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Anxiety Disorders Flashcards

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1
Q

What are the physical differentials for generalised anxiety disorder (GAD)?

A
  • Hyperthyroidism
  • Cardiac disease (palpitation causing conditions)
  • Medication-induced anxiety
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2
Q

Which medications can trigger anxiety?

A
  • Salbutamol (beta agonist)
  • Theophylline
  • Corticosteroids
  • Antidepressants
  • Caffeine
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3
Q

What is IAPT?

A

Improving Access to Psychological Therapy

Offers short-term psychological therapies for people suffering from anxiety, depression and stress

Service users can be referred or can refer themselves

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4
Q

What is the step-wise approach to managing GAD?

A
  • Step 1: Education about GAD and 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 (CBT or applied relaxation) or drug treatment
  • Step 4: Highly specialist input eg. Multi agency teams (complex, treatment refractory GAD)
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5
Q

What are psychoeducational groups?

A

Group behavioural treatments consisting of an explanation of the nature of a service user’s illness, from a multidimentional viewpoint, including familial, social, biological and pharmacological perspectives

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6
Q

What is the first line drug treatment for GAD?

A

Sertraline (SSRI)

For all SSRIs start at the low dose, give 4-6 weeks at that dose and then titrate up if needed

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7
Q

What is the second line drug treatment for GAD?

A

An alternative SSRI or SNRI (eg. duloxetine, venlafaxine)

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8
Q

What drug should be prescribed for GAD if the person can’t tolerate SSRIs or SNRIs?

A

Consider offering pregabalin

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9
Q

What is the guidance for prescribing recommended drugs for GAD in patients <30?

A

SU’s should be warned of increased risk of suicidal thinking and self-harm

Weekly follow up is recommended for the first month

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10
Q

What is the definition of generalised anxiety disorder?

A

General apprehension or excessive worry focused on everyday events not triggered by a specific stimulus

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11
Q

How long do symptoms of anxiety have to be present before a diagnosis is made?

A

Continuous, present for most days over 6 months

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12
Q

What are the risk factors for GAD?

A
  • History of physical/ emotional trauma
  • Low socioeconomic status
  • Substance abuse
  • Chronic physical health problem
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13
Q

What percentage of those diagnosed GAD also have depression?

A

62%

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14
Q

How often should service users (SUs) taking drugs for GAD be monitored?

A

Every 2-4 weeks for the first 3 months, then every 3 months (if <30 monitor 1 week after starting and consider monitoring weekly)

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15
Q

Why should benzodiazepines not be prescribed for GAD?

A

They’re addictive and patients may become tolerant leading to addiction and overdose

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16
Q

What score is used to screen for anxiety?

A

GAD-7 score

It can also be used in conjuction with CBT to monitor treatment efficacy

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17
Q

What is the GAD-7 score?

A
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18
Q

What are the symptoms of a panic attack?

A
  • Pounding/ racing heartbeat
  • Feeling faint, dizzy, light-headed
  • Extreme changes in body temperature
  • Sweating, trembling or shaking
  • Nausea
  • Chest/ abdominal pain
  • Difficulty breathing
  • Shaking legs
  • Feeling disconnected from the mind, body or surroundings
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19
Q

What is panic disorder?

A

Recurrent, unexpected panic attacks not triggered by a specific stimulus or situation, SUs may present with persistnet concern about the recurrent or significant of panic attacks

20
Q

What are the risk factors for panic disorder?

A
  • Traumatic or stressful life experience
  • Close family member with panic disorder
21
Q

What are the investigations for panic disorder?

A

Rule out organic causes:
- Hyperthyroidism
- MI
- Angina

Rule out drug/ alcohol withdrawal:
- CAGE questionnarie
- Urine drug screen (UDS)

22
Q

What is the management of panic disorder?

A
  • Step 1: Recognition and diagnosis
  • Step 2: Treatment in primary care
  • Step 3: Review and consideration of alternative treatments
  • Step 4: Review and referral to specialist mental health services
  • Step 5: Care in specialist mental health services
23
Q

What is the treatment for panic disorder in primary care?

A
  • CBT or drug treatment
  • SSRIs are first-line
  • Benzodiazepines are not indicated
24
Q

What are the alternative drug treatments to SSRIs in panic disorder?

A

If SSRIs are contraindicated or there is no response after 12 weeks, imipramine or clomipramine should be offered

25
Q

What is agoraphobia?

A

Excessive anxiety that occurs in response to multiple situations where escape might be difficult or help may not be available eg. public transport, being in crowds, being outside the home

Usually managed by patients by avoidance (people can become housebound)

26
Q

When is the typical onset for agoraphobia?

A

In the late 20s

27
Q

How is agoraphobia diagnosed?

A

Primarily a clinical diagnosis, may need to do home visits or phone call for initial assessment

Important to rule out organic causes

28
Q

What is the management of agoraphobia?

A
  • Step 1: psychoeducation and lifestyle changes (regular exercise, diet etc), self-help techniques (resist avoidance, breathing exercises, visualisations)
  • Step 2: guided self-help programmes
  • Step 3: individual CBT, applied relaxation
  • SSRIs can be used in severe cases
29
Q

What is applied relaxation?

A
  • Identifying situations in which panic is likely, as well as early panic cues
  • SUs are taught progressive muscle relaxation and learn to become relaxed more and more quickly over the course of treatment
30
Q

What are specific phobias?

A

Marked and excessive anxiety that consistently occurs upon exposure or anticipation of exposure to one or more specific objects or situations that is out of proportion to the acutal danger

31
Q

What is the typical onset for specific phobias?

A

Childhood, 5-9 years old

32
Q

What is the management of specific phobias?

A

Usually not debilitating enough to warrant treatment - avoidance usually works
- Graded exposure

33
Q

What is acrophobia?

A

Fear of heights

34
Q

What is aerophobia?

A

Fear of flying

35
Q

What is aquaphobia?

A

Fear of water

36
Q

What is claustrophobia?

A

Fear of confined spaces

37
Q

What is trypanophobia?

A

Fear of needles

38
Q

What is arachnophobia?

A

Fear of spiders

39
Q

What is nyctophobia?

A

Fear of the dark

40
Q

What is social phobia?

A

Marked and excessive fear or anxiety that consistently occurs in one or more social situations including:
- Social interactions
- Doing something whilst feeling observed (eg. eating and drinking in front of others)
- Performing in front of others (eg. public speaking)

41
Q

When is the typical onset for social phobia?

A

Typically occurs in childhood or adolescence

42
Q

What is the management for social phobia?

A
  • Step 1: individual CBT
  • Step 2: if individual CBT is declined, offer CBT-based support self-help
  • Step 3 (not first line): SSRI (escitalopram or sertraline) - can be alone or in combination with CBT
43
Q

What is the medical management for social phobia?

A

Not first line
- Step 1: SSRI eg. escitalopram or sertraline
- Step 2: Alternative SSRI
- Step 3: Monoamine oxidase inhibitors eg. phenelzine or moclobemide

44
Q

How does CBT for anxiety disorders work?

A

On the basis of exposure, dropping safety behaviours/avoidance and allowing anxiety to habituate

Eventually the levels of anxiety will reduce through repeated exposure

SUs should be warned that anxiety may increase at the beginning of treatment

45
Q

What’s the difference between PTSD and acute stress disorder?

A

Acute stress disorder is an accute stress reaction that occurs within 4 weeks of the traumatic event, PTSD is diagnosed after 4 weeks

Psych (13 decks)

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