anxiety clinical Flashcards
what are the 5 types of anxiety disorders
GAD
OCD
PTSD
panic disorder
phobic anxiety disorders
what is the epidemiology of anxiety
0.9-28%
what are the general clinical features of anxiety
anticipation
irritability
palpitations
breathlessness
worrying
dry mouth
heavy chest
tremor
insomnia
what are the treatments that can be used in anxiety
SSRI - 1st line for everything
benzos
pregabalin
TCAs - clomipramine
venlafaxine/duloxetine
which medications are used in anxiety that are off license
busipurone - long titration
mirtazapine
beta blockers
antihistamines
what are the non-pharmacological treatment options for anxiety
counselling
CBT
self-help
lifestyle
relaxation techniques
how are SSRIs used in anxiety
1st line for all disorders
12 weeks to response
increased suicidal thoughts risk in those under 30
what is GAD
anxiety lasting for more than 6m, worry out of proportion to risk
what are the symptoms of GAD
all general anxiety symptoms plus
- sweating
- trembling
- dry mouth
- fear of losing control
- poor concentration
- thinking the worst
O/E
- strained face
- close to tears
- restless
how is GAD diagnosed
DSM IV - 2x major symptoms on most days
- excessive worry
- not able to control worrying
3/6 of additional symptoms
- on edge/restless
- easily fatigues
- difficulty concentrating
- irritable
- muscle tension
what are the differential diagnosis for GAD
schizophrenia
depression
substance abuse
physical illness - thyrotoxicosis, hypoglycaemia
dementia
what are the steps in the GAD stepped care model
- assessment - monitor
- low intensity psychological interventions
- high intensity psychological interventions +/ meds
- specialist referral
what is the pharmacological treatment for GAD
- SSRI - fluox+sert - unlicensed but NICE, start at half doses and increase (12m)
- venlafaxine - 8 weeks response
- pregabalin
what short term adjuncts can be used in GAD
benzos
busipirone
beta blockers
pregabalin
venlfaxine/mirtazapine
antihistamines
antipsychotics
what is OCD
repeated, intrusive, obsessive thoughts, impulses or acts - that cause anxiety when restricted
OCD epidemiology
2-3%, most common in adolescents and early adulthood
what is the pharmacological treatment of OCD
- SSRI or clomipramine
- only central serotonin enhancers are effective - fluox, sert and clomipramine
- high doses
- max dose tolerated for 3m to assess, treatment 1-2 years to prevent relapse
what is social anxiety
excessive anxiety evoked by a specific object or situation - high in alcohol dependency
how is social anxiety treated
- SSRI/venlafaxine - at least 12 weeks
what are the symptoms of panic disorder
SOB, palpitations, chest discomfort, sweating, nausea, trembling
how is panic disorder treated
self-help/CBT
mod-severe
1. SSRI - (es)citalopram, sertraline or paroxetine
2. clomipramine or imipramine if no SSRI response after 12 weeks
anxiety pathophysiology
abnormal regulation of fear response
amygdala activated by fer - more activity in amygdala
