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Anxiety disorders Flashcards

1
Q

What is neurosis

A

Group of psychiatric disorders

Characterised by distress

Non-organic

Discrete onset

No hallucinations or delusions

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2
Q

What is anxiety

A

Unpleasant emotional state

Subjective fear

Somatic symptoms

Problematic when excessive and inappropriate

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3
Q

What are the psychological features of anxiety

A

Anticipatory fear of impending doom

Worrying thoughts

Exaggerated startle response

Restlessness

Poor concentration and attention

Irritability

Depersonalisation

Derealisation

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4
Q

What are the non-psychological features of anxiety

A

CVS
- Palpitations, chest pain

Resp
- Hyperventilation, cough, chest tightness

GI
- Abdominal pain, loose stools, nausea and vomiting, dysphagia, dry mouth

Urinary
- Frequency, failure of erection, menstrual discomfort

Neuromuscular
- Tremor, myalgia, headaches, paraesthesia, tinnitus

Behaviours
- Avoidant

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5
Q

What is generalised (free-floating) anxiety

A

Present most of the time

Not associated with specific objects or situations

Excessive/inappropriate worries about normal life events

Long duration

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6
Q

What is episodic (paroxysmal) anxiety

A

Abrupt onset

Discrete episodes

Severe

Strong autonomic symptoms

Short-lived

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7
Q

What are the conditions related to anxiety

A

Medical
- Hyperthyroidism, hypoglycaemia, anaemia, phaeochromocytoma, Cushing’s, COPD, heart failure, malignancy

Substance-related
- Intoxication, withdrawal, medication side-effect

Psychiatric
- Eating disorders, somatoform disorders, depression, schizophrenia, OCD, PTSD, adjustment disorders, anxious avoidant personality disorder

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8
Q

What is generalised anxiety disorder

A

Ongoing, uncontrollable, widespread worry about many events

Thoughts recognised by patient as being excessive and inappropriate

Most days for >6 months

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9
Q

What is the epidemiology of generalised anxiety disorder

A

2-4%

F>M

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10
Q

What are the risk factors for generalised anxiety disorder

A

Predisposing
- Genetics, upbringing, personality type, demand for high achievement, divorce, live alone, single parent, low socioeconomic status

Precipitating
- Stressful life event

Perpetuating
- Controlling stressful event, marital status, living alone, certain ways of thinking

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11
Q

What are the clinical features of generalised anxiety disorder

A

Chest and abdomen
- Difficulty breathing, feeling of choking, chest pain, nausea, abdominal pain, loose stools

Brain
- Dizzy, feeling of dying, fear of losing control, derealisation, depersonalisation

General
- Hot flushes, cold chills, numbness/tingling, headaches

Tension
- Muscle aches, restlessness, feeling on edge, difficulty swallowing, lump in throat

Non-specific
- Startled, difficulty concentrating, persistent irritability, sleep disturbances

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12
Q

What is the ICD-10 criteria for generalised anxiety disorder

A

> 6 months of prominent tension, worry, and feelings of apprehension about everyday events/problems

At least 4 symptoms, at least 1 of autonomic arousal (palpitations, sweating, shaking/tremor, dry mouth)

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13
Q

What are the investigations for generalised anxiety disorder

A

Bloods
- FBC TFTs, glucose

ECG
- Tachycardia

Questionnaires
- GAD-2, GAD-7, Beck’s anxiety inventory, hospital anxiety and depression scale

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14
Q

What are the differential diagnoses for generalised anxiety disorder

A

Neurotic disorders
- Panic disorder, specific phobias, OCD, PTSD

Depression

Schizophrenia

Personality disorders
- Anxious, dependent

Excessive caffeine/alcohol

Withdrawal from drugs

Organic
- Anaemia, hyperthyroidism, phaeochromocytoma, hypoglycaemia

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15
Q

What is the biological management for generalised anxiety disorder

A

First line: SSRI (sertraline)

SNRI (venlafaxine, duloxetine)

Pregabalin (if SSRI/SNRI not affective)

Continue for 1 year

Do not give benzodiazepines (only short term during crisis)

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16
Q

What is the psychological management for generalised anxiety disorder

A

Psychoeducation

CBT

Applied relaxation techniques

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17
Q

What is the social management for generalised anxiety disorder

A

Self-help methods

Support groups

Encourage exercise

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18
Q

What is the NICE stepped care model for generalised anxiety disorder

A

Step 1

  • Identification and assessment
  • Psychoeducation and active monitoring

Step 2

  • Low intensity psychological intervention
  • Self-help, psychoeducation, group-based therapy

Step 3

  • High intensity psychological intervention
  • CBT or applied relaxation
  • Drug treatment

Step 4

  • Highly socialised input
  • Drug and psychological therapy
  • Consider involving crisis team
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19
Q

What is a phobia

A

Intense, irrational fear of an object/situation/person/place

Recognised as excessive and unreasonable (out of proportion to threat)

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20
Q

What is agoraphobia

A

Fear of public spaces

Fear where immediate escape would be difficult

25-30s

Strongly linked to panic disorder

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21
Q

What is social phobia

A

Social anxiety disorder

Fear of social situations

Due to fear of humiliation, criticism, or embarrassment

Late adolescence

22
Q

What is a specific (isolated) phobia

A

Fear of a specific object or situation

Conditioning event in early life

23
Q

What are the risk factors for phobic anxiety disorders

A

Aversive experience

Stress and negative life events

Other anxiety disorders

Mood disorders

Substance misuse

Family history

24
Q

What are the clinical features of phobic anxiety disorders

A

Biological
- Tachycardia, vasovagal response

Psychological
- Anticipatory anxiety, inability to relax, urge to avoid, may have fear of dying

25
What is the ICD-10 criteria for agoraphobia
Consistent fear and avoidance of at least 2 of: crowds, public spaces, travelling alone, travelling away from home 2+ symptoms of anxiety in feared situations Significant emotional distress Symptoms restricted to feared situations
26
What is the ICD-10 criteria for social phobia
Marked fear of being the focus of attention, or embarrassment 2+ symptoms of anxiety and one of: blushing, fear of vomiting, urgency Significant emotional distress Symptoms restricted to feared situation
27
What is the ICD-10 criteria for specific phobia
Marked fear of specific object/situation Symptoms of anxiety in feared situation Significant emotional distress Symptoms restricted to feared situation
28
What investigations are needed for phobic anxiety disorders
Social phobia inventory Liebowitz social anxiety scale
29
What is the management for phobic anxiety disorders
Establish good rapport Avoid anxiety-inducing substances (caffeine...) Urine drug screen Thorough risk assessment Agoraphobia - CBT, gradual exposure, SSRIs Social phobias - CBT, gradual exposure, SSRIs/SNRIs, psychodynamic psychotherapy Specific phobias - CBT, gradual exposure, benzodiazepines (short term use)
30
What is panic disorder
Recurrent, episodic, severe panic attacks Unpredictable, not restricted to a particular situation
31
What are the causes for panic disorder
Biological - Genetic, linked to serotonin/adrenaline, stimulation of sympathetic nervous system Cognition - Misinterpretation of somatic symptoms Environment - Life stressors
32
What is the epidemiology of panic disorder
1% prevalence 3 times more likely in females Onset in late adolescence
33
What are the risk factors for panic disorder
Family history Major life event Recent trauma Other mental disorders White ethnicity Asthma/cigarette smoking Benzodiazepine withdrawal
34
What is the ICD-10 criteria for panic disorder
Recurrent panic attacks not associated with a specific situation Often occur spontaneously Peak in a few minutes Last a few minutes At least one symptom of autonomic arousal
35
What is the management for panic disorder
First line: SSRIs - If no improvement in 12 weeks, give imipramine or clomipramine Do not give benzodiazepines CBT Self-help methods Support groups Encourage exercise
36
What is the NICE stepped care approach for panic disorder
Step 1 - Recognition and diagnosis Step 2 - Psychological therapies, medications, self-help methods Step 3 - Alternative treatment (if initial one failed) Step 4 - Refer to specialist Step 5 - Care in specialist mental health setting
37
What is PTSD
Intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event
38
What are the causes of PTSD
Exceptionally stressful life event Genetic Failure to process emotions
39
What is the epidemiology of PTSD
25-30% of those who have been through a traumatic event F>M More common in certain professions (medics, military...), refugees, asylum seekers
40
What are the risk factors for PTSD
Pre-trauma - Previous abuse, history of mental illness, low socioeconomic background, childhood abuse Peri-trauma - Severity of trauma, perceived threat to life, adverse emotional reaction during/straight after event Post-trauma - Concurrent life stressors, lack of social support
41
What are the clinical features of PTDS
Develop within 6 months of event Reliving situation - Persistent, intrusive, involuntary thoughts - Flashbacks, vivid memories, nightmares Avoidance - Avoid similar situations, inability to recall certain parts of event Hyperarousal - Irritability, outbursts, difficulty sleeping, hypervigilance, exaggerated startle response Emotional numbing - Negative thought about self, difficulty expressing emotions, detachment from others
42
What are the stages of grief
Denial Anger Bargaining Depression Acceptance
43
What investigations are needed for PTSD
Questionnaires Consider CT head
44
What is the management for PTSD
<3 months since trauma - Watchful waiting (if mild trauma) - Trauma-focussed CBT - Short-term sleep medication (zopiclone) - Thorough risk assessment >3 months since trauma - Trauma-focussed CBT - Eye movement desensitisation and reprocessing - Drug treatment (paroxetine, mirtazapine, amitriptyline, phenelzine)
45
What is OCD
Recurrent obsessional thoughts and compulsive acts Obsessions - Unwanted intrusive thoughts, images, or urges - Distressing to individual - Not able to resist them - Recognise them as absurd Compulsions - Repetitive, stereotyped behaviour or mental act that the person feels driven to perform
46
What are the causes of OCD
Biological - Low serotonin, genetic, childhood group A strep infection Behavioural - Operant conditioning Strongly linked with other psychiatric disorders
47
What are the epidemiology and risk factors for OCD
Mostly in early adulthood M=F Carrying out compulsions exacerbates obsessions Neglect, abuse, bullying, social isolation
48
What is the ICD-10 criteria for OCD
Symptoms most days for 2 weeks Cause distress or interfere with functioning
49
What are the clinical features of OCD
Failure to resist Originate from person's mind Repetitive or distressing Carrying out compulsions is not pleasurable (but reduces anxiety) OCD cycle (obsession, anxiety, compulsion, relief)
50
What is the management for OCD
CBT (cause anxiety, prevent them from carrying out action) Medication (SSRIs) Education, distraction techniques, self-help groups Thorough risk assessment Mild OCD - Low intensity psychological intervention Moderate OCD - SSRIs or high intensity psychological intervention Severe OCD - Combined SSRIs and CBT

Psych (11 decks)

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