Anxiety Disorders Flashcards
What is Anxiety?
unpleasant emotional state involving subjective fear and somatic symptoms, impacting daily life
prevalence 14%
What are some types of anxiety disorders?
- phobic anxiety
- panic
- GAD
- OCD
- adjustment disorder
- PTSD
How might anxiety be investigated?
FBC - infection
TFT - hyper
glucose - hypo
ECG - tachycardia
What is General Anxiety Disorder?
ongoing, uncontrollable, widespread worry about many events Orr thoughts that patient recognises as excessive and inappropriate
*lasting over 6m with Sx most days
*3% popn
What are some symptoms of GAD?
(psychological, physical)
psychological: fearful anticipation, irritability, restless, poor concentration, anxious thoughts
physical
GI+CVS: tight chest, difficulty breathing, nausea, epigastric discomfort, palpitation
Brain: tremor, fear of dying, pins and needles, headache
general: hot flushes, numbness, irritable
tension: muscle tension, aches
Sleep: insomnia, night terrors
What is the rough aetiology of GAD?
upbringing - predispose, not cause
personality type - more likely to worry or PD and coping
stressful life events or ways of thinking and behaving
How is GAD diagnosed?
- period of at least 6m with prominent tension, worry and feelings of apprehension about daily events
- 4 symptoms and at least 1 of autonomic arousal ( sweating shaking, tremor, dry mouth )
What are some differentials of GAD?
depression
schizophrenia
dementia
caffeine withdrawal
physical illness: thyrotoxicosis, pheochromocytoma etc
What is GAD treatment?
psychoeducation groups for low intensity or CBT for high with relaxation techniques
SSRI/ SNRI
self help and support groups
exercise
treat co-morbid substance uses
What is the role of pharmacotherapy in the management of anxiety?
The first-line drug treatment of choice is an SSRI (sertraline is recommended) If not, SNRI (e.g. venlafaxine or duloxetine)
if both ineffective pregabalin
*review within a month then 3 monthly
*Medication should be continued for at least a year.
*Benzodiazepines should not be offered except as short-term measures during crises as they can cause dependence.
What are some cautions to consider when prescribing SSRI?
cough medication alongside, drowsiness
concomitant NSAID use has bleeding risk
cocaine use alongside cause serotonin syndrome
What is a phobia?
intense, irrational fear of object, situation, place or person that is recognised as excessive or unreasonable
childhood to late adolescent onset
*anxiety, avoidance, anticipatory anxiety which cannot be reasoned
What is agoraphobia?
fear of public spaces where immediate escape would be difficult in the event of a panic attack –> onset mid 20s and mid 30s
onset away from home, anxiety occurs in same place, maintained by avoidance
*leads to anticipatory anxiety, avoidance, anxious thoughts
What are the ICD-10 criteria for agoraphobia?
marked and consistently manifest fear in , or avoidance of, at least 2 of the following
- crowds, public paces, travelling alone, travelling away from home
symptoms of anxiety in feared situation with anxiety symptoms (at least one autonomic)
How might agoraphobia be managed?
exposure
antidepressants
CBT
What is social phobia?
a fear of social situations which may lead to humiliation, criticism or embarrassment, often begins with an acute attack
*fear of scrutiny by other people
“do you ever worry about what ppl think of you”
“does this cause you to avoid situations”
What are the ICD-10 criteria for social phobia?
marked fear or avoidance of being the focus of attentions, or fear of humiliation
at least 2 Sx of anxiety in feared situation plus one of blushing/ fear of vomiting/ urgency or fear of peeing or pooing
How might social phobias be managed?
exposure
SSRI/ moclobemide (MOAI)
anxiolytics
CBT
What is panic disorder?
recurrent , episodic , severe panic attacks, which are unpredictable and not restricted to any particular situation or circumstance.
ate adolescence to early adulthood onset
What is Panic disorder characterised by?
- discrete episode of intense fear or discomfort
- starts abruptly
- reaches a crescendo within a few minutes and lasts at least some minutes
- at least one symptom on autonomic arousal
- other GAD symptoms
How is panic disorder managed?
- SSRI first line, check 12 weeks then TCA, NOT benzo
*Imipramine TCA- helps sleep, ANS arousal - CBT
- self help: information of condition, support groups
- encourage exercise
*hope for improvement within 6m
What is OCD?
recurrent obsessional thoughts or compulsive acts , or commonly both, one of the top ten most disabling illnesses in terms of impact upon quality of life.
*associated with depression
Differentiate between the obsession and the compulsion.
obsession is an unwanted intrusive thought , image or urge that repeatedly enter the individual’s mind, distressing and attempts to resist them (egodystonic)
where as the compulsion is a repetitive, stereotyped behaviour or mental act that a person feels driven into performing: can be overt or covert
What is the aetiology of OCD?
- genetic
- organic: post childhood group A beta-haemolytic streptococcal infections usually 3-12 years
- early experiences
- precipitated by life events, maintained by avoidance or rituals and operant conditioning
What are the ICD-10 criteria for OCD?
- either obsessions or compulsions present on most days for at least 2w
- both must share all of: failure to resist, originate from pt mind, repetitive and distressing, obsessive thought not pleasurable
What is the OCD cycle?
obsessions cause anxiety
carrying out compulsion relieves
compulsion reinforces obsession
How is OCD managed?
CBT including ERP (exposure to obsession without acting compulsion, anxiety reduces overtime)
SSRI - fluoxetine etc // MOAI clomipramine
psychoeducation, distracting techniques, manage risks, treat depression
What is Post traumatic stress disorder?
intense, prolonged, delayed reaction following exposure to exceptionally traumatic event
How is PTSD differentiated from acute stress and adjustment disorder?
- acute: immediate onset following stressor, within hour, Sx diminish within 8-48h
- adjustment: identifiable stressor within one month of onset, Sx present for less than 6m
- PTSD: symptoms onset within 6m and lasting over 6m
What are the clinical features of PTSD?
- reliving: flashbacks, vivd memories, when exposed to similar stressors
- avoidance: any reminders of trauma
- hyperarousal: irritable, concentration difficulty, inability to recall aspects if trauma
- emotional numbing: negative self thoughts, detachment, giving up previously enjoyed activities
What are the ICD-10 criteria for PTSD?
- exposure to stressful event
- persistent remembering
- avoidance of similar situations
- either inability to recall important details or increase psychological sensitivity
- the above within 6m of incident
How might PTSD be managed?
- within 3m: watchful wait, CBT, short term zopiclone for sleep, risk assess
- over 3m: trauma-focused, CBT, EMDR to help brain process the event, meds when little improvement, pt preference, depression alongside like paroxetine, mirtazapine
