Anxiety disorders Flashcards
Risk factors for GAD
Being aged between 35 and 54
Being divorced or separated
Living alone as a lone parent
Diagnostic criteria for GAD
Excessive anxiety and worry occurring more days than not for at least six months
Difficult to control the worry
Restlessness
Easily fatigued
Difficulty concentrating
Autonomic arousal symptoms in GAD
Palpitations or pounding heart Tachycardia Sweating Trembling or shaking Dry mouth
Step 1 of stepped care model for management of GAD
Identification, assessment, education, monitoring
Step 2 of stepped care model for management of GAD
Low-intensity psychological intervention
Non-facilitated or guided self-help
Psycho-educational groups
Step 3 of stepped care model for management of GAD
CBT/applied relaxation or drug treatment
Step 4 of stepped care management of GAD
Specialised drug and/or psychological treatment, multi-agency teams, crisis intervention, outpatient or inpatient care
Pharmacological intervention for rapid response in acute anxiety
Sedative antihistamines
Benzodiazepines(should not be used beyond 4 weeks)
Buspirone
First line pharmacological intervention in GAD
SSRI or venlafaxine
Which SSRIs are licensed for treatment of GAD
Escitalopram
Paroxetine
Which medication can be considered in patients who cannot tolerate SSRIs
Pregablin
Definition of panic attacks
Must be associated with >1 month’s duration of subsequent, persisting anxiety about recurrence of attacks
Features of panic attacks
Attacks usually last at least 10 minutes but their duration is variable
Symptoms must not arise as a result of alcohol or substance misuse, medical conditions or other psychiatric disorders, in order to satisfy diagnostic criteria
Symptoms experienced during panic attacks
Palpitations Sweating Trembling or shaking Dry mouth SOB Feeling of choking Chest pain Nausea
Which medications can panic disorders be associated with
SSRIs
Benzodiazpine withdrawal
Zopiclone withdrawal
What in the history would suggest a panic disorder with agoraphobia
Attacks that arise in an inconsistent or unpredictable way following exposure to a given anxiety-provoking situation or event
Associated psychiatric disorders with panic disorders
Agoraphobia +/- social phobia
Mood disorders such as depression
Step 2 of management of panic disorders
Involve patient's family/carer Advise avoiding anxiety-producing substances(caffeine) Exclude alcohol or drug misuse CBT SSRIs
Which medication can be considered in panic disorder management if SSRIs have not helped
Consider imipramine or clomipramine if no improvement after 12 weeks
Features of self-help advice for patients with anxiety
Give details of books based on CBT principles and contact details of support groups
Promote exercise
Abdominal/diaphragmatic breathing
Features of PTSD
Re-experiencing flashbacks, nightmares and distressing images
Avoidance of people and situations
Hyperarousal and hypervigilance for threat
Emotional numbing(feeling detached)
Management of PTSD for mild symptoms lasting less than 4 weeks
Following a traumatic event, single-session interventions are not recommended
Watchful waiting
Management of severe PTSD
Trauma-focused cognitive behavioural therapy(CBT)
Eye movement desensitisation and reprocessing(EMDR) therapy may be used in more severe cases
Pharmacological options in PTSD
Should not be used as a routine first-line
Venlafaxine or an SSRI such as sertraline
NICE recommends risperidone in severe cases
Physical symptoms of social anxiety
Trembling Blushing Sweating Palpitations Chronic insecurity about their relationships with others
what are the two forms of social anxiety
Generalised social anxiety - affects most, if not all areas of life
Performance social anxiety - only occur in a few specific situations such as public speaking
Identification and assessment of social anxiety phobia
3-item mini-social phobia inventory(Mini-SPIN)
Do you find yourself avoiding social situations or activities?
Are you fearful or embarrassed in social situations?
Initial treatment options for social anxiety disorder
Individual CBT
SSRI such as escitalopram or sertraline if CBT is declined
Short-term psychodynamic psychotherapy if meds and CBT declined
