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Anxiety disorders Flashcards

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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
Q

What is the ICD-10 criteria for agoraphobia

A

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
Q

What is the ICD-10 criteria for social phobia

A

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
Q

What is the ICD-10 criteria for specific phobia

A

Marked fear of specific object/situation

Symptoms of anxiety in feared situation

Significant emotional distress

Symptoms restricted to feared situation

28
Q

What investigations are needed for phobic anxiety disorders

A

Social phobia inventory

Liebowitz social anxiety scale

29
Q

What is the management for phobic anxiety disorders

A

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
Q

What is panic disorder

A

Recurrent, episodic, severe panic attacks

Unpredictable, not restricted to a particular situation

31
Q

What are the causes for panic disorder

A

Biological
- Genetic, linked to serotonin/adrenaline, stimulation of sympathetic nervous system

Cognition
- Misinterpretation of somatic symptoms

Environment
- Life stressors

32
Q

What is the epidemiology of panic disorder

A

1% prevalence

3 times more likely in females

Onset in late adolescence

33
Q

What are the risk factors for panic disorder

A

Family history

Major life event

Recent trauma

Other mental disorders

White ethnicity

Asthma/cigarette smoking

Benzodiazepine withdrawal

34
Q

What is the ICD-10 criteria for panic disorder

A

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
Q

What is the management for panic disorder

A

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
Q

What is the NICE stepped care approach for panic disorder

A

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
Q

What is PTSD

A

Intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event

38
Q

What are the causes of PTSD

A

Exceptionally stressful life event

Genetic

Failure to process emotions

39
Q

What is the epidemiology of PTSD

A

25-30% of those who have been through a traumatic event

F>M

More common in certain professions (medics, military…), refugees, asylum seekers

40
Q

What are the risk factors for PTSD

A

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
Q

What are the clinical features of PTDS

A

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
Q

What are the stages of grief

A

Denial

Anger

Bargaining

Depression

Acceptance

43
Q

What investigations are needed for PTSD

A

Questionnaires

Consider CT head

44
Q

What is the management for PTSD

A

<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
Q

What is OCD

A

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
Q

What are the causes of OCD

A

Biological
- Low serotonin, genetic, childhood group A strep infection

Behavioural
- Operant conditioning

Strongly linked with other psychiatric disorders

47
Q

What are the epidemiology and risk factors for OCD

A

Mostly in early adulthood

M=F

Carrying out compulsions exacerbates obsessions

Neglect, abuse, bullying, social isolation

48
Q

What is the ICD-10 criteria for OCD

A

Symptoms most days for 2 weeks

Cause distress or interfere with functioning

49
Q

What are the clinical features of OCD

A

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
Q

What is the management for OCD

A

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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