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3a psychiatry > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

What is anxiety

A
  • a normal physiological response to potential threat/ danger
  • subjective, unpleasant sense of unease and worry
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2
Q

What is generalised anxiety disorder

A

excessive and disproportional anxiety, which is not related to a specific event, that negatively impacts the person’s everyday activity

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3
Q

Give 6 key features of anxiety. What is required for diagnosis

A

Excessive anxiety and worry associated with 3 or more of the following:
* Restlessness
* irritability
* difficulty concentrating
* easily fatigued
* sleep disturbance
* muscle tension
(symptoms present for more days than not for the past 6 months)

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4
Q

Give some physical symptoms of anxiety

A
  • tension headaches
  • Sweating
  • palpitations and tachycardia
  • diarrhoea and nausea
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5
Q

Give 5 secondary causes of anxiety

A
  • hyperthyroidism
  • alcohol/ drug abuse
  • drug withdrawal
  • phaeochromocytoma - tumour of medulla and adrenal glands
  • hypoglycaemia
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6
Q

What medications may trigger anxiety

A
  • salbutamol
  • theophylline
  • corticosteroids
  • antidepressants
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7
Q

What questionnaire is used to assess the severity of anxiety

A

generalised anxiety disorder questionnaire (GAD-7)

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8
Q

Describe GAD-7

A

7 questions each scored depending on how often the symptoms are experienced.

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9
Q

Describe the step-wise approach to managing generalised anxiety disorder

A
  1. education about GAD + active monitoring
  2. low-intensity psychological interventions(non-facilitated or guided self-help
  3. high-intensity psychological interventions (CBT) or drug treatment
  4. highly specialist input e.g. Multi agency teams
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10
Q

What is the drug treatment for managing generalised anxiety disorder

A
  • first line: sertraline
  • 2nd line: alternative SSRI or SNRI
  • pregabalin if above ineffective/ not tolerated
  • propranolol - reduce sympathetic overactivity
  • benzodiazepines - only short term/ crisis
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11
Q

What are panic attacks

A
  • sudden onset of intense physical and emotional symptoms of anxiety
  • last <20 mins
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12
Q

Features of a panic attack

A
  • physical: dry mouth, palpitations, sweating, SOB
  • Emotional: panic, fear, danger, depersonalisation
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13
Q

What is a panic disorder

A
  • unpredictable recurrent panic attacks resulting in worry about further attacks and maladaptive behaviour
  • > 4 episodes within one month
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14
Q

How are panic disorders managed

A
  • recognition and diagnosis
  • CBT or drug treatment
  • Drugs: SSRIs first line, if CI/ ineffective after 12w -> imipramine or clomipramine
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15
Q

What is social phobia

A

fear of social situations due to preoccupation about being judged negatively by others

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16
Q

What is a phobia

A

extreme, irrational fear of certain situations/ things causing symptoms of anxiety and panic

17
Q

Define agoraphobia

A
  • fear of unfamiliar surroundings in which they may be unable to escape if something goes wrong
  • avoidance of open air/ crowded spaces
18
Q

What is post traumatic stress disorder (PTSD)

A

Condition that may develop following exposure to a traumatic event/ experience

19
Q

State 4 examples of events that could cause PTSD

A
  • military/ war/ combat
  • major health event - heart attack, traumatic childbirth
  • violence - SA, domestics, abuse
  • natural disasters
20
Q

Give 3 core features of PTSD

A
  • re-experiencing the event in the present (flashbacks, nightmares)
  • deliberate avoidance of triggers
  • hyperarousal - hypervigilance, exaggerated startle response
21
Q

Give 5 additional features of PTSD

A
  • dissociation and depersonalisation
  • emotions - anger, shame, depression
  • sleep disturbance
  • social withdrawal
  • suicidality
22
Q

How long should symptoms be present to make a diagnosis of PTSD

A

should be present for at least one month

23
Q

How is PTSD managed psychosocially

A
  • risk assess - others, self (suicide)
  • Trauma-focused CBT
  • eye movement desensitisation and reprocessing (EMDR) therapy
  • support groups
24
Q

How is PTSD managed pharmacologically

A

only if adult has a preference for drug Tx or CBT/ EMDR therapy ineffective
* SSRI - sertraline
* SNRI - venlafaxine
* severe cases: risperidone
* <18y - don’t offer meds

25
Q

What is obsessive compulsive disorder

A

mental health disorder characterised by persistent obsessions and compulsions

26
Q

Define an obsession

A

an unwanted intrusive thought, image or urge that repeatedly enters the person’s mind

27
Q

Define a compulsion

A
  • repetitive behaviours or mental acts that the person feels driven to perform
  • A compulsion can either be overt and observable by others or a covert mental act that cannot be observed
28
Q

Give an example of an obsession

A

overwhelming fear of contamination with dirt or germs

29
Q

Give an example of a compulsion

A
  • overt: repeatedly checking that all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down
  • covert: repeating a certain phrase or words in one’s mind
30
Q

Describe the cycle in OCD

A

obsession
anxiety
compulsion
temporary relief
obsession reappears - cycle reoccurs

31
Q

RFs of OCD

A
  • family history
  • age: peak onset is between 10-20 years
  • pregnancy/postnatal period
  • history of abuse, bullying, neglect
32
Q

What is the scale used to assess the severity of OCD

A

Yale-Brown obsessive-compulsive scale (Y-BOCS)

33
Q

How is OCD with mild functional impairment managed

A
  • low-intensity CBT with exposure and response prevention (ERP)
  • If this is insufficient/ inappropriate, offer SSRI or more intensive CBT + ERP
34
Q

How is OCD with moderate functional impairment managed

A
  • offer choice of SSRI or more intensive CBT (including ERP)
  • consider clomipramine if trialled SSRI has been ineffective or poorly tolerated
  • clomipramine may be an alternative first line if the patient prefers clomipramine or has had a previous good response to it, or if an SSRI is contraindicated
35
Q

How is OCD with severe functional impairment managed

A
  • refer to the secondary care mental health team for assessment
  • whilst awaiting assessment - offer combined treatment with an SSRI and CBT (including ERP) or consider clomipramine as an alternative
36
Q

What SSRI should be given specifically for body dysmorphic disorder

A

fluoxetine

37
Q

Compared to depression, what is usually required for an initial response to SSRIs in OCD

A

Higher doses and a longer duration of SSRI treatment (>12w)

38
Q

If an SSRI is effective in the management of OCD, how long should it be continued to prevent relapse

A

at least 12 months

39
Q

What is exposure and response prevention

A

involves exposing a patient to an anxiety provoking situation and then stopping them engaging in their usual safety behaviour

3a psychiatry (10 decks)

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