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Psychiatry (Brian) > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

What are the 3 models of stress?

A
  • Biomechanical “engineering”
  • Medicophysiological
  • Psychological (transactional)
    • Emphasises interaction between individual and environment
    • Environment does not cause stress, but individual response to stressor does
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2
Q

What are the different foccuses for coping mechanisms?

A
  • Problem focussed
    • Where stressor is modified
    • Such as preparation, studying or interview practice
  • Emotion focussed
    • Modify emotional reaction
    • Such as mental defence mechanisms (denial relaxation training) or taking sedative drugs
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3
Q

What model describes how you need some stress to perform at best?

A

Yerkes Dodson curve

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4
Q

What are human reactions to stress producing anxiety?

A
  • Psychological arousal
    • Fearful anticipation
    • Irritability
    • Sensitivity to noise
    • Poor concentration
    • Worrying thoughts
  • Autonomic arousal
    • Symptoms mediated by autonomic nervous system
      • GI
        • Dry mouth
        • Swallowing difficulties
        • Dyspepsia, nausea and wind
        • Frequent loose motions
      • Resp
        • Tight chest, difficulty inhaling
      • CVS
        • Palpitations/missed beats
        • Chest pain
      • Genitourinary
        • Frequency/urgency of micturition
        • Amenorrhoea/dysmenorrhoea
        • Erectile failure
      • CNS
        • Dizziness and sweating
  • Muscle tension
    • Tremor
    • Headache
    • Muscle pain
  • Hyperventilation
    • Hypocapnia
    • Numbness and tingling in extremities due to carpopedal spasm
    • Breathlessness
  • Sleep disturbance
    • Initial insomnia
    • Frequent waking
    • Nightmares and night terrors
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5
Q

What is seen in psychological arousal in response to stress?

A
  • Psychological arousal
    • Fearful anticipation
    • Irritability
    • Sensitivity to noise
    • Poor concentration
    • Worrying thoughts
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6
Q

What is seen in autonomic arousal in response to stress?

A
  • Autonomic arousal
    • Symptoms mediated by autonomic nervous system
      • GI
        • Dry mouth
        • Swallowing difficulties
        • Dyspepsia, nausea and wind
        • Frequent loose motions
      • Resp
        • Tight chest, difficulty inhaling
      • CVS
        • Palpitations/missed beats
        • Chest pain
      • Genitourinary
        • Frequency/urgency of micturition
        • Amenorrhoea/dysmenorrhoea
        • Erectile failure
      • CNS
        • Dizziness and sweating
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7
Q

What are signs of muscle tension in response to stress?

A
  • Muscle tension
    • Tremor
    • Headache
    • Muscle pain
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8
Q

What is seen in hyperventilation in response to stress?

A
  • Hyperventilation
    • Hypocapnia
    • Numbness and tingling in extremities due to carpopedal spasm
    • Breathlessness
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9
Q

What are signs of sleep disturbances in response to stress?

A
  • Sleep disturbance
    • Initial insomnia
    • Frequent waking
    • Nightmares and night terrors
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10
Q

What is the difference between phobic anxiety disorders and general anxiety disorders?

A

Both have same core anxiety symptoms but the either occur in particular circumstances:

  • Phobias
    • Agarophobia (fear of leaving home and entering crowded places, travelling alone)
    • Social phobia
    • Specific (isolated) phobias
  • General anxiety disorder (GAD)
    • Occurs persistently
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11
Q

What does GAD stand for?

A

General anxiety disorder

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12
Q

What are different kinds of phobias?

A
  • Agarophobia (fear of leaving home and entering crowded places, travelling alone)
  • Social phobia
  • Specific (isolated) phobias
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13
Q

What is agarophobia?

A
  • Agarophobia (fear of leaving home and entering crowded places, travelling alone)
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14
Q

Pathology - generalised anxiety disorders

A

Persistent (several months) and symptoms not confined to a situation or object

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15
Q

Aetiology - generalised anxiety disorders

A
  • No clear line between “normal” anxiety and anxiety disorders
    • Differ in extent of symptoms and durations
  • Stressor acting on personality predisposed to disorder
    • Due to genetic factors and environmental influences since childhood
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16
Q

Epidemiology - generalised anxiety disorders

(sex, prevalence)

A
  • W>M
  • Prevalence 5%
17
Q

Presentation - generalised anxiety disorders

A
  • Psychological arousal
  • Autonomic arousal
  • Muscle tension
  • Hyperventilation
  • Sleep disturbance
18
Q

Differential diagnosis - generalised anxiety disorders

A
  • Psychiatric conditions
    • Depression
    • Schizophrenia
    • Dementia
    • Substance misuse
  • Physical conditions
    • Thyrotoxocosis
    • Phaeochromoctoma
    • Hypoglycaemia
    • Asthma
19
Q

Management - generalised anxiety disorders

A
  • Counselling
    • Clear plan of management
    • Explanation and education
    • Advice regarding caffeine, alcohol, exercise
  • Relaxation training
  • Medication
    • Antideppresants
      • SSRI
      • TCA
    • Not sedatives as high risk dependency
  • Cognitive behavioural therapy (CBT)
20
Q

Classification - phobic anxiety disorders

A
  • 3 clinically important syndromes
    • Specific phobia
      • Common ones include: heights, blood, germs, dentist
    • Social phobia
      • Anxiety in situations where person feels observed or could be criticised
      • Normal presentation combined with blushing and tremor
    • Agorophobia
21
Q

Presentation - phobic anxiety disorders

A
  • Same core features as general anxiety but occur only in specific circumstances
22
Q

Complications - phobic anxiety disorders

A
  • Leads to people avoiding these circumstances
  • Could lead to panic attack
23
Q

Management - social phobia

A
  • CBT
  • Education and advice
  • Medication
    • SSRI antideppresants
24
Q

What are the core features of OCD?

A

Core features are experience of recurrent obsessional thoughts and/or compulsive acts

25
Q

What are obsessive thoughts?

A
  • Ideas, images or impulse
  • Occurring repeatedly and not willed
  • Unpleasant and distressing
  • Recognised as individual’s own thoughts
  • Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist
26
Q

What are compulsive acts of rituals?

A
  • Behaviours that are repeated again and again
  • Not enjoyable
  • Not helpful
  • Viewed by sufferer as
    • Preventing some harm to self or others
    • Viewed as pointless and resisted with key anxiety symptoms accompanying resistance
27
Q

What are the rituals during OCD viewed as by the patient?

A
  • Viewed by sufferer as
    • Preventing some harm to self or others
    • Viewed as pointless and resisted with key anxiety symptoms accompanying resistance
28
Q

Aetiology - OCD

A
  • Genetic
    • Gene coding for 5HT receptors
  • 5HT function abnormalities
29
Q

Epidemiology - OCD

(prevalence, sex)

A
  • Prevalence 2%
  • M=F
30
Q

Management - OCD

A
  • General measures
    • Education and explanation
    • Involve partner/family
  • Serotonergic drugs
    • SSRI such as Fluoxetine
    • Clomipramine
  • CBT
  • Psychosurgery
31
Q

Pathology - PTSD

A

Delayed and/or protracted reaction to a stressor of exceptional severity (would distress anyone), could be:

  • Combat
  • Natural or human0caused disaster
  • Rape
  • Assault
  • Torture
  • Witnessing any of the above
32
Q

What are some things that could cause PTSD?

A
  • Combat
  • Natural or human0caused disaster
  • Rape
  • Assault
  • Torture
  • Witnessing any of the above
33
Q

Aetiology - PTSD

A
  • Stressful event which is of exceptional severity
  • Vulnerability factors
    • Mood disorder
    • Previous trauma – especially as child
    • Lack of social support
    • Female
  • Protective factors
    • Higher education and social group
    • Good paternal relationship
34
Q

What are vulnerability and protective factors for PTSD?

A
  • Vulnerability factors
    • Mood disorder
    • Previous trauma – especially as child
    • Lack of social support
    • Female
  • Protective factors
    • Higher education and social group
    • Good paternal relationship
35
Q

Epidemiology - PTSD

(prevalence, sex)

A
  • 1-4% 1 year prevalence
  • M:F 1:2
36
Q

Presentation - PTSD

A
  • 3 key elements to reaction
    • Hyperarousal
      • Persistent anxiety
      • Irritability
      • Insomnia
      • Poor concentration
    • Re-experiencing phenomena
      • Intense intrusive images
        • Flashbacks when awake
        • Nightmares during sleep
    • Avoiding reminders
      • Emotional numbness
      • Cue avoidance
      • Recall difficulties
  • Can happen months/years after event
37
Q

What are the 3 key elements to PTSD reaction?

A
  • Hyperarousal
    • Persistent anxiety
    • Irritability
    • Insomnia
    • Poor concentration
  • Re-experiencing phenomena
    • Intense intrusive images
      • Flashbacks when awake
      • Nightmares during sleep
  • Avoiding reminders
    • Emotional numbness
    • Cue avoidance
    • Recall difficulties
38
Q

Management - PTSD

A
  • Survivors of disasters screened at 1 month
  • Mild symptoms
    • Watchful waiting and review 1 month on
  • More severe symptoms
    • CBT
    • Eye movement desensitisation and reprocessing
  • Medication
    • SSRI or TCA

Psychiatry (Brian) (16 decks)

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