Anxiety Disorders Flashcards
Pathological anxiety vs normal anxiety?
Pathological is pathological in extent (extremeness) and in context (situations that shouldn’t be anxiety inducing)
What acts as an emotional filter in the brain?
Amygdala
-Assesses whether sensory material via thalamus requires stress or fear response, this is modified by the later received cortically processed signal
(Ie act first, think later)
What is generalised anxiety disorder?
Anxiety which is generalized and persistent but not restricted to, or even strongly predominating in any particular environmental circumstances
Dominant symptoms of GAD?
- Complaints of persistent nervousness
- Trembling
- Muscular tensions
- Sweating
- Light headedness
- Palpitations
- Dizziness and epigastric discomfort
- Irritability
- Easily fatigued
- Sleep disturbance
What must GAD no be due to?
Any other disorder (eg hyperthyroidism)
What does GAD need to be for diagnosis?
Severe enough to be long lasting (most days for at least 6 months)
Not controllable
Causing signif distress/impaired function
Who gets GAD?
Typically: 20-40
2:1 female to male
Treatment of choice for GAD?
Psychoeducation
CBT
Pharmacological treatment of GAD?
SSRIs/SNRIs
Pregabalin
AVOID Benzos because chronic
GAD stepwise treatment?
Panic disorder essential feature?
Recurrent attacks of sever anxiety which are not restricted to any particular situation or circumstances are are therefore unpredictable
Which anxiety is more severe GAD or Panic disorder?
Panic disorder
However it is short lasting and person feels fine after episode (GAD has constant background anxiety)
Dominant symptoms of panic disorder?
- Sudden onset chest pain
- Palpitations
- Choking sensations
- Dizziness and feelings of unreality
- Secondary feeling of fear of dying, losing control or going mad
Which more common GAD or PD?
GAD
Typical onset of PD?
Late adolescence- Mid 30s
Treatment of choice for PD?
CBT
If no benefit from CBT in PD what next?
SSRIs or SNRIS
OR
Tricyclics can be used (clomipramine, despiramine, imipramine, iofepramine)
Benzos only short term
What is agoraphobia?
Well defined cluster of phobias embracing fears of leaving home, entering shops, crowds, and public spaces or travelling alone on trains, buses or planes
People with agoraphobia experience _______ because _________?
Little anxiety
They avoid the situations (like the plague)
Is Agoraphobia normally primary or secondary?
Secondary to PD or depression
First line agoraphobia treatment?
CBT
Exposure therapy
SSRIS/SNRIS only if needed
What is a specific phobia?
Marked and persistent fear that is XSive or unreasonable, cued by presence or anticipation of specific object or situation
Treatment for specific phobias?
Behavioural therapy and graded exposure
Add in CBT if necessary
SSRIS/SNRIS if required can be helpful to augment BT
What is social anxiety disorder?
Persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others
Common symptoms of social anxiety disorder?
Blushing/shaking
Fear of vomiting
Urgency or fear of micturition/defaecation
Treatment of choice for SAD?
CBT
May add SSRI/SNRI, benzos only short term
What is OCD?
Recurrent obsessional thoughts and/or compulsive acts
Criteria for OCD?
- Obsessional symptoms must be present most days for <2 weeks AND be source of distress and interference with activities
- Obsessions must be individuals own thoughts
- Resistance must be present
- Rituals are not pleasant
- Obsessional thoughts/impulses must be repetitive
Mean age of onset for OCD?
20 y/o
What percentage of OCD patients experience at least 1 major depressive episode?
60-90%
Main OCD treatment?
CBT, then may add SSRIs
What is involved in fear response?
Amygdala centred circuit
What is involved in worry?
Cortico-striatal-thalamic-cortical circuit
-This produces apprehension, anxiety and obsessions
What is the main inhibitory transmitter in brain?
GABA
-Reduces activity of neurons in the amygdala and CSTC circuit
What do benzodiazepines do?
Enhance GABA action hence decreasing anxiety
-They target GABA receptors
Main benzos used?
Lorazepam (ativan)
Diazepam (valium)
Chlordiazepoxide (alcohol withdrawal use)
What can benzo overdose be treated with?
Antagonist flumazenil
Symptoms of benzo withdrawal?
Abdo pain Increased anxiety Muscle tension Chest pain Palpitations Sweating Shaking Blurred vision Depression Paraesthesia Nausea Insomnia
Withdrawing someone from BZDs?
Transfer ptnt to equivalent daily dose of diazepam/chlordiazepoxide preferably taken at night
Reduce dose very 2-3 weeks in steps of 2-2.5mg
May take 4 weeks to a year
What does acute stress increase?
Cortisol levels
What can acute stress lead to?
Dose dependant increase in catecholamines and cortisol
(cortisol acts to mediate & shut down stress response through -ve FB it acts on pituitary, hypothalamus, hippocampus and amygdala
Sites responsible for cortisol release
When should GAD treatment be reviewed?
Up to 12 weeks to assess efficacy
The continue treatment for 18 months if effective
