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Mental health > Anxiety and phobic disorders > Flashcards

Anxiety and phobic disorders Flashcards

1
Q

Name five autonomic symptoms of anxiety?

A
  • Headaches
  • Chest tightness; dyspnoea
  • Tachycardia; palpitations
  • Perspiration
  • Dizziness
  • Insomnia; restlessness
  • Loss of appetite; abdominal pain
  • Muscle ache
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2
Q

Describe the Yerkes-Dodson law

A
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3
Q

Request four investigations to exclude organic causes of anxiety

A
  • FBC
  • CRP/ESR
  • Metabolic profile
  • EEG
  • Thyroid function tests
  • Urinalysis; CXR: exclude delirium sources
  • Urine drug screen
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4
Q

How can the common neuroses (mental illness associated with stress without psychosis) be categorised?

A
  • Anxiety and phobic disorders
  • Stress-related disorders
  • OCD
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5
Q

List five types of anxiety/phobic disorders

A
  • Panic disorder
  • Agoraphobia
  • Generalised anxiety disorder
  • Specific phobias
  • Social phobia
  • Hypochondriasis
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6
Q

List three cognitive symptoms of anxiety disorders?

A
  • Fear of dying
  • Fear of losing control
  • Catastrophising
  • Anticipatory anxiety
  • Presence of obsessive thoughts
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7
Q

What differentiates social phobia, generalised anxiety, and agoraphobia?

A
  • Social phobia: anxiety amongst crowds/groups of people
  • Agoraphobia: anxiety amongst places and situations
    • Can occur in the absence of people
  • GAD: persistent anxiety not restricted to a particular place
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8
Q

What co-morbidities occur frequently alongside neuroses (stress-related mental illness without psychosis)?

A
  • Other neuroses
  • Depression
  • Substance misuse
  • Personality disorder
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9
Q

Describe the concept of specific phobias

A
  • Recurring, excessive, and unreasonable
  • Psychological or autonomic symptoms of anxiety
  • In the presence of a specific object or situation
  • Leading to avoidance
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10
Q

Name three common types of specific phobia?

A
  • Animals
  • Storms
  • Heights
  • Illness; Injury
  • Death
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11
Q

Describe the concept of social anxiety disorder

A
  • Symptoms of incapacitating anxiety
  • Restricted to particular social situations
  • Strong desire for avoidance
  • Associated with fear of criticism; low self esteem
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12
Q

What management options are available for specific phobia and social anxiety disorder?

A
  • Psychotherapy
    • Social anxiety: CBT (Clark and Wells model)
    • Specific phobia:
      • Systemic desensitisation
      • Exposure therapy
      • Flooding
  • SSRI or SNRI
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13
Q

Outline the DSM-5 criteria for generalised anxiety disorder

A
  • At least 6-months of:
    • Excessive, uncontrollable worry about everyday issues
    • Disproportionate to inherent risk
    • Causes distress or impairment
  • Worry not confined to other mental disorders; substance abuse; or organic conditions
  • 3+ of the following symptoms most of the time:
    • Restlessness; nervousness
    • Easily fatigued
    • Poor concentration
    • Irritibility
    • Muscle tension
    • Sleep disturbance
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14
Q

Outline the management options for generalised anxiety disorder

A

Stepped-care model

  1. Education; active monitoring
  2. Self-help; psychoeducational groups
  3. CBT or applied relaxation; SSRI or SNRI
  4. Specialist input; crisis services; inpatient care
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15
Q

Outline the DSM-5 diagnostic criteria for agoraphobia

A
  • Marked disproportionate fear when confronted with 2+:
    • Open spaces; public transport; crowded areas
  • Immediate anxiety response on exposure to phobic stimulus
  • Recognition of fear as disproportionate
  • Avoidance behaviours; distress or anticipatory anxiety
    • Significantly disrupts quality of life
  • Symptoms for 6+ months
  • Not due to other mental/organic disorder; substance abuse
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16
Q

How can the severity of anxiety in Agoraphobia be assessed?

A

Presence of physiological symptoms of anxiety:

  • Dry mouth
  • Shaking, sweating
  • Light-headedness
  • Nausea
  • Dyspnoea; chest pain; muscle tension
17
Q

What management options exist for agoraphobia?

A
  • Psychoeducation
  • Psychotherapy:
    • Exposure techniques
    • Relaxation training CBT (Graded exposure)
  • Medication:
    • Antidepressants: SSRIs 1st line for 12-18 months
    • Short term anxiolytics such as diazepam
18
Q

What is a panic attack?

A

Period of intense fear, in absence of threat or cause:

  • 4+ symptoms:
    • Dyspnoea
    • Palpitations
    • Shakiness
    • Nausea
    • Hot or cold fulshes
    • Dizziness
    • Fear of dying
  • Rapid onset with 20-30min duration
19
Q

Outline the emergency treatment of an acute panic attack

A
  • Maintain a reassuring and calm attitude
  • If symptoms are severe and distressing: consider BDZs
  • Exclude organic causes if first presentation
  • Recurrent: consider panic disorder and manage accordingly
20
Q

What is panic disorder?

A
  • Recurrent panic attacks
    • Not secondary to any particular situation
    • Therefore unpredictable
  • Secondary fears of dying result in presentation to A+E
21
Q

Name two common comorbidities of panic disorder

A
  • GAD
  • Agoraphobia (30-50%)
  • Depressive disorder
  • Other anxiety disorders
  • Substance misuse
22
Q

Outline the long-term management of panic disorder

A

Stepwise treatment:

  1. Education; active monitoring
  2. Individual self-help; support groups
  3. CBT; SSRI or TCA
  4. Referral to specialist mental health services
  5. Specialist management
23
Q

Give three poor prognostic factors for panic disorder

A
  • Very severe initial symptoms
  • Marked agoraphobia
  • Low socioeconomic status
  • Long duration of symptoms
  • Restricted social networks
  • Personality disorder

Mental health (27 decks)

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