Anxiety Disorders Flashcards
How does an Anxiety Disorder differ from Anxiety?
Anxiety = Normal reaction to stressful situations.
Anxiety Disorder = Prolonged duration and experienced at a disabling intensity, affecting the person’s function and overall well-being.
NICE Anxiety : Excessive worry about a number of different events associated with heightened tension.
Give three organic causes of Continuous Anxiety.
- Hyperthyroidism.
- Alcohol.
- Caffeine.
Give six organic causes of Episodic Anxiety.
- Caffeine.
- Alcohol.
- Drugs.
- Arrhythmias.
- Hypoglycaemia.
- Phaechromocytoma.
Explain the Aetiology of Anxiety using 4 theories.
- Neurochemical Theory : Dysregulation of neurotransmitters like Noradrenaline, Serotonin, GABA.
- Behavioural Theory : Classical condition - negative reinforcement e.g. running away from situation allays fear.
- Cognitive Theory : Worrying thoughts are repeated in an automatic way which both induces and maintains an anxiety response.
- Attachment Theory : Insecure attachment with parents predisposes an individual to an anxiety disorder.
Explain the Yerkes-Dodson Curve.
X-Axis : Arousal; Y-Axis : Performance.
- Increasing Attention and Interest.
- Optimal Performance and Optimal Arousal.
- Impaired Performance - Strong Anxiety.
What is Global Hystericus?
A form of somatisation disorder - a subjective feeling of a lump in the throat, unrelated to swelling.
List the 7 methods of management of anxiety.
- Symptom Control.
- Regular Exercise and Meditation (Mindfulness Meditation).
- CBT and Relaxation (Best Specific Measures) - education about physiology, techniques for managing arousal, exploring likelihood of events that the patient’s worrying about actually occurring.
- Behavioural Therapy - graded-exposure to anxiety-provoking stimuli.
- Pharmacological Therapy.
- Progressive Relaxation Training - Deep Breathing using Diaphragm and Specific Muscle Group Training.
- Hypnosis - inducing progressively deeper trances and concentration on bodily sensations.
What is Neurosis?
Maladaptive psychological symptoms that are not due to organic causes or psychosis - usually precipitated by stress.
What is Generalised Anxiety Disorder (GAD)?
A mental health condition that causes excessive and disproportionate anxiety and worry that negatively affects a person’s everyday activity - at least 6 months. The worry is not confined to features of another mental disorder or substance abuse or a general medical condition. It must be free-floating (no particular environmental circumstance; persistent).
Give the diagnostic criteria of symptoms of GAD.
At least 3 of :-
- Restlessness.
- Nervousness.
- Fatigue.
- Poor Concentration.
- Irritability.
- Muscle Tension.
- Sleep Disturbance.
What can be used to investigate the severity of Generalised Anxiety Disorder? (3)
- GAD-7 Questionnaire.
- Assessment for Co-Morbid Mental Health Problems.
2B. Use HAD to screen in people with physical health problems. - Assessment for Triggers and Contributors.
What is the NICE suggested approach to GAD? (4)
Step-wise Approach :
1. Education about GAD and Active Monitoring.
2. Low-Intensity Psychological Interventions e.g. Individual Non-Facilitated Self Help, Individual-Guided Self-Help, Psychoeducational Groups.
3. High-Intensity Psychological Interventions e.g. CBT, Applied Relaxation, Drug Therapy.
3B. Sertraline SSRI - 1st line.
3C. Alternative SSRI/SNRI e.g. Duloxetine, Venlafaxine - 2nd Line.
3D. Pregabalin - 3rd Line.
4. Highly-Specialist Input e.g. Multi-Agency Teams.
Give three techniques to control Panic Attacks.
- Focusing on breathing (stamping on the spot).
- Focusing on senses (cuddling soft, mint-flavoured sweets/gum).
- Grounding Techniques.
How is someone in A&E who experiences a panic attack managed? (4)
- Ask if they already receive treatment for panic disorder.
- Undergo minimum necessary investigations.
- Not admitted to a medical/psychiatric bed for panic attack.
- Referred to primary care for subsequent care.
What is Agoraphobia?
Fear of being unable to escape to a safe place (usually home) so fear of open places, confined situations that are difficult to leave without attracting attention. If severe, can make the patient house-bound and onset is mid-20s.
What is PTSD?
Post-Traumatic Stress Disorder; mental health problem that one can develop after experiencing traumatic events. DSM-IV : Symptoms must be present for more than 1 month.
Give 4 common clinical features of PTSD.
- Reliving aspects of the trauma e.g. vivid flashbacks, nightmares.
- Alertness/Feeling on edge e.g. panicking, sleep disturbance, emotional instability.
- Avoiding Feelings/Memories e.g. distractions, emotional numbness.
- Difficult Beliefs/Feelings e.g. lack of trust, communication.
How is PTSD generally treated?
- Trauma-Focused CBT.
- EMDR - Eye Movement Desensitisation and Reprocessing.
- Pharmacological Therapy.
3A. Venlafaxine (SNRIs) or SSRIs.
3B. Risperidone.
What is OCD?
Obsessive-Compulsive Disorder - frequently debilitating and often severe anxiety disorder characterised by obsessions and compulsions.
Obsessions lead to anxiety; anxiety leads to compulsions; compulsions lead to a temporary improvement in anxiety.
What is an Obsession?
Unwelcome thoughts, images, urges or worries that repeatedly appear in the mind - cause of anxiety. They must be the individual’s own thoughts/impulses and at least one thought or act is still resisted unsuccessfully.
What is a Compulsion?
Repetitive activities that one does to reduce the anxiety caused by the obsession.
How is OCD managed?
Mild : 1. Low-Intensity Psychological Interventions e.g. CBT, ERP (Exposure-Response Prevention). 2. SSRI/More-Intensive CBT. Moderate/Severe : 1. SSRI + CBT Combined.
What is ERP?
Exposure-Response Prevention; psychological method involving exposure to an anxiety-provoking situation e.g. dirty hands and stopping them engaging in their usual safety behaviour e.g. washing.
How must SSRIs be used in OCD?
Continue for at least 12 months to prevent a relapse and allow time for improvement.
What is BDD?
Body Dysmorphic Disorder - OCD relating to physical appearance e.g. obsession - invisible/very slight imperfection; compulsion - mirrors, skin-picking.
What SSRI is specifically used in BDD?
Fluoxetine.
What is Hypochondriasis?
Health Anxiety/Illness Anxiety Disorder - obsessional preoccupation with the idea that they are currently or will be experiencing a physical illness e.g. cancer, HIV, AIDS.
Give 4 risk factors for the development of GAD.
- Age : 35-54.
- Being Divorced/Separated.
- Living Alone.
- Being a Lone Parent.
