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Y5 Psych > Anxiety > Flashcards

Anxiety Flashcards

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1
Q

What are theories for anxiety?

A
  • Underactive neurotransmitter (serotonin, noradrenaline, GABA)
  • Psychological - behaviour, cognitive therapies (classical conditioning, negative reinforcement, cognitive theories)
  • Neuroatomical - hyperactivity of amygdala, leading to anxiety
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2
Q

What is generalised anxiety disorder (GAD)?

A

continuous, generalised anxiety for >6 months NOT triggered by a specific stimulus
Minimum 4 symptoms
Causes worrying about anything

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3
Q

What are differential diagnoses for GAD?

A

Organic: hyperthyroidism, substance misuse (intoxication,withdrawal), excess caffeine

Depression/mixed anxiety and depression
> anxiety symptoms are common in depression
> diagnose whichever came first

Another anxiety disorder
- panic disorder / social anxiety disorder / PTSD

Anxious/avoidant Personality Disorder

Dementia

Schizophrenia

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4
Q

What are symptoms of GAD?

A

Psychological:

  • fears/worries
  • poor concentration
  • irritability
  • unreality (depersonalisation, derealisation)
  • insomnia
  • night terrors

Motor symptoms:

  • restless, fidgety
  • unable to relax

Neuromuscular:

  • trembling, tremor
  • headache (tension headache)
  • muscle ache
  • dizziness
  • tinnitus

GI

  • dry mouth, difficulty swallowing
  • nausea
  • indigestion, stomach pains
  • butterflies in stomach
  • flatulence
  • frequent, loose stool

CV
-palpitations

Resp

  • difficulty inhaling
  • tight,constricted chest

GU

  • urinary frequency
  • erectile dysfunction
  • amenorrhoea
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5
Q

What are phobic anxiety disorders?

A

Intermittent anxiety occurring in SPECIFIC but ordinary circumstances

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6
Q

What does the seriousness of a phobia depend on?

A

On how easily the person can avoid the thing they fear

So on what kind of disability it causes

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7
Q

What is agoraphobia?

A

fear of being unable to escape to a safe place

> fear of open spaces /confined places

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8
Q

What are examples of places someone with agoraphobia will struggle with?

A

trains, planes, lifts, supermarkets, large crowds

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9
Q

What are symptoms of agoraphobia?

A

Overwhelming urge to return to safety
Prospect of leaving home generates anxiety
Presence of dependable companion helps

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10
Q

What are differentials for agoraphobia?

A

Depression (social withdrawal)
Social phobia (fear of scrutiny, humiliation)
OCD (rituals can confine people to their homes)
Schizo (confined to home, esp if paranoid)

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11
Q

What is a social phobia?

A

Social anxiety disorder

The fear of being scrutinised or criticised by others

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12
Q

What situations are hard for those with social phobia?

A

Small groups, where the focus is on them

Dinner parties, board meetings, public speaking

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13
Q

How do patients with social phobia self medicate?

A

With alcohol/drugs

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14
Q

What are differentials for social phobia?

A

Shyness
Agoraphobia (getting to safe space > social scrutiny)
Anxious PD (PPP)
ASD

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15
Q

When do specific phobias develop?

A

In childhood

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16
Q

What is panic disorder?

A

Intermittent anxiety with no obvious trigger and recurrent panic attacks for several months

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17
Q

What are patients with panic disorder like in between episodes?

A

Free of anxiety

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18
Q

How do you investigate anxiety disorder?

A

history and physical exam
Anxiety Rating scale
Social and occupational assessment for QoL assessment
COllateral hx

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19
Q

What are examples of anxiety rating scales?

A

GAD7 questionnaire

Beck anxiety inventory

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20
Q

What is the benefit of using anxiety rating scales?

A

They provide a baseline score for measuring treatment response

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21
Q

How do you manage anxiety disorders without medication?

A

Mild - advice and reassurance
Basic counselling
Problem-solving (to help deal with stressors)
Relaxation techniques, breathing exercises
CBT - provided by IAPT

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22
Q

What kind of therapy is good for phobias?

A

Exposure therapy

  • gradual exposure to threat > desensitisation
  • Habituation
  • Extinction
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23
Q

What is pharm management for anxiety disorders?

A

Antidepressants:

  • SSRI - therapeutic dose for anxiety higher than for depression and response takes longer (6-8 weeks)
  • SNRI
  • TCA

Anxiolytics:

  • Buspirone (increases action of SSRI)
  • Pregabalin
  • Benzodiazepines

Beta-blockers (for adrenergic sx)

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24
Q

What is the MOA of Buspirone?

A

Serotonin Partial Agonist

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25
Q

What do you need to keep in mind when prescribing Benzos?

A

Tolerance builds quickly, dependence is an issue

Give for SHORT TERM anxiety treatment only

26
Q

How long can you prescribe Benzos for?

A

2-4 weeks MAX

27
Q

What are Side Effects of Benzos?

A

amnesia
ataxia
resp depression

28
Q

What is the prognosis in anxiety disorders?

A

Rule of 3s
1/3 recover
1/3 improve partially
1/3 do poorly > have considerable disability

29
Q

How do you diagnose OCD?

A

Either obsessions or compulsions (or both), present on most days for a period of at least two weeks.

30
Q

What is an obsession?

A

Recurrent unwanted obtrusive thought/images/impulses that enter the pt’s mind despite attempts to resist them

31
Q

How are obsessions different to delusions?

A

Patient is aware obsession is untrue/irrational and their own (not a thought insertion)

32
Q

What is a compulsion?

A

repeated and stereotyped rituals that the patient feels compelled to carry out, even though it is irrational and may not be associated to the obsession

33
Q

What are ddx for OCD?

A

Organic causes (Tourette’s, Sydenam’s, Huntington’s)

Anxiety disorders
Depression (50% of OCD patients have depressive sx - depression takes priority)
Anakastic personality disorder
Autism - repetitive behaviour, need for routine
Schizophrenia

34
Q

How do you manage OCD?

A

Education and self help, mindfulness (notice thoughts, r rather than avoid them)

CBT - Exposure and response prevention

Medication - SSRI, clomipramine (TCA). second gen antipsychotic if resistant

So:
1. CBT with ERP
2nd line: add SSRI
3rd line (after 12 weeks): clopiramine or alternative SSRI

35
Q

What are symptoms of an acute stress reaction?

A

Transience (starts in mins, resolves in hours)
Dazed/detached
Amnesia
Depersonalisation, derealisation
Disorientation, agitation, irritability, panic, aggression

36
Q

How do you manage Acute Stress Reaction?

A

Exclude injury
Support and Reassurance
Benzos (short term)

37
Q

What does PTSD occur following?

A

Follows exposure to a stressful situation of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.

38
Q

What is the latency period of PTSD?

A

Usually within 6months of trauma

39
Q

What is clinical presentation of PTSD?

A

RE-EXPERIENCING

  • Flashback s
  • Nightmares
  • Intrusive memory

AVOIDANCE

  • avoids reminders (e.g. specific setting) of event
  • avoids thinking about it

HYPERAROUSAL

  • persistent inability to relax
  • hypervigilance
  • enhanced startle reflex
  • insomnia
  • poor concentration
  • rritability

EMOTIONAL CHANGES

  • Emotional detachment
  • Powerful emotions e.g. anger, loss of control, shame, crying
  • Decreased interest in activities
40
Q

Ddx for PTSD

A

Anxiety disorders
Depression
Adjustment

41
Q

Mx for PTSD

A

Trauma-Focused CBT
Eye movement desensitisation and processing (EMDR)

Group therapy
SSRI(paroxetine)/Venlaxafine

42
Q

What is adjustment disorder?

A

Person’s reaction to life changes that require adaptations to cope is greater than usually expected

Symptoms start within 1 month of stressor, resolve within 6m

43
Q

What are risk factors for generalised anxiety disorder?

A

Physical or emotional trauma
Low socioeconomic status
Substance abuse
Chronic painful illness

44
Q

What is the management for GAD?

A
  1. Social:
    - relaxation training,
    - meditation training,
    - sleep hygien
    - exercise
  2. Psych: CBT for 4-12 weeks
  3. Medication: Sertraline (2nd line: other SSRI or SNRI, 3rd line: Pregabalin)
  4. Specialist assessment
45
Q

What are drugs given for GAD management=

A

SSRI
SNRI
Pregabalin

46
Q

When is Benzo given in anxiety

A

As a LAST RESORT for <4 weeks

or AS A ONE OFF

47
Q

What are criteria for agoraphobia diagnosis?

A

Minimum 2 of fear in the following:

  • crowds
  • public places
  • travelling away from home
  • travelling alone
48
Q

What are signs/symptoms of agoraphobia?

A

House bound
Panic attacks when outdoors / confined places
Dependency on other

49
Q

What are signs/symptoms of social phobia?

A 
Social withdrawal 
Blushing
Tremor 
Panic attack 
Alcohol abuse
50
Q

What is a specific phobia?

A

Out of proportion fear to the demands of a situation, due to specific trigger

Cannot be reasoned away as it is involuntary (stems from the deep brain aka amygdala)

51
Q

How do specific phobias present?

A

Avoidance
Fear
Disability

52
Q

How does a panic attack present?

A 
Breathing difficulty, choking feeling 
Fear of suffocating/dying 
Hyperventilation > dizziness, parasthesia 
Palpitations
Depersonalisation / derealisation 
Lasts <30 mins, self resolving
53
Q

What differentials do you rule out for panic disorder?

A

Other anxiety disorders (GAD; agoraphobia)
Depression
Alcohol or drug withdrawal
Organic causes (CV, respiratory, phaeo)

54
Q

What is the difference in panic attack presentations in panic disorder vs other anxiety disorders?

A

in panic disorders, they have no obvious trigger

In other disorder (e.g. GAD), they occur with trigger and mark severity of the condition

55
Q

Give examples of obsession categories that could occur in OCD

A

Contamination e.g. something getting dirty
Infection e.g. getting HIV
Aggression e.g. thought of harming others
Morality (sex/religion) e.g. sacrilege - shout blasphemous things in a church
e.g. thinking they might be a pedophile

56
Q

What are examples of compulsion categories in OCD?

A

Cleaning
Counting
Checking
Ordering objects

57
Q

What is the triad of symptoms that occurs in PTSD?

A

Re-experiencing
Avoidance
Hyperaro\usal

58
Q

What time frame do symptoms have to occur in to be qualified as PTSD

A

> 4 weeks from event

Usually present within first 6 months

59
Q

Explain how CBT works for anziety disorders

A

Aims to reduce patients expectations to threat and the behaviours that maintain threat-related beliefs

Structure:

  • explore likelihood and impact of anticipated catastrophe
  • Test feared situation using behavioutal experiment
  • This increases the patient’s confidence in their capacity to cope with the feared situatio
60
Q

Explain how exposure therapy works for anxiety

A

Expose person to perceived threat

Exposure is achieved gradually, via desensitisation

In the absence of actual harm, body can only remain anxious for 45minds before habituation occurs and aniety drops
Anxiety decreases until extinction

61
Q

How does EMDR work

A

Eye movement desensitisation and reprocessing

Experience orignal trauma in as much detail as possible (ask patient to narrate)
while they do this, they fix eye on therapists finger as it quickly passess from side to side
eye movements. can be replaced by alternating left right stimulus
this aids memory processing

Y5 Psych (17 decks)

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