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Pyschiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

General anxiety affects X areas of the body

A

6:
- Brain
- Heart
- Lungs
- GIT
- GU system
- Muscles

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2
Q

Anxiety symptoms affecting the brain

A

Feeling of worry
Poor concentration
Depersonalisation
Derealisation
Irritability
Poor sleep

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3
Q

Anxiety symptoms affecting the muscles

A

Tremor
Headache
Muscle ache
Restlessness

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4
Q

Anxiety symptoms affecting the GIT

A

Dry mouth
Flatulence
Frequent/loose stools
Indigestion

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5
Q

Anxiety symptoms affecting the heart

A

Palpitations
Chest discomfort

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6
Q

Anxiety symptoms affecting the lungs

A

SOB - tachypnoea can cause pins and needles
Dizziness
Constricted chest

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7
Q

Anxiety symptoms affecting the GU system

A

Incontinence
Amenorrhoea
Erectile dysfunction

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8
Q

GAD typically affects X year olds

A

35-54

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9
Q

Other risk factors for GAD include

A

Divorced or lone parent
Living alone
Female
Low SES
Poor education
Unemployment

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10
Q

Protective factors for GAD include

A

Cohabiting
16-24 year old
Marriage

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11
Q

The main tool we use to assess GAD in PC is the

A

GAD-7

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12
Q

Other tools we may use to assess GAD include

A

HADS
Becks anxiety Inventory

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13
Q

GAD-7 scoring

A

0-21
5-9 = Mild anxiety
10-14 = Moderate anxiety
15+ = Severe anxiety

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14
Q

The NICE stepwise approach to managing GAD

A

1 - Psychoeducation + active monitoring
2 - Low level psychological intervention
3 - High level psychological intervention + drug intervention
4 - Referral for specialist assessment

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15
Q

Low intensity psychological interventions include

A

Individual non-guided self help - 6 weeks
Individual guided self help for 6 weeks
Psychoeducational groups for 6 weeks

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16
Q

High intensity psychological interventions include

A

CBT for 12-15 weeks
Applied relaxation

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17
Q

Skip straight to step 3 of GAD management if

A

Marked functional impairment at presentation or pregnant woman with GAD

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18
Q

First line drug treatment for GAD

A

Sertraline

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19
Q

If sertraline doesn’t work in GAD, we should switch to

A

alternative SSRI or SNRI

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20
Q

If SSRI/SNRI isn’t tolerated well in GAD, offer

A

pregabalin

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21
Q

SSRI/SNRI use in pregnant women

A

after week 20 of pregnancy it will increase the risk of PPHN therefore aim to treat with lowest effective dose

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22
Q

When should <30 year olds be reviewed if started on SSRI/SNRI

A

After 1 week due to increased suicide risk - everyone else should be reviewed 4/6 weeks after starting.

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23
Q

In what anxiety disorders are males = females epidemiologically

A

OCD
BDD
Social anxiety disorder

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24
Q

How long does stress after trauma need to last to be PTSD - when does it need to occur

A

Needs to occur within 6 months of the trauma, needs to last more than 1 month to be called PTSD. Onset is typically delayed (latency period)

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25
Q

What are the 3 key domains of PTSD symptoms

A

Re-experiencing
Avoidance
Hyperarousal

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25
Q

PTSD re-experiencing symptoms include

A

Flashbacks
Memories
Repetitive thoughts/nightmares

26
Q

PTSD avoidance includes

A

Avoiding people/situations related to trauma

27
Q

PTSD can also cause negative cognition such as

A

Self harm, substance abuse
Depression and anxiety
Numbness, anhedonia
Headaches, dizziness, GI upset

27
Q

PTSD hyper-arousal includes

A

Easy to startle
Insomnia
Hypervigilance
Irritable/restless

28
Q

PTSD investigation

A

Trauma screening questionnaire

28
Q

PTSD sub threshold management

A

Watchful waiting if mild symptoms within a month of trauma

29
Q

PTSD mainstay management

A
  • Trauma focused CBT
  • EMDR used in more severe cases
  • Drug treatment if psychological therapy declined/not responded to
30
Q

PTSD drug managment

A

SSRI or venlafaxine. Last resort = antipsychotics e.g. risperidone if non responsive.

31
Q

Acute stress reaction vs PTSD

A

Much more rapid onset than PTSD.
Doesn’t last longer than 1 month.

32
Q

Possible presentation of acute stress reaction

A

Initial state of daze (tunnel vision, not responding to stimuli, disorientation), followed by either further withdrawal or a state of agitation/anxiety - can get autonomic features of anxiety e.g. flushing, can also get partial amnesia

33
Q

Management of acute stress reaction

A
  • Trauma focused CBT
  • Benzodiazepnes may be used for short term distress
34
Q

X is not recommended for management of acute stress reaction

A

Psychological debriefing following trauma - can increase the risk of developing PTSD

35
Q

When does adjustment disorder need to occur

A

Within 3 months of change, doesn’t last more than 6 months.

36
Q

Adjustment disorder management

A

Support, reassurance - maybe psychotherapy in the form of CBT or group therapy.

36
Q

Symptoms of adjustment disorder

A

Symptoms of anxiety and depression may coexist but they will be subclinical so that neither diagnosis can be made.

37
Q

OCD investigation

A

Yale brown obsessive compulsive scale

38
Q

mild OCD management

A

Low intensity psychological interventions: brief CBT (10 hours- either individual self-guided or group), including ERP

39
Q

moderate OCD management

A

More intensive CBT including ERP or can use drugs - SSRI

40
Q

What does ERP involve?

A

Aims to allow anxiety to habituate: we trigger anxiety through introducing the obsession/thought to the patient, instead of engaging in the compulsion, they experience the anxiety. They learn to adjust to this and then we scale up the obsession trigger.

41
Q

What pharmacotherapy is recommended in OCD

A

SSRI = first line. If they don’t work after 12 weeks we can trial alternative SSRI or clomipramine (TCA)

42
Q

How does pharmacotherapy differ in OCD compared to depression

A

SSRI requires 12 weeks opposed to 4-6 weeks to see effects in OCD, larger dose also required therefore weaning of SSRIs in OCD needs 12 months rather than 6

43
Q

Panic disorder investigations

A
  • TFT - hyperT
  • Depression screen - if depression precedes, it is not panic disorder
  • UDS - substance use
  • ECG - MI
  • BM - hypo
44
Q

Panic disorder management

A
  1. Recognition and diagnosis
    2 (mild-moderate). Primary care treatment: individual self help and information about support groups
    3 (moderate-severe): CBT or SSRI. 2nd line = imipramine or clomipramine (trial for 12 weeks)
  2. Refer to specialist MHS if 2 interventions trialled
  3. Specialist care
45
Q

Phobias, encompass [1,2,3] represent a cluster of anxiety disorders characterized by excessive and irrational fears.

A

Specific phobia, social anxiety disorder (SAD), and agoraphobia

46
Q

What is needed for OCD diagnosis

A

The presence of obsessions and/ or compulsions which cause significant distress and are time-consuming (take up an hour or more of the day).

47
Q

What are obsessions

A

Unwanted intrusive thoughts or images that are egodystonic and cause distress

48
Q

What are compulsions

A

Repeated stereotyped rituals that the individual feels the need to do in order to suppress their anxiety - they can be covert or overt.

49
Q

OCD prognosis

A

Runs a chronic course, with symptoms worsening at times of stress. Without treatment, it is disabling; 50% of cases have comorbid depression.

50
Q

What are phobias

A

Intermittent anxiety occurs in specific but ordinary circumstances. People characteristically avoid or escape feared situations, only seeking treatment when this becomes disabling.

51
Q

What is agoraphobia

A

Fear of large open spaces where you are unable to get to safe place (home)

52
Q

Agoraphobia onset

A

20s- mid 30s - may be gradual or precipitated by sudden panic attack

53
Q

Typical presentation of bad agoraphobia

A

Patient is housebound with close circle of family and friends. Comorbid depression = common

54
Q

What is social phobia

A

Social anxiety disorder = fear of being judged by others. People worry that they will embarrass themselves in public.

55
Q

Social phobia vs agoraphobia

A
  • With social phobia, patients can cope in the agoraphobia situations e.g. large crowds, as long as attention is not on the. ∴ they tolerate smaller situations e.g. dinner parties less well. Patients often worry about particular symptoms e.g. blushing.
  • Social phobia also has a slightly earlier diagnosis than agoraphobia.
56
Q

What is the main symptom of phobias

A

Avoidance is the main symptom, where this is not possible, the person experiences disabling anxiety.

57
Q

What is the mainstay of phobia management

A

Graded exposure therapy

58
Q

What is graded exposure therapy

A

Utilizes systematic desensitization, based on the principle that anxiety habituates and doesn’t last more than 45 minutes ish. There you build up a tolerance over sessions with an increasing stimulus of the phobia

59
Q

How is social phobia usually managed

A

Normally the patient engages in SSBs and active monitoring to avoid embarassment. Therapy focuses on dropping SSBs and confronting (exposure therapy) social situations that challenge assumptions.

Pyschiatry (6 decks)

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