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PHA333 > anxiety disorder > Flashcards

anxiety disorder Flashcards

1
Q

What is anxiety?

A

normal response to threat or danger and part of the usual human experiance

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2
Q

When is anxiety a mental health problem?

A

if the response is exaggerated, lasts more than 3 weeks and interferes with daily life

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3
Q

characteristics of anxiety

A 
worry
aggitation
rapid breathing
fast heartbeat
hot/cold sweats
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4
Q

4 types of anxiety symptoms

A

somatic
emotional
cognitive
behavioral

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5
Q

somatic symptoms of anxiety

A 
goosebumps
muscle tense
inc HR
respiration inc
liver releases carbs
bronchioles widen
pupils dilate
perspiraton inc
AD secreted
stomach acid is inhibited
salivation dec
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6
Q

emotional symptoms of anxiety

A

sense of dread
terror
restlessness
irritability

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7
Q

congitive symptoms of anxiety

A 
anticipation of harm
exaggerating of danger
porblems in concentrating
hypervigilance
worried thinking
fear of losing control
fear of dying
sense of unreality
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8
Q

behavioral symptoms of anxiety

A 
escape
avoidance
aggression
freezing
dec appetite
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9
Q

GAD

A

generalised anxiety disorder

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10
Q

What is GAD (generalised anxiety disorder)?

A

characterised by excessive and inappropriate worrying that is persistent and not restricted to particular circumstances

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11
Q

What can GAD be comorbid with?

A

major depression
panic disorder
phobic anxiety disorder
OCD

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12
Q

What is panic disorder?

A

recurrent unexpected surges of severe anxiety (painc attack) with varying degrees of anticipatory anxiety between attacks

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12
Q

panic attack

A

discrete periods of intense fear or discomfort with at least 4 physical/psychological anxiety symptoms

reach peak within 10mins and last around 30-45mins

develop fear of having another panic attack

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13
Q

What is agoraphobia?

A

fear in places/situations from which escape might be difficult or which might not be available in the event of hving a panic attack

crowd, outside home, using public transport -> avoided or endured with distress

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14
Q

social phobia - social anxiety disorder

A

marked persistent and unreasonable fear of being abserved/evaluated negatively by other people in social/performance situations associated with physical/psychological anxiety symptoms

-> situations are either avoided/endured with distress

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15
Q

What is specific phobia?

A

specific/simple/isolated phobia characterised by excessive/unreasonable fear of people/animals/objects/situations which are avoided/endured with significant personal distress

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16
Q

PTSD

A

post traumatic stress disorder

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17
Q

What is PTSD characterised by?

A

history of exposure to trauma with a response of intense fear, helplessness or horror

development of re-experiencing symptoms, avoidance symptoms, hyper-arousal symptoms

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18
Q

trauma that can cause PTSD

A

actual/threatened death
serious injury
therats to physical integrity of self/others

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19
Q

re-experiencing symptoms of PTSD

A

intreuive recollections
flashbacks
dreams

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20
Q

hyper-arousal symptoms of PTSD

A

disturbed sleep
hypervigilance
exaggerated startle response

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21
Q

When does PTSD usually occur?

A

within 6mths of exposure to trauma

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22
Q

What is OCD?

A

recurrent obsessional ruminations, images, impulses and/or recurrent physical/mental rituals which are distressing, time-consuming and cause interference with social/occupational function

obsessions - contamination, accidents, religious, sexual

rituals - washing, checking, cleaning, counting, touching

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23
Q

steps for presentation of anxiety disorder

A

1 identification

  1. low-intensity psychological interventions
  2. high intensity treatment
  3. highly specialist treatment
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24
Q

step 1 education/treatment and monitoring part

A
  • provide education about GAD and treatment options
  • monitor symptoms
  • discuss OTC meds/preparations
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25
Q

step 2 - not responded to step 1 (for GAD)

A

low-intensity psychological interventions

  • individual non-facilitated self help
  • individual guided self help
  • psychoeducational groups
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26
Q

step 3 - no improvemetn in step 2 (for GAD)

A

high intensity treatment

  • individual high intensity psychological intervention using CBT/applied relaxation/drug treatment
  • SSRIs
  • no antipsychotics
  • no BDZs except ST crisis measure
27
Q

drug choice for step 3 high intensity treatment

A

sertraline

  • 1st line most cost effective
28
Q

inadeauqte response to step 3

A

GAD not responded to
- high intensity psychological intervention offer drug treatment

  • drug treatment offer high intensity psychological intervention/alt drug
  • responded to drug offer high intensity psychological intervention in addition to drug
29
Q

when to refer to step 4

A

severe anxiety with marked functional impairment and

  • risk of self harm/suicide
  • significant comorbidity
  • self neglect
  • inadequate response to step 3
30
Q

step 4 - highly specialised treatment

A
  • psychological and drug treatments
  • combinations of antidepressants
  • augmentation of antidepressant with other drugs

-> caution due to lack of evidence and in risk of s/e

31
Q

causes of anxiety

A
  • genetic basis
  • environmental factors
  • structural changes in neural pathway from amygdala to cortex, hyperactive sensory processing of threat stimuli
  • cognitive control mechanisms that terminate the emotional response to the sensory cues to deficient
32
Q

biological basis of anxiety

A
  • dec 5-HT neurotransmission
  • overactivity of NA systems
  • deficient inhibition of the GABA interneurons with reduced sensiticity to postsynaptic GABAa R
  • excessive activity of glutamate neurons at NMDA R in anygdala responsible for fear conditioning
  • supersensitivity of R for peptide NTs such as cholecystokinin and neuropeptide Y
  • inc role of brain derived neurotropic factor (BDNF) in modulating neural plasticity in anxiety state
33
Q

What drugs are effective for anxiety disorders for 1st line?

A

SSRIs

34
Q

benzodiazepines for anxiety disorders

A

effective in anxiety disorders but their use should be short term and only in resistant cases because of s/e and dependence

35
Q

other drugs for anxoety disorders

A

TCAs
MAOIs
antipsychotics
anticonvolsants

36
Q

s/e with SSRIs

A

initial worsening of anxiety/agitation

rare - suicidal

37
Q

What can happen when stopping antidepressants/BDZs?

A

adverse effects

  • discontinuation symptoms
  • rebound anxiety
  • withdrawal
  • dependence

-> monitor

38
Q

phacmacological treatment for GAD

A 
SSRIs - escitalopram, paroxetine, sertraline
venlafaxine
some BDZs - alprazolam, diazepam
imipramine
buspirone
hydroxyzine
39
Q

psychological treatment of GAD

A

CBT

40
Q

1st line treatment for GAD

A

SSRI

41
Q

How long until you can asses efficacy of treatment?

A

up to 12 weeks

42
Q

LT treatment fo GAD

A
  • contiue treatment for further 6mths in pts who are responding at 12 weeks
  • use approach that will prevent relapse
  • SSRIs best
  • CBT can reduce relapse rates better than drugs
  • monitor efficacy/tolerability regularly
43
Q

combination of drugs and psychological treatment

A

combining drug and psychological not recommended for initial treatment

44
Q

when treatment of GAD fails

A
  • switch to another treatment
  • switch to venlafine/imipramine no response to SSRI
  • BDZ after no response to SSRIs/SNRIs
45
Q

detection and diagnosis of panic disorder

A
  • assess level of agoraphobic avoidance, get severity

- ask about panic attacks and agoraphobia when chest pain/SOB

46
Q

acute treatment of panic disorder

A

pharmacological - SSRIs, some TCAs, some BDZs, venlafaxine, reboxetine

psychological - CBT

47
Q

How to minimise s/e of SSRIs?

A

slowly increasing dose

48
Q

1st/2nd line for LT treatment of panic disorder

A

1st SSRI

2nd imipramine

49
Q

when initial treatments fail in panic disorder

A
  • add paroxetine or buspirone to psychological treatments after partial response
  • paroxetine and continue CBT aftre initial non-response
  • group CBT non-responders to pharmacological
  • referral to specialist, severe
50
Q

detection and diagnosis of social phobia

A
  • assess level to distinguish from shyness

- ask about social anxiety symptoms in pts with depression/panic attacks/alcohol misuse

51
Q

pharmacological treaments for social phobia

A 
SSRIs - escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
venlafaxine
phenelzine
moclobemide
some BDZs
anticonvulsants
olanzapine
52
Q

treatmens fail for social phobia

A
  • switch to venlafaxine no response to SSRI
  • add bupirone after partial response to SSRI
  • BDZs no response
  • evidence based treatments
  • comb drug + CBT
  • referral to specialist, severe
53
Q

treatment for prevention of PTSD symptoms

A

propranolol

54
Q

acute treatment of PTSD

A
  • some SSRIs (fluoxetine, paroxetine, sertraline)
  • some TCAs (amitriptyline, imipramine)
    • phenelzine
  • mirtazepine
  • venlafaxine
  • lamotrigine
55
Q

LT treatment for PTSD

A

pt responding at 12 weeks, continue for further 12mths

56
Q

when initial treatments fail for PTSD

A
  • switch to other evidence based treatment after no resp
  • combining evidence based treatments when no c/i
  • combining drug and psychological
  • atypical antipsychotic too antidepressant after initial no resp
  • referral to specialist
57
Q

pharmacological treatments for OCD

A

clomipramine

SSRIs

58
Q

psychological treatments for OCD

A

exposure therapy

CBT

59
Q

1st line drug treatment for OCD

A

SSRIs

60
Q

LT treatment for OCD

A

continue drug for 12mths if responding aftre 12 weeks

61
Q

when treatment fails for OCD

A
  • inc dose of clomipramine or SSRI
  • switch to proven treatments
  • combining evidence based treatments
  • combining evidece based treatment when no c/i
  • combine drug + exposure therapy/CBT
  • augment with antipsychotics/pindolol (SSRI no resp)
  • referral
62
Q

children/adolecents

A
  • drugs when no resp to psychological if benefits > risks
  • drugs: SSRIs 1st choice
  • avoid BDZs, TCAs (adverse effects)
  • careful doses, age/size (start low dose)
  • monitoring for adverse effects
63
Q

elderly

A

careful of interactions/comorbidities/reduced metabolism/inc sensitivity to adverse effects

64
Q

cardial disease and epilepsy

A
  • avoid TCAs in cardiac disease
  • QT prolongation with venlafaxine predisposes to cardiac arrhythmias, avoid in high risk of arrhythmias
  • avoid antidepressants that lower seizure thershold in epilepsy
  • interactions between antidepressants and other drugs (anticonvolsants)
65
Q

pregnancy and breastfeeding

A
  • risk vs benefit of drug treatment
  • fluoxetine/TCAs 1st line
  • SSRIs/TCAs in bf
  • . except fluoxetine and citalopram
  • > secretion into breast milk is low

PHA333 (27 decks)

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