Anxiety Disorders Flashcards
1
Q
What is anxiety?
A
- Normal
- Can be low or higher level - fight or flight response
- Moderate levels improve performance (eg stress)
- Should be proportionate to situation
2
Q
Fight or flight response
A
- In significant threat to life, body takes certain measures to improve ability to fight or run away - autonomic nervous system activated
- Increased HR, dilating pupils, sweating, RR increases
- In anxiety, this occurs when not appropriate to occur
3
Q
What is neurosis?
A
Older term, used to describe anxiety symptoms (sometimes depression too)
4
Q
Types of stress
A
- Acute stress - helpful in small doses, response to recent or anticipated challenge or event
- Episodic acute stress - feel like always under pressure, do things wrong. Can be exhausting
- Chronic stress - ongoing from long term emotional pressure eg job, family, money issues. Can lead to physical health problems left untreated.
5
Q
When does anxiety become a problem?
A
- When the response is to a perceived threat and not an actual threat
- Symptoms and psychological response/arousal to real threat still occur
- Can be difficult to manage - need to be willing to learn new things quickly and experience more stress before getting better sometimes
(neurosis)
6
Q
What is the psychological model of threat?
A
- Threat causes arousal
- Depends on balance - perceived ability to cope with threat, tendency to react to stress with high arousal (fight or flight), perceived ability to cope with arousal
- Treatment revolves around coping with arousal by nullifying threat or the response
7
Q
Types of anxiety disorder
A
Sometimes people overlap into different groups
8
Q
Ages of development of types of anxiety
A
- Social phobia 11
- Agaraphobia - 20ish
- GAD - 30 years
- Phobias/seperation - 7 years
9
Q
Epidemiology of anxiety disorders
A
- Most severe condition is GAD - over half need treatment
- More common younger women
- Most common condition varies with age
- Some do not need treatment
10
Q
Generalised anxiety disorder - key points
A
- Uncontrollable and diffuse
- Often co-morbid with other conditions (can stand alone)
- Persistent, excessive, unrealistic - worry about everything in life
- Most prevalent 35-55
11
Q
Risk factors for GAD
A
- Genetic factors
- Childhood adversity
- Imbalance serotonin and nordrenaline
- Co-morbid physical health conditions
- Gender - female
- Stressor event - triggers
12
Q
Diagnosis criteria for GAD
A
- Most days for several weeks (usually for several months)
- Apprehension - worries, feeling on edge, difficulty concentrating
- Motor tension - restless, fidgeting, tension headaches
- Autonomic overactivity
ICD-10 = at least 6 months of worry, tension and apprehension about everyday events or problems. At least four symptoms out of list, one of which should be autonomic arousal symptom eg sweating, palpitations or pounding heart, trembling, dry mouth
13
Q
Physical symptoms of GAD - each system
A
- Sometimes can present with globus
- Can start to breathe too fast - develop habit
14
Q
Psychological symptoms of GAD
A
15
Q
Differentials for GAD
A
- Depression - stage of depression, when recovered from deepest depths then get anxious, OR can get agitated depression (appear worried and stressed, pacing, aggressive)
- Schizophrenia - persecutory worries, delusions (if GAD will develop more gradually then become fixed)
- Dementia - can often be confused with severe depression or anxiety
- Withdrawal of substances eg caffeine
- Physical illness - thyrotoxicosis, phaechromocytoma, paroxysmal tachycardia, Meniere’s = most related to adrenaline high
Anxiety disorders are common in schizophrenia
16
Q
GAD management
A
- Psychoeducation - explain, clear plan
- Reduce stressors
- Advise self help
- Psychological therapy - CBT
- SSRI (higher doses in OCD) /SNRI
- Avoid benzodiazepines - will make them feel very good briefly, become tolerant, need more, will reduce willingness to engage in psychological therapies
- Continue treatment after remission to ensure continues
- Mirtazapine can help sleep
17
Q
Cautions for when prescribing SSRI
A
- Short term increase in anxiety - monitor for suicidality if under 30
- Review within a month then 3 monthly
- If use cough medication alongisde –> drowsiness
- Concomitant use of NSAIDs –> bleed risk
- Alcohol use - limits effectiveness
- Cocaine use –> serotonin syndrome
18
Q
When can benzodiazepines be useful in GAD?
A
- Can be useful for flying/in scenarios that can not expose themselves to often
- If needed use diazepam as addiction potential lower than Lorazepam
19
Q
Theory behind SSRI increasing suicide rate
A
- Feel so low have no energy or ability to think about how to commit suicide
- When take SSRI gives slight bit of energy to be able to carry out suicide
- But unsure if this is the case really with new evidence - without SSRIs people can commit suicide
20
Q
Main psychological therapy for anxiety disorders
A
- Cognitive behavioural therapy
- Mixed cognitive and behaviour therapy
- Helps patient understand anxiety - understand thoughts that might trigger
- Thoughts can then impact behaviours which can in turn influence more negative thoughts, can get panic symptoms
- Behaviour then involves actions that make you avoid anxiety -> but then results in more anxiety the next time this situation arises, resulting in more avoidance and this can be attached to other situations - eg fear of presenting –> fear of crowds –> fear of working –> fear of leaving house
21
Q
Stepped care model for GAD
A
- Assess degree of illness and give proportionate treatment
- VitaMinds used in Leicester for CBT - good to self refer as requires motivation to complete so good first step (but often don’t take patients already managed by secondary care)
22
Q
Prognosis of GAD
A
- 50% improve in 3 weks
- 80% have diagnosis
23
Q
Panic disorder
A
- Excessive arousal with fear that the symptoms are evidence of catastrophe
- Collection of symptoms
- No triggers
- Get panic attacks
- Situational triggers can occur
- Comorbid GAD, phobia, hyperventilation, depression, alcohol withdrawal
24
Q
Panic treatment
A
25
Q
Panic treatment NICE if present to A&E
A
26
Q
Simple phobias
A
- Anxiety in particular situations
- Features inc avoidance, anticipatory anxiety, can’t be reasoned away
- Examples include crowds, living things eg snakes
- Managed via self help, medication, CBT, exposure therapy
27
Q
Phobias treatment
A
- Self help
- Medication
- CBT - graded exposure/desensitisation
- Avoid flooding - overwhelming too much too quickly, causes more panic
28
Q
Graded hierarchy of exposure therapy for phobias - snakes as example
A
- Think about them
- See picture
- See movie
- See in real life
- Watch someone do it
- Do it yourself
29
Q
What is agoraphobia?
A
- Fear of crowds, open spaces, difficulty getting home
- Avoidance
- 2 peaks onset - mid 20s and mid 30s
- Reduced with support, can be triggered by distance from home, crowding, open space, social situations
30
Q
Management of agoraphobia
A
- Exposure - hierarchy model
- Antidepressants
- CBT
31
Q
OCD cognitive model
A
- Trigger –> intrusive thought
- We then interpret this (give it meaning) and appraise it and can cause emotion
- We neutralise this with an action (eg wash hands)
- Consequences can result in repetitive cleaning
- This can then repeatedly enter your mind and be distressing as you think you are a bad person
32
Q
Management of OCD
A
- Self help - resist rituals
- Treat with SSRI - high dose sertraline or Clomipramine
- Continue fro 6 months after remission
- CBT - exposure and response prevention - thought stopping
33
Q
PTSD key symptoms
A
- Hyperarousal
- Avoidance of situation
- Re-experiencing the event - true flashbacks, relives the experience
34
Q
What is PTSD?
A
- Reaction to prolonged stress
- After exposure of extremely stressful events - not all exposed to trauma develop PTSD
- Lasts for more than 4 weeks
35
Q
Management PTSD
A
- CBT
- SSRI
- EMDR - eye movement desensitisation and reprocessing - have something move in front of face repeatedly while eyes move (what they do during REM) and recall memories - reprogrammes memories to sit better
36
Q
A
