Anxiety Disorders Flashcards
What are the 2 brain systems involved in response to external stimuli?
Appetitive systems - seeking behaviours
Aversive systems - avoidant behaviours
What hormones are the 2 brain systems involved in response to external stimuli controlled by?
Appetitive system - dopamine
Aversive system - serotonin
What are schema?
Deep rooted, unconditional basic beliefs that stem from early childhood experiences that are pervasive, stable and shape our assumptions and automatic thoughts
When is anxiety classed as a disorder?
When symptoms are so marked in respect to severity or context that they impact a patient’s life
More extreme than is ‘normal’ or ‘necessary’, and in situations that are not ‘normally’ anxiety provoking
What are physical symptoms of anxiety?
Tremor Sweating Palpitations Chest pain Difficulty breathing Nausea Hot flashes, cold chills Dizziness or lightheadedness Difficulty talking Lump in throat, difficulty swallowing
What are cognitive symptoms of anxiety?
Mind blanks Racing thoughts Feeling tense Reduced concentration Hyper-vigilance Derealisation Depersonalisation Worrying about health and physical symptoms
What is derealisation?
Feeling that the world around you is unreal
What is depersonalisation?
Feeling that the self is distant or not really here
What are behavioural symptoms of anxiety?
Restlessness Agitation Irritability Avoidance of triggers Exaggerated response to minor situations Seeking reassurance Use of drugs and alcohol to cope
What are the examples of anxiety disorders?
Generalised anxiety disorder
Panic disorder
Phobias: agoraphobia, social phobia and specific phobia
Obsessive compulsive disorder
What is the clinical course of generalised anxiety disorder?
Chronic, fluctuating
What is generalised anxiety disorder?
Excessive worry that is persistent and generalised, free-floating (not restricted to particular circumstances) and present for most days for at least 6 months
What are physical disorders that present similarly to anxiety?
Arrhythmia, asthma, hyperthyroidism, irritable bowel syndrome
What is the non-pharmacological management of generalised anxiety disorder?
Psychoeducation
Guided self-help (relaxation techniques, sleep hygiene, meditation, exercise)
CBT
How can CBT help in anxiety?
Based on identifying an individual’s automatic thoughts, cognitive biases and schemas
Help the individual identify thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety
What are the pharmacological options for management of generalised anxiety disorder?
- SSRI (sertraline)
- SNRI (venlafaxine)
- Pregabalin
- consider beta blockers for physical symptoms, consider short course of benzodiazepines
What is panic disorder?
Recurrent attacks of severe anxiety
What are the characteristics of panic attacks?
Not consistently associated with a specific situation
Not associated with exertion or exposure to dangerous situations
Discrete episode of fear or discomfort associated with multiple physical and psychological symptoms of anxiety
Onset is abrupt and symptoms crescendo in severity
Last a few minutes
Why does avoidance behaviour occur in panic disorder?
Individuals develop an anticipatory fear of having another attack which causes a lot of distress so they avoid things that could trigger an attack
What disorder is seen in 2/3rds of patients with panic disorder?
Agorophobia
What is the management for an acute panic attack?
Reassurance, encourage to slow breathing
Benzodiazepines
What is the non-pharmacological treatment for panic disorder?
Psychoeducation
Guided self-help
CBT
What is the pharmacological treatment for panic disorder?
- any SSRI
- tricyclic - clomipramine, imipramine
- venlafaxine
What are phobias?
Disorders where anxiety occurs only in particular circumstances
Anticipatory anxiety at the prospect of encountering the circumstance
Avoidance behaviour to prevent exposure
Recognised as irrational by the patient
What are the disorders included in ‘phobias’?
Specific phobia
Agoraphobia
Social phobia
What are specific phobias?
A marked and persistent fear caused by a specific situation or object
Exposure to the stimulus provokes an immediate anxiety response
What are the management options for specific phobias?
CBT - graded exposure
Short term benzodiazepines
What is agoraphobia?
Phobia associated with fear of being in unfamiliar places in which they cannot easily escape from - crowds, public places, travelling alone or away from home
What are management options for agoraphobia?
Psychoeducation and relaxation techniques
CBT - graded exposure
SSRI (fluoxetine)
What is social phobia?
A marked, persistent and unreasonable fear of being observed or evaluated negatively by other people in social or performance situations - e.g. public speaking, classes, parties
The fear results in severe avoidance of triggering circumstances
What are management options in social phobia?
Psychoeducation CBT Social skills training SSRI Alternatives: SNRI, clonazepam, gabapentin
What is OCD?
Recurrent obsessive ruminations, images or impulses, and/or recurrent physical or mental compulsive acts
What are obsessions?
Recurrent, intrusive and distressing thoughts or ideas that are unwanted and out of the patient’s control
Ego-dystonic
What does ego-dystonic mean?
Cause distress, not what they agree with or want to be thinking about
What are compulsions?
Repetitive behaviours that the individual is driven to carry in order to reduce anxiety
Not enjoyable
Recognised as irrational by patient but need to reduce anxiety overcomes rational thought
Resisting causes distress and ability to do so diminishes over time
What is needed for a diagnosis of OCD?
Obsessional symptoms or compulsive acts must be present most days for at least 2 weeks
Must be a source of distress and interfere with activities
What is the non-pharmacological treatment of OCD?
Psychoeducation and self-help
Response prevention - after preparing them, get them to do something that would trigger a compulsion and tell them to resist it for increasing amounts of time
What is the pharmacological treatment of OCD?
- SSRI
- tricyclic - clomipramine
Augmentation: risperidone, lamotrigine
What is done if there are significant anxiety related symptoms and impaired function AND moderate/severe depression?
Treat depression
What is the diagnosis if there are significant anxiety related symptoms and impaired function AND trauma history and flashbacks?
PTSD
What is the diagnosis if there are significant anxiety related symptoms and impaired function AND obsessions +/- compulsions?
OCD
What is the diagnosis if there are significant anxiety related symptoms and impaired function AND uncontrollable worry about several areas?
Generalised anxiety disorder
What is the diagnosis if there are significant anxiety related symptoms and impaired function AND intermittent panic/anxiety attacks and avoidance AND fear of social scrutiny?
Social phobia
What is the diagnosis if there are significant anxiety related symptoms and impaired function AND intermittent panic/anxiety attacks and avoidance caused by a discrete object/situation?
Specific phobia
What is the diagnosis if there are significant anxiety related symptoms and impaired function AND intermittent panic/anxiety attacks and avoidance AND some uncued/spontaneous attacks?
Panic disorder
