Anxiety Disorders Flashcards
Risk factors for anxiety disorders
Lower social class
Unemployment
Divorced
Renting rather than owning
No educational qualifications
Urban living
Differentials for anxiety disorders
Hyperthyroidism
Cardiac disease
Medication-induced anxiety
What medications can induce anxiety?
Salbutamol
Theophylline
Corticosteroids
Antidepressants
Caffeine
ICD-10 criteria for generalised anxiety disorder
Generalised and persistent “free-floating” anxiety symptoms involving elements of:
Apprehension
Motor tension
Autonomic overactivity
Differentials for GAD
Hyperthyroidism
Substance misuse
Excess caffeine
Anxious personality disorder
Dementia (early)
Schizophrenia (early)
Clinical features of GAD
Depersonalisation (altered/lost sense of personal reality/identity)
Derealisation (surroundings feel unreal)
Conservative management of GAD
Step-wise approach
1) Education & active monitoring
2) Low intensity psych interventions (individual non-facilitated or guided self help, psycho-educational groups)
3) High intensity psych interventions (CBT/applied relaxation) or drug treatment
4) Highly specialist input e.g. multi-agency teams
Pharmacological management of GAD
Sertraline is first line SSRi
If sertraline ineffective, try alternative SSRI or SNRI
SSRI/SNRI not tolerated, try pregabalin
What must patients under 30 be warned of when starting SSRIs?
Initial increased risk of suicide & self-harm
Recommend weekly follow up for first 30 days
ICD-10 criteria for panic disorder
Recurrent attacks of severe anxiety not restricted to any particular situation or set of circumstances
Secondary fears of dying, losing control or “going mad”
How to distinguish panic disorder from GAD
Panic disorder attacks usually last for minutes
Comparative freedom from anxiety symptoms between attacks
Panic disorder differentials
GAD & agoraphobia
Depression
Alcohol or drug withdrawal
Organic causes e.g. CVS or respiratory disease, hypoglycaemia, hyperthyroidism, phaeochromocytoma
Conservative management of panic disorder
Reassurance
CBT (effective in 80-100%)
Initial education
Cognitive restructuring
Interoceptive exposure techniques e.g. controlled exposure to somatic symptoms (e.g. breathing in CO2)
Pharmacological management of panic disorder
SSRIs first line drug treatment
Clomipramine
ICD-10 criteria for specific phobias
Fear restricted to highly specific situations such as proximity to particular animals, heights, hunger, flying, blood etc.
What is important to exclude in specific/isolated phobas?
Co-morbid depression
ICD-10 criteria for agoraphobia
Fear not only of open spaces but also related factors e.g:
Presence of crowds
Difficulty of immediate easy escape back to safe place (usually home)
Differentials for agoraphobia
Depression
Social phobia
OCD
Schizophrenia
ICD-10 criteria for social phobia
Fear of scrutiny by other people in comparatively small groups, leading to avoidance of social situations
Differentials for social phobia
Shyness
Agoraphobia
Anxious personality disorder
Poor social skills/autistic spectrum disorder
Benign essential tremor
Distinguishing between social phobia and benign essential tremor
BET is familial, worse in social situations, responds to benzo and alcohol
Investigations in anxiety disorders and phobias
History & examination
Rating scales of anxiety e.g. Beck Anxiety Inventory and HADs score
Social and occupational assessments for effect in QoL
Collateral history
Management of specific/isolated phobias
Behvaioural therapy
Exposure techniques aiming to reach systemic desensitisation e.g. flooding, modelling
Management of agoraphobia and panic disorders
CBT 1st line
SSRIs and MAOIs (phenelzine) 2nd line
