Anxiety Disorders Flashcards
Define ANXIETY.
Anxiety is a universal sensation characterised by tension, dread and terror. It is a physiology sensation in response to fear. Its aim is to activate the sympathetic nervous system; “fight or flight.”
Anxiety becomes a pathology when the terror / fear is out of proportion to the stimuli, or impacts on the individuals’ day to day functioning.
Describe the manifestations of anxiety in terms of:
- physical
- psychological
- behavioural
PHYSICAL - increased HR, palpitations, sweating, shortness of breath, tremour, restlessness, agitation
PSYCHOLOGICAL - preoccupied thoughts, poor concentration
BEHAVIOURAL - pacing, unable to sit still, avoidance behaviour
Identify differential diagnoses for ANXIETY.
Cardiovascular ✔️ arrhythmia (e.g. SVT) ✔️ post-MI ✔️ PE ✔️ valvular pathologies
Respiratory ✔️ asthma ✔️ COPD ✔️ pneumonia ✔️ hyperventilation syndrome
Endocrine and Metabolic ✔️ hyperthyroidism ✔️ Cushing's Disease ✔️ acromegaly ✔️ phaeochromocytoma
Substance Induced
✔️ caffeine overdose
✔️ stimulant overdose
✔️ alcohol or benzodiazepine withdrawal
Psychological
✔️ mood disturbances
✔️ psychosis
✔️ mania
DSM-V criteria for GENERALISED ANXIETY DISORDER.
A. Excessive worry and / or fear that is excessive in proportion to the stimuli which occurs most of the day, for more days than none, for a SIX MONTH period.
B. Individual finds it difficult to control worry.
C. As well as excessive worry / fear, the individual experiences at least THREE of the following SIX:
✔️ B - blank mind
✔️ E - easily fatigued
✔️ S - sleep disturbances
✔️ K - “kept” up
✔️ I - irritability
✔️ M - muscle stiffness / tension
D. The symptoms cause significant distress to the patient and clinically impair their function in one or more domains of work, social skills, education, personal care.
E. The symptoms are not attributed to organic cause or drug / alcohol withdrawal or intoxication.
Outline the management of generalised anxiety disorder in terms of lifestyle / non-pharmacological, psychological and pharmacological options.
LIFESTYLE MODIFICATIONS
✔️ sleep hygiene
✔️ reduce caffeine and alcohol consumption
✔️ reduce / eliminate life stressors (if possible)
PSYCHOLOGICAL TECHNIQUES
✔️ cognitive behavioural therapy
✔️ mindfullness
✔️ relaxation techniques
PHARMACOLOGICAL
✔️ anti-depressants (e.g. SSRIs) –> first line medication
✔️ bupropion –> second line medication
✔️ benzodiazepines should NOT be used for ongoing management; may have some role in acute situations
✔️ avoid beta-blockers for symptom control
N.B. for all medications used to treat anxiety, start low, aim high, go slow…
DSM-V criteria for PANIC DISORDER.
A. Recurrent panic attacks; a panic attack is an isolated event in which maximal anxiety is reached within minutes and at least FOUR of the following symptoms are experienced:
✔️ S - sweating
✔️ T - tremour
✔️ U - unsteadiness / dizziness
✔️ D - depersonalisation / derealisation
✔️ E - excessive HR / palpitations
✔️ N - nausea
✔️ T - tinginling / parasthesia
✔️ S - shortness of breath
✔️ fear of …
✔️ C - chocking
✔️ C - chills
✔️ C - chest pain
B. In the month following the panic attach, the individual experiences either one or both of the following:
✔️ excessive fear or worry about additional panic attacks and their consequences
✔️ significant changes to behaviour to prevent subsequent panic attacks from occurring
C. The disturbance is not due to an organic pathology of the effects of drug intoxication / withdrawal
D. Disturbance is not better explained by another mental health disorder
N.B. Panic attacks are NOT the same as panic disorder; panic disorder is inclusive of panic attacks, however, other criteria must also be met.
Outline the management of panic disorder in terms of lifestyle / non-pharmacological, psychological and pharmacological options.
LIFESTYLE MODIFICATIONS
✔️ stress reduction
✔️ mindfulness techniques
PSYCHOTHERAPY
✔️ exposure and response therapy
✔️ CBT
PHARMACOTHERAPY
✔️ SSRIs
✔️ benzodiazepines may have some role in symptomatic / short term relief; should not be used over a prolonged period of time
✔️ avoid beta-blockers
N.B. for all medications used to treat anxiety, start low, aim high, go slow…
DSM-V criteria AGOROPHOBIA.
A. Marked fear or anxiety regarding at least TWO of the following five situations…
✔️ using public transport
✔️ being alone outside of the house
✔️ being in enclosed public spaces
✔️ being in wide-open public spaces (e.g. fields, meadows)
✔️ standing in line or in a large crowd
B. The individual fears these situations as they fear that help may not be available or that they may not be able to escape if a panic attack does come on.
C. The fear is disproportionate to the severity of the circumstance.
D. Individual actively tries to avoid these situations.
E. Symptoms are present for > 6 months.
F. Symptoms cause significant impairment and distress.
G. Not due to psychological effects of a medication / drug or withdrawal / intoxication.
H. Symptoms not better explained by a different diagnosis.
Outline the principles of PHOBIAS.
Phobic conditions include:
✔️ specific phobia (e.g. heights, spiders)
✔️ social phobia
In each of the situations, exposure to a certain stimuli invariably prompts a fear / stress response.
The individual recognises that this response is out of proportion to the severity of the stimuli.
Other features:
✔️ stimuli are actively avoided
✔️symptoms significantly impair individuals’ functioning
What is the mainstay treatment for phobic conditions?
Exposure + response therapy.
DSM-V criteria OBSESSIVE COMPULSIVE DISORDER (OCD).
A. The presence of obsessions, compulsions or both:
✔️ obsessions are characterised by (1). recurrent, persistent thoughts that are often unwanted and intrusive and cause the individual significant impairment and distress (2). must be neutralised by the individual performing certain rituals
✔️ compulsions are characterised by (1). repetitive actions, thoughts or mental acts that the individual feels compelled to perform to alleviate an obsession (2). behaviour is aimed to alleviate the fear associated with the obsession
B. These behaviours take up > 60 minutes of time per day and cause significant impairment in life functioning.
C. Not attributed to any other organic cause, or drug intoxication / withdrawal.
D. Symptoms not better explained by another mental health condition.
Outline treatment for OCD.
PHARMACOTHERAPY - fluoxetine 80mg per day (supra-therapeutic dose)
PSYCHOTHERAPY - CBT, mindfulness, exposure therapy
DSM-V criteria POST TRAUMATIC STRESS DISORDER.
✔️ T - trauma experienced / witnessed by the individual
✔️ R - re-experience of that trauma (e.g. thoughts, dreams, flashbacks)
✔️ A - avoidance of stimuli
✔️ U - unable to function
✔️ M - month duration (PTSD requires symptoms for > 30 days)
✔️ A - activity and arousal increased
✔️ N - negative symptoms (e.g depressed mood, reduced interest in activities, negative emotional state, feelings of detachment from others)
Identify side effects of anti-anxiety / anti-depressant medications.
✔️ hyponatremia ✔️ increased bleeding risk ✔️ weight gain ✔️ nausea and vomiting ✔️ orthostatic hypotension ✔️ sexual dysfunction ✔️ anticholinergic side effects
