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Y4 Psych > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

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1
Q

What is Anxiety?

A

unpleasant emotional state involving subjective fear and somatic symptoms, impacting daily life

prevalence 14%

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2
Q

What are some types of anxiety disorders?

A
  • phobic anxiety
  • panic
  • GAD
  • OCD
  • adjustment disorder
  • PTSD
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3
Q

How might anxiety be investigated?

A

FBC - infection
TFT - hyper
glucose - hypo
ECG - tachycardia

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4
Q

What is General Anxiety Disorder?

A

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

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5
Q

What are some symptoms of GAD?
(psychological, physical)

A

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

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6
Q

What is the rough aetiology of GAD?

A

upbringing - predispose, not cause
personality type - more likely to worry or PD and coping
stressful life events or ways of thinking and behaving

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7
Q

How is GAD diagnosed?

A
  • 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 )
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8
Q

What are some differentials of GAD?

A

depression
schizophrenia
dementia
caffeine withdrawal
physical illness: thyrotoxicosis, pheochromocytoma etc

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9
Q

What is GAD treatment?

A

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

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10
Q

What is the role of pharmacotherapy in the management of anxiety?

A

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.

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11
Q

What are some cautions to consider when prescribing SSRI?

A

cough medication alongside, drowsiness
concomitant NSAID use has bleeding risk
cocaine use alongside cause serotonin syndrome

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12
Q

What is a phobia?

A

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

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13
Q

What is agoraphobia?

A

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

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14
Q

What are the ICD-10 criteria for agoraphobia?

A

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)

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15
Q

How might agoraphobia be managed?

A

exposure
antidepressants
CBT

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16
Q

What is social phobia?

A

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”

17
Q

What are the ICD-10 criteria for social phobia?

A

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

18
Q

How might social phobias be managed?

A

exposure
SSRI/ moclobemide (MOAI)
anxiolytics
CBT

19
Q

What is panic disorder?

A

recurrent , episodic , severe panic attacks, which are unpredictable and not restricted to any particular situation or circumstance.

ate adolescence to early adulthood onset

20
Q

What is Panic disorder characterised by?

A
  • 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
21
Q

How is panic disorder managed?

A
  • 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
22
Q

What is OCD?

A

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

23
Q

Differentiate between the obsession and the compulsion.

A

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

24
Q

What is the aetiology of OCD?

A
  • 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
25
Q

What are the ICD-10 criteria for OCD?

A
  • 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
26
Q

What is the OCD cycle?

A

obsessions cause anxiety
carrying out compulsion relieves
compulsion reinforces obsession

27
Q

How is OCD managed?

A

CBT including ERP (exposure to obsession without acting compulsion, anxiety reduces overtime)
SSRI - fluoxetine etc // MOAI clomipramine
psychoeducation, distracting techniques, manage risks, treat depression

28
Q

What is Post traumatic stress disorder?

A

intense, prolonged, delayed reaction following exposure to exceptionally traumatic event

29
Q

How is PTSD differentiated from acute stress and adjustment disorder?

A
  • 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
30
Q

What are the clinical features of PTSD?

A
  • 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
31
Q

What are the ICD-10 criteria for PTSD?

A
  • 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
32
Q

How might PTSD be managed?

A
  • 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

Y4 Psych (19 decks)

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