Anxiety Disorders Flashcards
def: anxiety
normal response to threat or dagner and part of normal human experince
can become MH problem if response exaggerated , lasts more than 3 weeks and interferes with daily life
aetiology: anxiety disorder
- hyperfunction of noradrenline
- hypofunction of serotonin
- dysfunction of GABA
epidemiology: anxiety disorders
- lifetime prevalence = 15%
- F:M 2:1
- multifactorial: genetics, neurobiological factors, childhood factords, personality types and environmental factors (stress)
- usually <25 y/o beginning
RFs: anxiety
- genetic: panic disorder x3 likely if in 1st degree reatives
- neurochemical abnormalities (hpo serotonin, hyper noradrenaline, GABA)
- environmental: stress, life events or chilhood stress/trauma
presentation: anxiety
cognitive
* agitation
* feeling of impending doom
* poor concentration
* insomnia
* repetitive thoughts and activities
somatic:
* tension
* trembling
* sense of collapse
* butterflies in stomach
* hyperventilation
* sweating
* palpitations
* globus hystericus feeling of having lump in throat
physcial:
* CV: palpitations, tachycardia, chest discomfort
* GI: dry mouth, abdominal pain, freq/loose motions, nausea
* respiratory: hyperventilation, difficult catchign breath, cheest tightness, feeling of choking
* GU: urinary frequency, erectile failure, amenorrhoea
* other: hot flushes/cold chills, tremor, headache, muscle pains, numbness/tingling around mouth and extremeties, feeling dizzy, fear of dying, fearof losing control
presentation: acute anxiety
STUDENTS Fear C’s
Sweating
Trembling
Unsteadiness or dizziness
Dissociation
Elevated HR
Nausea
Tingling
Shortness of breath
Fear of dying, losing control or going crazy
Chest pain
Chills
Choking
presentation: chronic anxiety
MISERA-ble
Muscle tension
Irratability
Sleep difficulty
Energy (decreased)
Restlesness
Attention (decreased)
-ble
rx: anxiety
- CBT - should be first line
- medications used sparingly (SSRI most common)
tx: anxiety
- SSRI first line
- 2nd line - alternative SSRI or SNRI (duloxetine)
- unable to tolerate SSRI/SNRI - pregabalin
- benzodiazepines ((risk of dependence) - short term
- beta blockers
def: generalised anxiety disorder
EGADS! I’m MISERA-ble
Excessive
Generalised
Anxiety Days (most)
Six or more months
worries in multiple arreas of life and out of proportion (not uying house for fear of earthquakes, not getting in relationship for fear of cheating etc)
MISERA-le - 3 or more symptoms for 6+ months
rx: GAD
- CBT
- SSRI
- uspirone
- (benzos)
def: panic attakcs
5-10 minutes of STUDENTS Fear C’s symptoms
presentation: panic attacks
STUDENTS Fear C’s
Sweating
Trembling
Unsteadiness or dizziness
Dissociation
Elevated HR
Nausea
Tingling
Shortness of breath
Fear of dying, losing control or going crazy
Chest pain
Chills
Choking
def: agoraphobia
anxiety in situations where escape may be difficult (fearing leaving home, travelling alone, crowded or public places)
epidemiology: agoraphobia
F:M 3:1
bimodal distribution - later in life may be associated with physical frailty
rx: agoraphobia
pharmacological:
* 1st line SSRI
* benzodiazepines only short term
psychological:
CBT inc applied relaxation and exposure therapy
def: social phobia
anxiety in social situations assoc. with low self-esteem and fear of criticism
may present with physical symptoms of anxiety - blushing, tremor, nausea, urgency of micturation
avoidance
epidemiology: social phobia
bimodal distribution - childhoodd and adolescence
rx: social phobia
pharmacological:
* 1st line SSRI
* benzodiazepines short term
* B-blockers for autonomic symptoms
psychological:
* CBT
rx: specific phobias
pharmacological:
* not used
psychological:
* exposure hierarchy
* applied relaxation
* exposure
def: panic disorder
- period of intense anxiety characterised by many symptoms reaching peak itensity in about 10 minutes and generally not lasting more than 20-30 minutes
- recurrent panic attacks not restricted to a particular situation
symptoms: panic attacks
autonomic arousal - palpatations, chest pain, choking sensation, dizziness
derealisation/depersonalisation
fear of dying/losing control/going mad
hyperventilation
epidemiology: panic disorder
F:M 2-3:1
highest peak in late adolescence/early adulthood
rx: panic disorder
pharmacological:
1st line: SSRI
benzodiazepines only sort term
psychological:
CBT
