Anxiety Flashcards
What conditions are seen as pathological anxiety in terms of extent and context?
Panic
Phobias
OCD
GAD - Generalised Anxiety Disorder
What are the general symptoms of anxiety?
Sweating Cold Chills Trembling Muscle tension Dizzy Dry mouth Choking Lump in throat Palpitations Nausea
What are the cognitive symptoms of anxiety?
Fear of loosing control On edge Concentrating difficulties Hypervigilance Racing thoughts
What are the behavioural symptoms of anxiety?
Avoidance Exaggerated responce Restles Irritability Difficulty in getting to sleep Seeking reassurance
What hormones are involved in the stress response?
Catecholamines
Cortisol
Epidemiology of GAD
20-40 yrs
1 in 10
2:1
F:M
What is GAD?
Generalised and specific anxiety but not specific to a particular environment.
What needs to be investigated in order to diagnose GAD?
Hyperthyroidism and Substance abuse need to be ruled out.
In order to have a GAD diagnosis what must the patient present with?
Long lasting over 6 moths
Not controllable
Impaired function
What particular symptoms is GAD associated with?
Restlessness
Fatigued
Concentrating failure
Sleeplessness
What is first line treatment for GAD?
CBT
How long is a person required to undergo CBT in order to assess efficacy?
Up to 12 weeks
Less than 4 weeks a response is unlikely
What medication can be used in the treatment of GAD?
SSRIs SRNIs
Pregablin
BDZ ( acute short term if very distressed)
Epidemiology of Panic Disorders
Adolescence to middle 30’s
What are Panic Disorders?
Recurrent and unpredictable attacks of sever anxiety
What are some of the symptoms of Panic disorders?
Severe breathlessness
Dying
Depersonalisation
Dizziness
Once they have overcome this episode of Panic how do people with panic disorders usually feel?
Normal
What other causes of these symptoms need to be excluded before a diagnosis of Panic disorder is given?
Hyperthyroidism
Caffeine
Intoxication
Depression
What are some known triggers of a Anxiety attack?
Lactate infusion
Rebreathing CO2
What medications can be used in the treatment of Panic disorders?
CBT
SRRI SRNI
Tricyclics
How long does the course of treatment for Panic disorders last?
6 months
What is a phobia?
A predictable onset of sever anxiety
Fear is recognised and often irrational
Avoidance and anticipatory anxiety are common
What is Agoraphobia?
Fear of open spaces, crowds or being outside of ones home.
How do Agoraphobes appear?
Due to high prevalence of avoidance they aren’t overly anxious.
What are some signs someone maybe a Agoraphobe?
Others do their shopping for them
Drink alcohol before venturing out
Go shopping at night
Internet shopping
What is a Specific phobia?
Marked or persistent fear that is excessive and caused by something specific.
How does someone with a specific phobia present?
Immediate onset upon stimulation
Insight that response is unreasonable
Normal function is often impaired by phobia
What is the treatment for phobias?
Exposure behaviour therapy +/- CBT
SSRIs SRNIs
What is a Social Anxiety disorder?
Persistent fear of social performance
fear of intimate relations i.e. small group sessions
What can proceed a Social Anxiety Disorder?
An embarrassing and humiliating experience
Why do Social Anxiety Disorders have such an impact the QOL of a patient?
Poor social, school and poor employment
React to novelty experience by avoidance
What is a Social Anxiety disorder?
Persistent fear of social performance
fear of intimate relations i.e. small group sessions
What can proceed a Social Anxiety Disorder?
An embarrassing and humiliating experience
Why do Social Anxiety Disorders have such an impact the QOL of a patient?
Poor social, school and poor employment
React to novelty experience by avoidance
What is OCD?
Recurrent obsessional thoughts and or compulsive acts
What are obsessional thoughts?
Ideas, images or impulses entering into the mind in a stereotyped way
Recognised as own by patients
Unpleasant and resisted
What are compulsive acts?
Repeated rituals or behaviours.
Not enjoyable
Not functional
Recognised as pointless
What must the patient have in order to have a diagnosis of OCD?
Present most days for at least two weeks
+ source of distress
What are some common obsessions?
Contaminated with dirt germs viruses etc
Fear of harm
Excessive concern with order and symmetry
What are some common compulsions?
Checking Cleaning Repeating acts Hoarding Mental compulsion e.g. special words phrases repeated
Epidemiology of OCD
No gender bias
Onset at any age but mean is 20 years
What are some co-morbid diseases commonly found with OCD?
Schizophrenia
Tourettes
ED
Body dysmorphia
What is first line treatment for OCD?
Low intensity psychological help - CBT - individual or group.
What is second line for OCD treatment?
Intensive CBT or SSRI
Fluoxetine
What is third line treatment for OCD?
SSRI + CBT
What is 4th line for treatment of OCD?
Clomipramine - TCA
PTSD - mild and 4 weeks post event - Treatment.
Watching and waiting
PTSD - Within three months of event - Treatment
CBT (brief)
Hypnotic medication for sleep
PTSD - Severe or more than three months post event- Treatment
Trauma focused CBT or EMDR
What drugs have limited evidence but can be use for the treatment of PTSD?
Paroxetine and Amitriptyline
What is first line for social anxiety?
Individual CBT
What is second line for social anxiety?
SSRI review at 12 weeks
What SSRI is used in social anxiety?
Setraline
What is third line for social anxiety?
SSRI + CBT
What is an alternative SSRI which can be used for social anxiety?
Fluvoxamines
What SRNI can be used for social anxiety?
Venlafaxine
What is 4th line for social anxiety?
Alternative SSRI or SRNI
What is 5th line for Social anxiety?
MAOI - Moclobemide
What is first line for Panic Disorder?
Self help
What is second line for Panic Disorder?
CBT or SSRI
What is third line for Panic disorder?
Tricyclics (Clomipramine)
How long should treatment for panic disorder last?
6 months
What treatments should be avoided in Panic disorder ?
Propanolol
BDZ
Sedatory 5-HT
