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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
step 1 education/treatment and monitoring part
- provide education about GAD and treatment options - monitor symptoms - discuss OTC meds/preparations
25
step 2 - not responded to step 1 (for GAD)
low-intensity psychological interventions - individual non-facilitated self help - individual guided self help - psychoeducational groups
26
step 3 - no improvemetn in step 2 (for GAD)
high intensity treatment - individual high intensity psychological intervention using CBT/applied relaxation/drug treatment - SSRIs - no antipsychotics - no BDZs except ST crisis measure
27
drug choice for step 3 high intensity treatment
sertraline - 1st line most cost effective
28
inadeauqte response to step 3
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
when to refer to step 4
severe anxiety with marked functional impairment and - risk of self harm/suicide - significant comorbidity - self neglect - inadequate response to step 3
30
step 4 - highly specialised treatment
- 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
causes of anxiety
- 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
biological basis of anxiety
- 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
What drugs are effective for anxiety disorders for 1st line?
SSRIs
34
benzodiazepines for anxiety disorders
effective in anxiety disorders but their use should be short term and only in resistant cases because of s/e and dependence
35
other drugs for anxoety disorders
TCAs MAOIs antipsychotics anticonvolsants
36
s/e with SSRIs
initial worsening of anxiety/agitation | rare - suicidal
37
What can happen when stopping antidepressants/BDZs?
adverse effects - discontinuation symptoms - rebound anxiety - withdrawal - dependence -> monitor
38
phacmacological treatment for GAD
``` SSRIs - escitalopram, paroxetine, sertraline venlafaxine some BDZs - alprazolam, diazepam imipramine buspirone hydroxyzine ```
39
psychological treatment of GAD
CBT
40
1st line treatment for GAD
SSRI
41
How long until you can asses efficacy of treatment?
up to 12 weeks
42
LT treatment fo GAD
- 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
combination of drugs and psychological treatment
combining drug and psychological not recommended for initial treatment
44
when treatment of GAD fails
- switch to another treatment - switch to venlafine/imipramine no response to SSRI - BDZ after no response to SSRIs/SNRIs
45
detection and diagnosis of panic disorder
- assess level of agoraphobic avoidance, get severity | - ask about panic attacks and agoraphobia when chest pain/SOB
46
acute treatment of panic disorder
pharmacological - SSRIs, some TCAs, some BDZs, venlafaxine, reboxetine psychological - CBT
47
How to minimise s/e of SSRIs?
slowly increasing dose
48
1st/2nd line for LT treatment of panic disorder
1st SSRI 2nd imipramine
49
when initial treatments fail in panic disorder
- 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
detection and diagnosis of social phobia
- assess level to distinguish from shyness | - ask about social anxiety symptoms in pts with depression/panic attacks/alcohol misuse
51
pharmacological treaments for social phobia
``` SSRIs - escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline venlafaxine phenelzine moclobemide some BDZs anticonvulsants olanzapine ```
52
treatmens fail for social phobia
- 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
treatment for prevention of PTSD symptoms
propranolol
54
acute treatment of PTSD
- some SSRIs (fluoxetine, paroxetine, sertraline) - some TCAs (amitriptyline, imipramine) - - phenelzine - mirtazepine - venlafaxine - lamotrigine
55
LT treatment for PTSD
pt responding at 12 weeks, continue for further 12mths
56
when initial treatments fail for PTSD
- 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
pharmacological treatments for OCD
clomipramine SSRIs
58
psychological treatments for OCD
exposure therapy CBT
59
1st line drug treatment for OCD
SSRIs
60
LT treatment for OCD
continue drug for 12mths if responding aftre 12 weeks
61
when treatment fails for OCD
- 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
children/adolecents
- 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
elderly
careful of interactions/comorbidities/reduced metabolism/inc sensitivity to adverse effects
64
cardial disease and epilepsy
- 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
pregnancy and breastfeeding
- 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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