Anxiety disorders Flashcards
Name the curve that describes the effect of anxiety on performance
Yerkes-Dodson Law bell curve
List the psychological theory behind anxiety to a threat
- Reduced perception of ability to cope with threat
- Reduced perception of ability to cope with the symptoms of arousal
- Tendency to react to stress with arousal response
List the ICD-10 classifications of neurotic and stress-related disorders
Acute stress disorders:
- Acute stress reaction
- PTSD (post-traumatic stress disorder
- Adjustment disorder
Phobic anxiety disorders:
- Agoraphobia (with or without panic disorder)
- Social phobia
- Specific phobia
Other anxiety disorders:
- Panic disorder
- GAD (generalised anxiety disorder)
- Mixed anxiety and depressive disorder
Obsessive–compulsive disorder
State the 1 year prevalence of anxiety disorders
14%
Outline the features of generalised anxiety disorder (GAD), according to ICD-10 classification
- Anxiety that is generalised and persistent
- ‘Free floating’ = does not strongly predominate in any particular environmental circumstances
Worrying most days about most things, for a period of 6 months
List some psychological and physical symptoms of generalised anxiety disorder (GAD)
Psychological:
- Anxious thoughts
- Fearful anticipation
- Poor concentration
- Irritability
- Sensitivity
- Avoidance behaviour
Physical:
- Sleep disturbance
- Weight loss
GI - dry mouth, diarrhoea
Respiratory - tachypnoea, tight chest
CVS - tachycardia
Urinary - frequent urination
Neuromuscular - headache, tingling, tremor
State some proposed risk factors for development of anxiety disorders
Often an initial precipitant
- Genetic
- Upbringing
- Personality type e.g. more likely to worry or due to personality disorder
Often maintained by stressful life events or patterns of thinking
State the 3 factors involved in the CBT model
- Thoughts
- Feelings
- Behaviours
List some factors to consider when prescribing SSRIs for anxiety
- Short term increase in anxiety and suicide
- Review within a month, then 3 monthly thereafter
- Drug interactions
List some potential drug interactions for SSRIs
- Cough medication (drowsiness)
- NSAIDs (bleed risk)
- Alcohol (increased potency of alcohol)
- Cocaine (serotonin syndrome)
Outline the management of generalised anxiety disorder (GAD)
Stepwise treatment plan, escalating as appropriate
Step 1: Education (lifestyle measures) + active monitoring
Step 2: Low intensity psychological interventions
Step 3: High intensity psychological intervention
- CBT
- First line medications: antidepressants SSRIs / SNRIs
- Avoid Benzodiazepines (risk of addiction)
(continue treatment after remission for at least 6 months to ensure remission)
Step 4: highly specialist treatment e.g. high intensity psychological intervention, drug treatment, MDT involvement and crisis team
Outline agoraphobia (features from ICD-10 classification) and how it differs from social phobia
Fears of:
- Leaving home
- Entering shops / crowds / public places
- Travelling alone in trains, buses or planes
Co-morbid panic disorder, depressive symptoms, obsessional symptoms and social phobias often
Different from social phobia, fine with social situations, as long as at home
Briefly state what a social phobia is (features from ICD-10 classification)
- Fear of scrutiny by other people, leading to avoidance of social situations
- General anxiety symptoms present
- Symptoms may progress to panic attack
Outline the management of phobias (agoraphobia, social phobia, specific phobia)
- Self-help techniques
- CBT and other talking therapies
- SSRIs
Briefly state what a panic disorder is, based on ICD-10 classification
- Recurrent attacks of severe anxiety (panic)
- Not restricted to any particular situation / circumstances (unpredictable)
- Secondary fear of dying, losing control, or going mad
Briefly state how panic disorder is managed
- Self-help methods, support groups and exercise
- CBT
- SSRIs / SNRI or TCA (DON’T prescribe benzodiazepines)
List general features of PTSD, according to ICD-10 classification (triad plus other features)
Delayed response to an event of exceptionally threatening nature
3 key features:
- Re-experiencing event (flashbacks or nightmares)
- Hyperarousal
- Avoidance behaviours
Other features:
- Anxiety and depression (commonly associated)
- Insomnia
- Anhedonia
- Numbness
- Detachment from others
Symptoms last for > 4 weeks, (generally > 6 months)
The course is fluctuating but recovery can be expected in the majority of cases
Outline the management for post-traumatic stress disorder (PTSD)
Biological:
- Consider SSRIs if patient preference (avoid Benzodiazepines) e.g. Paroxetine or Mirtazepine
- Consider antipsychotics e.g. Risperidone, if severe and disabling
Psychological:
- Individual trauma-focused CBT interventions
- Consider eye-movement desensitisation and reprocessing (EMDR) if non-combat trauma
Social:
- Watchful waiting (if < 4 weeks)
- Support groups
Outline the features of obsessive compulsive disorder (OCD), according to ICD-10 classification
- Recurrent obsessional thoughts
- Compulsive acts
- Distressing thoughts (egodystonic) and try to resist them
- Recognised as patient’s own thoughts
Suggest some factors which may contribute to OCD
Precipitated by life event, maintained by avoidance or rituals
- Genetics
- Early experiences
- Organic e.g. PANDA syndrome
List 3 key features of PTSD
- Re-experiencing event (flashbacks or nightmares)
- Hyperarousal
- Avoidance behaviours
Briefly state the management options for patients with obsessive compulsive disorder (OCD)
- Psychoeducation
- Exposure and response therapy
- CBT
Moderate-severe or treatment resistant:
- Antidepressants (SSRIs)
- More intensive CBT
Briefly outline somatisation disorder (what it is and how it presents)
‘Briquet disorder’
- Multiple, recurrent and frequently changing physical symptoms
- Present for at least 2 years
- Symptoms may be referred to any system / part of body
- Often complicated history of contact with both primary and specialist services
Briefly outline hypochondriacal disorder (what it is and how it presents)
- Persistent preoccupation with the possibility of having one or more serious and progressive physical disorders
- ‘Normal’ sensations often interpreted by patients as abnormal
- Attention is usually focused upon 1 or 2 organs / systems of the body
Briefly outline medically unexplained symptoms and how they are managed
- Persistent symptoms for which examinations fail to reveal sufficient explanatory structural or other specified pathology
- Often presents as: generalised pain, fatigue or altered organ systems (e.g. stomach ache, breathlessness)
- Usually present for > 3 months, with impaired functioning.
Management:
- Reassurance and careful communication
- Screen for underlying mental health problems e.g. anxiety
- Psychosocial support and therapies such as CBT
Extensive investigations are unlikely to add to the diagnosis
Briefly outline somatoform disorder (what it is and how it presents)
- Physical symptoms that cannot be explained by a medical condition, drug or other mental health disorder
- Unconscious process
- Common presenting symptoms: GI symptoms and abdominal pain, fatigue, weakness and MSK symptoms
Briefly outline conversion disorder (what it is and how it presents)
- Psychiatric condition
- Presentation of neurological symptoms without any underlying neurological cause e.g. paralysis, pseudo-seizures, sensory changes
- Unintentional process, symptoms are very much “real” to the patient
- Linked to emotional stress
Outline the difference between Munchausen’s syndrome and malingering
Munchausen’s syndrome
- Patients intentionally fake signs and symptoms (e.g. adding blood to urine and complaining of pain)
- Aim is to gain attention and play “the patient role”
Malingering
- Patients intentionally fake or induce illness for secondary gain e.g. drug seeking
Difference is that both conditions have a different aim to why they are deliberately faking illness
Outline the features of adjustment disorder, according to ICD-10 classification
- Subjective distress and emotional disturbance, in response to a significant life change or a stressful life event
- Usually to level of interfering with social functioning and performance
- Persists for no longer than 6 months after stressor
State how a adjustment disorder can present and give some examples of some potential causes of adjustment disorders
Manifestations vary and include:
- depressed mood
- anxiety or worry
- feeling of inability to cope, plan ahead, or continue
May struggle to carry out ADLs
Examples:
- Bereavement
- Separation
- Migration / refugee
- Going to school
- Becoming a parent
- Failure to attain personal goal
- Retirement
Key difference: assumed that the condition would not have arisen without the stressor
Suggest the difference between adjustment disorder and acute stress disorder
In adjustment disorders, the stressful event (losing a job, relationship ending) is typically less traumatic than an event that causes acute stress disorder (sexual assault, mass shooting)
Suggest some management steps for adjustment disorders
Formal treatment is often not needed
Support:
- Help managing the stressful situation e.g. if bullied, contact the school / work
- Psychoeducation
- CBT or psychodynamic therapy
