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Charis & Ellie VS Psych > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

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1
Q

Pathological anxiety vs normal anxiety?

A

Pathological is pathological in extent (extremeness) and in context (situations that shouldn’t be anxiety inducing)

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2
Q

What acts as an emotional filter in the brain?

A

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)

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3
Q

What is generalised anxiety disorder?

A

Anxiety which is generalized and persistent but not restricted to, or even strongly predominating in any particular environmental circumstances

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4
Q

Dominant symptoms of GAD?

A
  • Complaints of persistent nervousness
  • Trembling
  • Muscular tensions
  • Sweating
  • Light headedness
  • Palpitations
  • Dizziness and epigastric discomfort
  • Irritability
  • Easily fatigued
  • Sleep disturbance
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5
Q

What must GAD no be due to?

A

Any other disorder (eg hyperthyroidism)

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6
Q

What does GAD need to be for diagnosis?

A

Severe enough to be long lasting (most days for at least 6 months)
Not controllable
Causing signif distress/impaired function

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7
Q

Who gets GAD?

A

Typically: 20-40
2:1 female to male

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8
Q

Treatment of choice for GAD?

A

Psychoeducation

CBT

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9
Q

Pharmacological treatment of GAD?

A

SSRIs/SNRIs
Pregabalin
AVOID Benzos because chronic

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10
Q

GAD stepwise treatment?

A
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11
Q

Panic disorder essential feature?

A

Recurrent attacks of sever anxiety which are not restricted to any particular situation or circumstances are are therefore unpredictable

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12
Q

Which anxiety is more severe GAD or Panic disorder?

A

Panic disorder

However it is short lasting and person feels fine after episode (GAD has constant background anxiety)

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13
Q

Dominant symptoms of panic disorder?

A
  • Sudden onset chest pain
  • Palpitations
  • Choking sensations
  • Dizziness and feelings of unreality
  • Secondary feeling of fear of dying, losing control or going mad
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14
Q

Which more common GAD or PD?

A

GAD

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15
Q

Typical onset of PD?

A

Late adolescence- Mid 30s

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16
Q

Treatment of choice for PD?

A

CBT

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17
Q

If no benefit from CBT in PD what next?

A

SSRIs or SNRIS

OR
Tricyclics can be used (clomipramine, despiramine, imipramine, iofepramine)

Benzos only short term

18
Q

What is agoraphobia?

A

Well defined cluster of phobias embracing fears of leaving home, entering shops, crowds, and public spaces or travelling alone on trains, buses or planes

19
Q

People with agoraphobia experience _______ because _________?

A

Little anxiety

They avoid the situations (like the plague)

20
Q

Is Agoraphobia normally primary or secondary?

A

Secondary to PD or depression

21
Q

First line agoraphobia treatment?

A

CBT
Exposure therapy

SSRIS/SNRIS only if needed

22
Q

What is a specific phobia?

A

Marked and persistent fear that is XSive or unreasonable, cued by presence or anticipation of specific object or situation

23
Q

Treatment for specific phobias?

A

Behavioural therapy and graded exposure
Add in CBT if necessary

SSRIS/SNRIS if required can be helpful to augment BT

24
Q

What is social anxiety disorder?

A

Persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others

25
Q

Common symptoms of social anxiety disorder?

A

Blushing/shaking
Fear of vomiting
Urgency or fear of micturition/defaecation

26
Q

Treatment of choice for SAD?

A

CBT

May add SSRI/SNRI, benzos only short term

27
Q

What is OCD?

A

Recurrent obsessional thoughts and/or compulsive acts

28
Q

Criteria for OCD?

A
  • 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
29
Q

Mean age of onset for OCD?

A

20 y/o

30
Q

What percentage of OCD patients experience at least 1 major depressive episode?

A

60-90%

31
Q

Main OCD treatment?

A

CBT, then may add SSRIs

32
Q

What is involved in fear response?

A

Amygdala centred circuit

33
Q

What is involved in worry?

A

Cortico-striatal-thalamic-cortical circuit

-This produces apprehension, anxiety and obsessions

34
Q

What is the main inhibitory transmitter in brain?

A

GABA

-Reduces activity of neurons in the amygdala and CSTC circuit

35
Q

What do benzodiazepines do?

A

Enhance GABA action hence decreasing anxiety

-They target GABA receptors

36
Q

Main benzos used?

A

Lorazepam (ativan)
Diazepam (valium)
Chlordiazepoxide (alcohol withdrawal use)

37
Q

What can benzo overdose be treated with?

A

Antagonist flumazenil

38
Q

Symptoms of benzo withdrawal?

A 
Abdo pain 
Increased anxiety 
Muscle tension 
Chest pain 
Palpitations 
Sweating 
Shaking 
Blurred vision 
Depression 
Paraesthesia 
Nausea 
Insomnia
39
Q

Withdrawing someone from BZDs?

A

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

40
Q

What does acute stress increase?

A

Cortisol levels

41
Q

What can acute stress lead to?

A

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

42
Q

When should GAD treatment be reviewed?

A

Up to 12 weeks to assess efficacy

The continue treatment for 18 months if effective

Charis & Ellie VS Psych (23 decks)

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