Anxiety disorders Flashcards
Define anxiety
NICE define the central feature as an ‘excessive worry about a number of different events associated with heightened tension.’
physical differentials for GAD
alternative causes include hyperthyroidism, cardiac disease and medication-induced anxiety, phaemochromocytoma, paroxysmal tachycardia, meniere’s disease, demetnia, MS, lupus, infection, anaemia
medications that can trigger anxiety
salbutamol, theophylline, corticosteroids, antidepressants and caffeine
management of GAD
step 1: education about GAD + active monitoring
step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment. See drug treatment below for more information
step 4: highly specialist input e.g. Multi agency teams
first line pharmacological tx of GAD
sertraline
other options - SNRI (duloxetine, venlafaxine), pregablin
sertraline risks <30 yr patients
weekly follow up for first month
management of panic disorder
CBT or drug therapy
SSRI’s first line, then <12 weeks, imipramine/clomipramine
types of anxiety disorders
- continuous/GAD
- Phobia anxiety disorder -> specific isolated phobia, social phobia, agorophobia
- Panic disorder/episodic
- Agoraophobia with panic
-PTSD - Health anxiety (hypochondriasis)
- OCD
- Body dysmorphic disorder
prevalence of anxiety disorders
common
most severe condition - GAD as half of pts require tx
younger women
phobias - younger onset
GAD sx
apprehension, difficult concentrating, motor tension (restless, fidget, tension headaches),
autonomic overactivity - dry mouth, loose stools, tight chest, palpitation, mictruition urgent, erectile dysfunction, amenorrhoea, tremor, tinnitus, insomnia
define panic disorder - with or without agoraophobia
a fear of your own physiological and psychological reactions
bodily changes = impending collapse, insanity or death
if then avoid situation - ie: outside world = agoraphobia
GAD
maintained by belief worry is useful
social anxiety disorder
fear of negative evaluation by others…avoidance, safety behaviours
OCD
unwanted recurring distressing intrusive thoughts or images = obsessions….attaching significance to an intrusive thought
- ego dystonic -> not fit with individuals moral and personality…‘thinks harming patients’
to neutralise distress = compulsions (overt - washing, covert - counting in head)
Body dysmorphic disorder
preoccupation with an imagined defect in appearance…time consuming behaviours
prevalence OCD
103% of population
risk fx for OCD
family history
age: peak onset is between 10-20 years
pregnancy/postnatal period
history of abuse, bullying, neglect
severity of OCD
Y-BOCS scale
mild, mod or severe
severe - >3 hrs a day
treatment OCD
mild - CBT in exposure and response prevention
SSRI or more intense CBT
moderate - SSRI or clomipramine
severe - refer to secondary care mental health for assessment + SSRI + CBT
NOTE - SSRI’s usually require higher dose than for depression
SSRI choice for body dysmorphic disorder
fluoxetine
CBT with ERP
psychological method which involves exposing a patient to an anxiety provoking situation (e.g. for someone with OCD, having dirty hands) and then stopping them engaging in their usual safety behaviour (e.g. washing their hands). This helps them confront their anxiety and the habituation leads to the eventual extinction of the response
PTSD cause
can develop in people of any age following a traumatic event, for example, a major disaster or childhood sexual abuse. It
PTSD diagnostic criteria
symptoms have been present for more than one month.
features of PTSD
re-experiencing - flashbacks, nightmares
avoidance - people, situations
hyperarousal - hypervigilance for threat, exagerrated response, sleep problem
emotional numbing
other features
- depression
- drug/alcohol misuse
- anger
- unexplained physical sx
PTSD management
<4 weeks - watchful waiting
military personnel - tx by armed force
trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy - more severe cases
drug treatments for PTSD should not be used as a routine first-line venlafaxine or a selective serotonin reuptake inhibitor (SSRI),. In severe cases, NICE recommends that risperidone may be used
benzodiazepines
can be used in PTSD alongside SSRI when waiting to work
generally avoid as dependence
benzodiazepine mechanism
enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels
benzodiazepines uses
sedation
hypnotic
anxiolytic
anticonvulsant
muscle relaxant
how long prescribed benzo
2-4 weeks
benzo withdrawn
The dose should be withdrawn in steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight
—> insomnia, irritability, anxiety, tremor, loss of appetite, tinnitus, perspiration, perceptual disturbances, seizures
benzo v barbiturates mechanism
benzo - frequency
barbit - duration
FREQUENCY BEND - DURING BARBEQUE
acute stress disorder
first 4 weeks after person has been exposed to a traumatic event
- negative mood, flashbacks, dissociation
tx with trauma focused CBT or benzo
