension
- Motor tension
a. Restless
b. Fidgeting
c. Tension-headache
d. Inability to relax - Autonomic overactivity
Describe panic disorder
Characterised by the presence of panic attacks that occur unpredictably and are not related to any particular situation (this would be phobic disorder) or danger.
Patients are relatively free of anxiety between attacks
Describe a panic attack
A short, discreet episode of extreme anxiety.
Important to define with the patient.
What is a phobic disorder ?
Anxiety provoked by specific situations or objects which are perceived to be more dangerous than they actually are and anticipatory anxiety and avoidance.
Onset is typically in childhood and it may be associated with panic attacks
Describe agoraphobia
Fear of entering crowded spaces (shops, trains, buses, elevators) where an immediate escape is difficult or in which help might not be available in the event of having a panic attack. They may perceive the area as being dangerous. Commonly begins with a panic attack and it is commonly diagnosed alongside panic disorder.
Describe what a social phobia is
How is it treated?
Fear social situations where they might be exposed to scrutiny by others that might lead to humiliation or embarrassment.
- Performance anxiety and fear or negative evaluation
This fear might be limited to an isolated fear (e.g. public speaking, eating in public, fear of vomiting, or interacting with the opposite sex) or may involve almost all social activities outside the home.
CBT is the treatment of choice
Give a general description of PTSD
What sort of symptoms would a patient have?
- Delayed and protracted response to a stressful event/ situation of an exceptionally threatening or catastrophic nature
- Disorder arises within 6 months of trauma (usually within one month)
- Results in significant distress or functional impairment
Symptoms
– Episodes of repeated reliving of the trauma in intrusive memories( flashbacks)
– Nightmares
– Numbness and emotional detachment
– Avoidance of activities or situations reminiscent of trauma
• Cause distress
– Autonomic Hyper arousal
– Hypervigilance
– Patients may experience hallucinations and illusions
what must you include in your differential for PTSD?
Epilepsy and head injury
how is PTSD managed?
CBT, EMDR (Eye movement desensitisation and reprocessing
High dose SSRI and TCAs
In OCD what does ego-dystonic refer to?
They must acknowledge their compulsions as unreasonable or excessive, with attempts to resist
what is a compulsion in OCD
recurrent intrusive thoughts, images, ruminations and impulses
Patients feel compelled to perform these acts in response to their own obsessions or a set of irrationally defined ‘rules.
The compulsions are performed to reduce anxiety by preventing the occurrence of a ‘dreaded’ event or they are ridiculously excessive
Give a run down of OCD
Compulsions - the experience of these cause distress and/or interfere with ADL.
OCD may be an primary illness or may be the clinical features of other psychiatric conditions
how is OCD managed
Often this is a combined psychological and pharmacological approach.
CBT
Clomipramine (TCA which is the drug of choice in OCD)
High dose SSRI
what are the features of adjustment disorder?
- When symptoms are considered significant enough to be out of proportion to the original stressor, or cause disturbance of social or occupational functioning, this can be described as an adjustment disorder.
Diagnostic criteria:
o Inappropriate subjective distress (not in relation to the nature of the event)
o Impaired functioning
o Behavioural symptoms need to occur within 3 months of the original stressor
