Anxiety Disorders Flashcards
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
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
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
What are the three classifications of anxiety disorders?
Generalised Anxiety Disorder (GAD)
Phobic Anxiety Disorder
Panic Disorder
What is generalised anxiety disorder?
It is defined as condition in which individuals experience persistent anxiety, which is not restricted to any specific circumstances
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
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
What is the key feature of phobic anxiety disorder?
Avoidance
What are the three subclassifications of phobic anxiety disorder?
Agoraphobia
Social Phobia
Specific Phobias
What is agoraphobia?
It is defined as an abnormal anxiety state related to crowds, public places and leaving home
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
What are the six clinical features of phobic anxiety disorder?
Anticipatory Anxiety
Palpitations
Dizziness
Sweating
Dyspnoea
Chest Pain
What is anticipatory anxiety?
It is defined as anxiety about thought of exposure to a precipitant
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
What are the seven clinical features of panic disorder?
Anxiety Crescendo
Fear of Dying
Palpitations
Dizziness
Sweating
Dyspnoea
Chest Pain
What are the three ABG features of panic disorder?
Increased pH Levels
Decreased CO2 Levels
Normal Oxygen Levels
What are the four risk factors of anxiety disorders?
Middle Aged, 35 – 54 Years Old
Divorced Or Separation
Living Along
Single Parent
What are the two protective factors of anxiety disorders?
Young Age, 16 - 24 Years Old
Married
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
