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Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Risk factors for anxiety disorders

A

Lower social class

Unemployment

Divorced

Renting rather than owning

No educational qualifications

Urban living

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2
Q

Differentials for anxiety disorders

A

Hyperthyroidism

Cardiac disease

Medication-induced anxiety

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3
Q

What medications can induce anxiety?

A

Salbutamol

Theophylline

Corticosteroids

Antidepressants

Caffeine

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4
Q

ICD-10 criteria for generalised anxiety disorder

A

Generalised and persistent “free-floating” anxiety symptoms involving elements of:

Apprehension

Motor tension

Autonomic overactivity

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5
Q

Differentials for GAD

A

Hyperthyroidism

Substance misuse

Excess caffeine

Anxious personality disorder

Dementia (early)

Schizophrenia (early)

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6
Q

Clinical features of GAD

A

Depersonalisation (altered/lost sense of personal reality/identity)

Derealisation (surroundings feel unreal)

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7
Q

Conservative management of GAD

A

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

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8
Q

Pharmacological management of GAD

A

Sertraline is first line SSRi

If sertraline ineffective, try alternative SSRI or SNRI

SSRI/SNRI not tolerated, try pregabalin

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9
Q

What must patients under 30 be warned of when starting SSRIs?

A

Initial increased risk of suicide & self-harm

Recommend weekly follow up for first 30 days

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10
Q

ICD-10 criteria for panic disorder

A

Recurrent attacks of severe anxiety not restricted to any particular situation or set of circumstances

Secondary fears of dying, losing control or “going mad”

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11
Q

How to distinguish panic disorder from GAD

A

Panic disorder attacks usually last for minutes

Comparative freedom from anxiety symptoms between attacks

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12
Q

Panic disorder differentials

A

GAD & agoraphobia

Depression

Alcohol or drug withdrawal

Organic causes e.g. CVS or respiratory disease, hypoglycaemia, hyperthyroidism, phaeochromocytoma

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13
Q

Conservative management of panic disorder

A

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)

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14
Q

Pharmacological management of panic disorder

A

SSRIs first line drug treatment

Clomipramine

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15
Q

ICD-10 criteria for specific phobias

A

Fear restricted to highly specific situations such as proximity to particular animals, heights, hunger, flying, blood etc.

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16
Q

What is important to exclude in specific/isolated phobas?

A

Co-morbid depression

17
Q

ICD-10 criteria for agoraphobia

A

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)

18
Q

Differentials for agoraphobia

A

Depression

Social phobia

OCD

Schizophrenia

19
Q

ICD-10 criteria for social phobia

A

Fear of scrutiny by other people in comparatively small groups, leading to avoidance of social situations

20
Q

Differentials for social phobia

A

Shyness

Agoraphobia

Anxious personality disorder

Poor social skills/autistic spectrum disorder

Benign essential tremor

21
Q

Distinguishing between social phobia and benign essential tremor

A

BET is familial, worse in social situations, responds to benzo and alcohol

22
Q

Investigations in anxiety disorders and phobias

A

History & examination

Rating scales of anxiety e.g. Beck Anxiety Inventory and HADs score

Social and occupational assessments for effect in QoL

Collateral history

23
Q

Management of specific/isolated phobias

A

Behvaioural therapy

Exposure techniques aiming to reach systemic desensitisation e.g. flooding, modelling

24
Q

Management of agoraphobia and panic disorders

A

CBT 1st line

SSRIs and MAOIs (phenelzine) 2nd line

25
Q

Management of social phobia

A

CBT

SSRIs and MAOIs (phenelzine

26
Q

What is obsessive compulsive disorder?

A

Recurrent obsessional thoughts and/or compulsive acts

Psychiatry (15 decks)

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