Anxiety Disorders Flashcards by amo x

What is anxiety?

It is defined as a constellation of psychological and physiological responses to a potential/uncertain threat

It is an essential function of the central nervous system, which motivates individuals to avoid harm

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What are anxiety disorders?

They are defined as the combination of high trait anxiety and a critical mass of psychosocial stressors, which result in overwhelming of the normal homeostasis of anxiety

This leads to excessive and persistent anxiety in which normally harmless situations seem threatening

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What are the three neurophysiological changes which are related to anxiety disorders?

There is reduced functional connectivity between the prefrontal cortex and the limbic system, which are thought to subserve conscious control/awareness of emotional states

There is single nucleotide polymorphism variations in 5-HT (serotonin) transporter, resulting in diminished 5-HT signalling

There is dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is a central component of the physiological response to stress

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What are the three classifications of anxiety disorders?

Generalised Anxiety Disorder (GAD)

Phobic Anxiety Disorder

Panic Disorder

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What is generalised anxiety disorder?

It is defined as condition in which individuals experience persistent anxiety, which is not restricted to any specific circumstances

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What are the nine clincial features of generalised anxiety disorder?

Fearful Anticipation

Poor Concentration

Muscular Tension/Restlessness

Palpitations

Dizziness

Sweating

Dyspnoea

Chest Pain

Sleep Disturbance

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What is phobic anxiety disorder?

It is defined as a condition in which individuals experience an abnormal anxiety state evoked only by a specific external situation/object, which is not dangerous

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What is the key feature of phobic anxiety disorder?

Avoidance

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What are the three subclassifications of phobic anxiety disorder?

Agoraphobia

Social Phobia

Specific Phobias

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What is agoraphobia?

It is defined as an abnormal anxiety state related to crowds, public places and leaving home

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What is social phobia?

It is defined as an abnormal anxiety state related to social situations

This is due to the individual’s low self-esteem and fear of criticism

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What are the six clinical features of phobic anxiety disorder?

Anticipatory Anxiety

Palpitations

Dizziness

Sweating

Dyspnoea

Chest Pain

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What is anticipatory anxiety?

It is defined as anxiety about thought of exposure to a precipitant

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What is panic disorder?

It is defined as a condition in which individuals experience recurrent, unpredictable episodes of severe acute anxiety, which are not restricted to particular stimuli or situations

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What are the seven clinical features of panic disorder?

Anxiety Crescendo

Fear of Dying

Palpitations

Dizziness

Sweating

Dyspnoea

Chest Pain

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What are the three ABG features of panic disorder?

Increased pH Levels

Decreased CO2 Levels

Normal Oxygen Levels

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What are the four risk factors of anxiety disorders?

Middle Aged, 35 – 54 Years Old

Divorced Or Separation

Living Along

Single Parent

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What are the two protective factors of anxiety disorders?

Young Age, 16 - 24 Years Old

Married

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What two guidelines are used to define the diagnostic criteria of anxiety disorders?

ICD-10

DSM-5

What are the three diagnostic criteria of anxiety disorders?

The anxiety should be persistent for a period greater than six months, during which individuals experience anxiety more days than not

The anxiety results in significant impairment, which affects personal, family, social, education and occupation areas of functioning

The anxiety is not a manifestation of another health condition or the effects of a substance/medication

What are three differential diagnoses of anxiety disorders?

Hyperthyroidism

Atrial Fibrillation

Cardiac Disease

What five drugs can cause anxiety?

Salbutamol

Theophylline

Corticosteroids

Antidepressants

Caffeine

What are the three psychological management options of anxiety disorders?

Psychoeducation

Cognitive Behaviour Therapy (CBT)

Applied Relaxation

What is psychoeducation?

It involves providing patients with information about anxiety and ways in which they can control and minimise it

What is CBT?

It is a talking therapy used to manage the way in which patients think, feel and behave

What is applied relaxation?

It involves educating individuals on how to focus on relaxing their muscles in a particular way during situations that precipitate anxiety

What are the two pharmacological management options of anxiety disorders?

Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

When are SSRIs used to manage anxiety disorders?

They are the first line pharmacological management option

Name two SSRIs used to manage anxiety disorders

Sertraline Citalopram

When are SNRIs used to manage anxiety disorders?

They are the second line pharmacological management option

Name two SNRIs used to manage anxiety disorders

Duloxetine Venlafaxine

What is step one management of anxiety disorders?

Supportive treatment, with psychoeducation and follow up appointments

When are follow up appointments arranged for following initial presentation of anxiety disorders?

> 2 weeks Then monthly appointments for three months

In which patient group should follow up appointments be weekly for first month following initial presentation of anxiety disorders?

Suicidal Risk

Which patient group are deemed at an increased risk of suicide?

Those under the age of 30

What is step two management of anxiety disorders?

Low intensity psychological interventions, usually individual guided self-help CBT or psychoeducational groups

What is step three management of anxiety disorders?

High intensity psychological interventions, usually individual CBT or applied relaxation OR Pharmacological management

What is the first line pharmacological management option of anxiety disorders?

Sertraline

How long should sertraline be trialled for before an alternative SSRI or SNRI is offerred?

12 weeks

What is step four management of anxiety disorders?

Psychiatric referral

Which drug class is contraindicated in anxiety disorders? Why?

Benzodiazepines This is due to their highly addictive effect and rapid tolerance

In which circumstance can benzodiazepines used to manage anxiety disorders?

In cases of transient causes of anxiety or in emergency cases only for a maximum of two weeks

What is the first line management option of panic disorder in primary care?

CBT SSRIs

What is the second line management option of panic disorders in primary care?

Tricyclic antidepressants

Name two tricyclic antidepressants used to manage panic disorder

Imipramine Comipramine