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Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

1
Q

what purpose does physiological anxiety serve?

A

prepares body for FIGHT OR FLIGHT

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2
Q

what does Yerke-Dodson curve show?

A

up to peak anxiety helps improve performance (concentration, focus attention), after peak causes decreased performed

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3
Q

how is the stress response formed in the brain?

A

Amygdala acts as the emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response (milliseconds)
this is modified by later-received cortically processed signal (i.e., act first, think later!)

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4
Q

which neurotransmitters are released in acute stress?

A

increase in catecholamines and cortisol

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5
Q

what is the role of cortisol in the acute stress response?

A

mediate (& shut down) the stress response via negative feedback on the pituitary, hypothalamus, hippocampus and amygdala – the sites of cortisol release

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6
Q

what is the physiological reactions to anxiety?

A

decreased blood flow to gut, smooth muscle contraction in the gut, increased blood flow to skeletal muscle, increased muscle tension, pupil dilation, nausea, increased HR, increased BP

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7
Q

what are the biological responses to anxiety?

A 
Sweating, hot flushes or cold chills
Trembling or shaking
Muscle tension, aches and pains
Numbness or tingling 
Feeling dizzy or lightheaded
Dry mouth
Feeling of choking
A sensation of a lump in the throat
Difficulty breathing
Palpitations
Chest pain 
Nausea
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8
Q

what are the cognitive responses to anxiety?

A 
Fear of losing control, 
Feeling on edge
Difficulty in concentrating,
Derealization
Depersonalization
Hypervigilance (internal and external)
Racing thoughts
Meta-worry
Health anxiety
Beliefs about the importance of worry
Preference for order and routine
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9
Q

what are the behavioural responses to anxiety?

A 
Avoidance of certain situations
Exaggerated response to  being startled
Difficulty in getting to sleep 
Excessive use of alcohol/drugs 
Restlessness 
Persistent irritability
Seek reassurance from family/GP
Checking behaviours
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10
Q

what are the different disorders of pathological anxiety?

A
  • Generalised Anxiety Disorder
  • Panic Disorder
  • Agoraphobia
  • Social Phobia
  • Specific Phobia
  • Obsessive Compulsive Disorder
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11
Q

what is the triple vulnerability model in GAD?

A

o Generalised biological vulnerability – genetic, neurobiological
o Generalised psychological vulnerability – diminished sense of control, parenting
o Specific psychological vulnerability – stressful life events

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12
Q

what is the pathophysiology of GAD?

A

Overactivity of ascending noradrenergic neurons – particularly the limbic system and neocortex.
Causes increased sympathetic and 5-HT activity

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13
Q

what is the DSM criteria of GAD?

A

A. Too much anxiety or worry over more than six months. This is present most of the time in regard to many activities.
B. Inability to manage these symptoms
C. At least three of the following occur
D. Symptoms result in problems with functioning.
E. Symptoms are not due to medications, drugs, other physical health problems
F. Symptoms do not fit better with another psychiatric problem such as panic disorder

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14
Q

What are the symptoms associated with part C of DSM criteria for GAD?

A
  1. Restlessness
  2. Tires easily
  3. Problems concentrating
  4. Irritability
  5. Muscle tension.
  6. Problems with sleep
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15
Q

what is the ICD criteria for GAD?

A

A. A period of at least six months with prominent tension, worry, and feelings of apprehension, about everyday events and problems.
B. At least four symptoms out of the following list of items must be present, of which at least one from items (1) to (4).
C. The disorder does not meet the criteria for panic disorder, phobic anxiety disorders, obsessive-compulsive disorder, or hypochondriacal disorder.

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16
Q

what are the Autonomic arousal symptoms associated with the ICD criteria for GAD?

A
  1. Palpitations or pounding heart, or accelerated heart rate.
  2. Sweating.
  3. Trembling or shaking.
  4. Dry mouth (not due to medication or dehydration).
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17
Q

what are the Symptoms concerning chest and abdomen associated with the ICD criteria for GAD?

A
  1. Difficulty breathing.
  2. Feeling of choking.
  3. Chest pain or discomfort.
  4. Nausea or abdominal distress (e.g. churning in the stomach).
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18
Q

what are the Symptoms concerning brain and mind associated with the ICD criteria for GAD?

A
  1. Feeling dizzy, unsteady, faint or light-headed.
  2. Feelings that objects are unreal (derealization), or that one’s self is distant or “not really here” (depersonalization).
  3. Fear of losing control, going crazy, or passing out.
  4. Fear of dying.
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19
Q

what are the general symptoms associated with the ICD criteria for GAD?

A
  1. Hot flashes or cold chills.

14. Numbness or tingling sensations.

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20
Q

what are the Symptoms of tension associated with the ICD criteria for GAD?

A
  1. Muscle tension or aches and pains.
  2. Restlessness and inability to relax.
  3. Feeling keyed up, or on edge, or of mental tension.
  4. A sensation of a lump in the throat or difficulty with swallowing.
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21
Q

what are the Other non-specific symptoms associated with the ICD criteria for GAD?

A
  1. Exaggerated response to minor surprises or being startled.
  2. Difficulty in concentrating or mind going blank, because of worrying or anxiety.
  3. Persistent irritability.
  4. Difficulty getting to sleep because of worrying.
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22
Q

what is the 1st line investigation or GAD diagnosis?

A

clinical diagnosis

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23
Q

what are the investigations to consider in GAD diagnosis?

A

TFTs, urine drug screen, 24hr urine for vanillylmandelic and metanephrines, PFTs, ECG

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24
Q

what is the 1st line management for GAD?

A

education about GAD + active monitoring

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25
Q

what is the 2nd line management for GAD?

A

low-intensity psychological interventions

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26
Q

what is the 3rd line management for GAD?

A

CBT or drug treatment

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27
Q

what is the 4th line management for GAD?

A

highly specialist input e.g. Multi agency team

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28
Q

what is the 1st line drug management for GAD?

A

SSRI

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29
Q

what is the 2nd line drug management for GAD?

A

SNRI

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30
Q

what is the 3rd line drug management for GAD?

A

tricyclic antidepressant or antipsychotic or benzodiazepine or pregabalin

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31
Q

what are the epidemiological factors of panic disorders?

A

2-3x in women

bimodal age of onset - 15-24, 45-54

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32
Q

what are the different pathophysiological models associated with panic disorder?

A 
serotonergic model
noradrenergic model
GABA model
Cholecystokinin–pentagastrin model
lactate model
false suffocation carbon dioxide hypothesis
neuroanatomical model
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33
Q

what is the serotonergic model associated with panic disorder?

A

exaggerated post-synaptic receptor response to synaptic serotonin

34
Q

what is the noradrenergic model associated with panic disorder?

A

increased adrenergic activity, with hypersensitivity of presynaptic α2 receptors

35
Q

what is the GABA model associated with panic disorder?

A

decreased inhibitory receptor with resultant excitatory effect

36
Q

what is the Cholecystokinin–pentagastrin model associated with panic disorder?

A

pentagastrin induces panic in a dose-dependent fashion in patients with panic disorder. Gene studies also implicate CCK gene polymorphisms in panic disorder

37
Q

what is the lactate model associated with panic disorder?

A

postulated aberrant metabolic activity induced by lactate

38
Q

what is the false suffocation carbon dioxide hypothesis associated with panic disorder?

A

explains panic phenomena by hypersensitive brainstem receptors.

39
Q

what is the neuroanatomical model associated with panic disorder?

A

amygdala, hippocampus, periaqueductal grey, locus coeruleus, thalamus, cingulate, and orbitofrontal areas.

40
Q

how long to panic attacks normally last?

A

10-20 mins but can last hours

41
Q

what is the DSM criteria of panic attacks?

A

Abrupt onset of 4/13 of the following:
Pounding or fast heart rate, Chest pain, Sweating, Trembling, SOB, Nausea, Dizziness, Chills, Numbness, Feelings of choking, Feeling of being detached from oneself, Fears of losing control, Fear of dying

42
Q

what is the diagnostic criteria of panic attacks?

A

o Recurrent panic attacks (2 or more, unexpected)
o Also need persistent worry and change in behaviour = avoidance
o Not effects of substance
o Aren’t better explained another disorder

43
Q

what is the management of an acute panic attack?

A

reassurance +/- benzodiazepines

44
Q

what is the 1st line management of panic disorder?

A

CBT + SSRI

45
Q

what is the 2nd line management of panic disorder?

A

CBT + benzodiazepines or TCAs

46
Q

what are the causes of phobias?

A
  • Damage in brain areas
  • Inherited
  • Frightening or Disgusting experience
47
Q

what is the pathophysiology of phobias?

A

• Amygdala, anterior cingulate cortex, and insula hyperactivity (particularly left side)
Acute, exaggerated parasympathetic nervous system activity

48
Q

what are the clinical features of phobias?

A
  • Anticipatory anxiety
  • Behavioural avoidance
  • Symptoms of anxiety and panic attacks
49
Q

what are the different types of phobias?

A

agoraphobia
social phobia
specific phobia

50
Q

what is agoraphobia?

A

A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes.

51
Q

what are the features of agoraphobia?

A

Avoidance

Some people with agoraphobia experience little anxiety because they are able to avoid their phobic situations.

52
Q

what are social phobias?

A

o A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

53
Q

what are the features of social phobias?

A

Blushing or shaking, Fear of vomiting, Urgency or fear of micturition or defaecation.
o Can result in poor school performance, school refusal, poor employment history

54
Q

what are specific phobias?

A

o A marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation

55
Q

what are the features of specific phobias?

A

o Response, akin to a panic attack

o The person recognises that the fear is excessive or unreasonable

56
Q

what are the different types of specific phobias?

A

animals, aspects of the natural environment, blood/injection/injury, situational and ‘other’

57
Q

what is the 1st line management of all phobias?

A

CBT, graded exposure, education

58
Q

what is the 2nd line management of all phobias?

A

pharmacological

59
Q

what is the pharmacological management of agoraphobia?

A

Antidepressants, BDZ (short term)

60
Q

what is the pharmacological management of specific phobias?

A

only in severe cases – BDZ and B Blockers

61
Q

what is the pharmacological management of social phobia?

A

B blockers, SSRI, SNRI and MAOIs

also RIMAs or addition BDZ

62
Q

what are the causes of OCD?

A
  • Genetic (family)
  • environment
  • experiences – PANDAs, psychological trauma
63
Q

what are the epidemiological factors of OCD?

A

men and women equal, starts late teans/early adults

64
Q

OCD is also associated with what additional psychiatric conditions?

A

depression, schizophrenia, sydenhams chorea, tourettes, anorexia

65
Q

What is the neurotransmitter pathophysiology associated with OCD?

A

Abnormalities in serotonin, dopaminergic and glutamate transmission

66
Q

what is the neuroanatomy pathophysiology associated with OCD?

A
  • hypermetabolic brain circuit involving the orbital-frontal cortex, anterior cingulate, thalamus, and striatum
  • reduction in caudate size
67
Q

OCD is a combination of?

A

obsessions and compulsions

68
Q

what are obsessions?

A

recurrent, intrusive, thoughts

69
Q

what are the features of obsessions?

A

o Result in marked distress

o Patient typically recognises these thoughts as irrational, but own thoughts

70
Q

what are some examples of obsessions?

A

fear of contamination, need for symmetry or exactness, fear of causing harm to someone, sexual obsessions, religious obsessions, fear of behaving unacceptably, and fear of making a mistake

71
Q

what are compulsions?

A

repeated rituals or stereotyped behaviours to reduce (“neutralise”) anxiety from obsessions

72
Q

what are the features of compulsions?

A

o Non-functional, non-enjoyable, impacts daily life

o Recognised as pointless

73
Q

what are common examples of compulsions?

A

checking, cleaning, washing, repeating act as mental compulsions, ordering, collecting, counting

74
Q

what are the additional symptoms that may be associated with OCD?

A

phobias, anxiety, depression, depersonalisation

75
Q

what is the ICD criteria for OCD?

A

• Obsessional symptoms or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and interference with activities
o Obsessions must be individuals own thoughts
o Resistance must be present
o Rituals are not pleasant
o Obsessional thoughts/images/impulses must be repetitive

76
Q

what is the DSM criteria for OCD?

A
  1. obsession, compulsions, or both
  2. time consuming
  3. not physiological effects of substance or medication
  4. not better explained by another disorder
77
Q

what is the management of OCD causing mild functional impairment?

A

1st line = low-intensity psychological treatments - CBT, ERP

2nd line = course of an SSRI or more intensive CBT (including ERP

78
Q

what is the management of OCD causing moderate functional impairment?

A

either a course of an SSRI or more intensive CBT

79
Q

what is the management of OCD causing severe functional impairment?

A

combined treatment with an SSRI and CBT (including ERP)

80
Q

what other medication can be used in the management of OCD?

A

Clomipramine, citalopram, venlafaxine, antipsychotics

81
Q

what physical managements can be used in the management of OCD?

A

ECT, psychosurgery, deep brain stimulation

Psychiatry (11 decks)

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