Anxiety disorders Flashcards
What is anxiety?
Anxiety is a feeling of unease, such as worry or fear, that can be mild of severe.
Everyone will feel anxious at some point in their lives e.g. exams, interviews, which is normal.
However, in anxiety disorders, it starts affecting people’s functioning. People find it hard to control their worries, have constant feeling of anxiety that can affect their daily life.
How does anxiety present?
Motor tension
- restless
- fidgeting
- tension headaches
- trembling
- inability to relax
Autonomic over activity
- light headedness
- sweating
- tachycardiac
- epigastric discomfort
- dizziness
- dry mouth
Apprehension
- worries about future
- misfortunes
- feeling on edge
- difficulty in concentrating
What is panic attack?
Panic attack refers to a sudden onset of extreme anxiety and intense fear that usually peaks around a 10 minutes and can last from few minutes to 30 minutes.
It can be spontaneous or situational.
How does panic attack present?
Trembling or shaking
Numbness and tingling
Dizziness
Heart palpitations
Nausea
Chills or hot flushes
Hyperventilation
What is generalised anxiety disorder?
Anxiety that is generalised and persistent.
Described as ‘free floating’ because it is just there regardless of what the environment is.
How is generalised anxiety disorder (GAD) diagnosed?
Clinical diagnosis
- have primary symptoms of anxiety (apprehension, motor tension, and autonomic overactivity)
- must occur for most days for several weeks at a time
- can have symptoms such as low mood
- BUT pt must not meet full criteria for depressive episode, phobic anxiety disorder, panic disorder, or OCD
What is GAD ICD-11? What is the criteria?
Generalised anxiety disorder International Classification of Diseases (ICD-11).
- Excessive worry and apprehension.
- Difficulty controlling worry.
- Associated symptoms: Restlessness, muscle tension, fatigue.
- Significant distress in other important aspects of life (e.g. personal, family, education, social)
- Duration: At least 6 months.
What is the common scoring scales for generalised anxiety disorder (GAD)?
GAD-7
Hospital Anxiety and Depression Scale
- screening in people with physical health problems
How is generalised anxiety disorder (GAD) treated?
Psychological -CBT
Medication:
- 1st line: SSRI (sertraline)
- 2nd line: Venlafaxine, escitalopram
- 3rd line: consider pregabalin
Benzodiazepines (can be useful for short-term)
What is panic disorder?
Recurring panic attacks
- sudden onset of physical and cognitive symptoms
Persistent worry about having another panic attack.
They may avoid situations that trigger attack.
More common in females.
They may experience chest pain and think it’s a heart attack.
What is agoraphobia?
Refers to anxiety and panic symptoms associated with places or situations where escaping that place may be difficult or embarrassing (e.g. crowds, public places).
This leads to avoidance.
Physical health can be linked to this too -for e.g. if pt is worried about having accidents.
More common in females.
What is social phobia?
Overwhelming anxiety in everyday social situations, which leads to desire for escape or avoidance.
Common in teenagers.
What is simple or specific phobia?
Recurring excessive and unreasonable symptoms of anxiety in presence of specific feared object or situations, leading to avoidance.
How is panic disorder treated?
Psychological:
- CBT
Medication:
- 1st line: SSRI (sertraline)
- 2nd line: Clomipramine or Imipramine
- Benzodiazepines (can be useful for emergencies)
Self help:
- directed to useful books
- exercise
- support groups
Tx is not given in any order and can be based on pt preference.
If no response to at least two interventions, then refer to specialist mental health services.
What happens if a pt presents to A&E with a panic attack?
- Ask if they are already receiving tx for panic disorder
- undergo the minimum IVx necessary
- not usually admitted to a medical or psychiatric bed
- refer to primary care for subsequent care
- educate about panic attacks
- offer written information about sources of support, including voluntary and self-help groups.
