Anxiety Disorders Flashcards
Anxiety Disorders
Anxiety Causes
Primary vs Secondary
Primary
- Unknown cause
Secondary
- Medical condition
- Medication & drugs
- Psychiatric Disorder
Anxiety Disorders
Medical Conditions that cause anxiety
- Endorine: hyperthyroidism, hypoglycaemia, phaeochromocytoma
- Respiratory: hypoxia, COPD, asthma
- Neurological: epilepsy (especially temporal lobe epilepsy), cerebral trauma, neoplasms
- Cardivascular: arrhythmia, CCF, mitral valve prolapse
Anxiety Disorders
Medications and drugs that cause anxiety
- Common - Caffeine and nicotine
- Meds - captopril, antihistamines, interferon, baclofen, narcotics, theophylline, salbutamol
- Illicit - marijuana, amphetamines, ecstasy
Anxiety Disorders
Psychiatric Disorders that cause anxiety
- Depression
- Schizophrenia
- Organic states (delirium, dementia)
Anxiety Disorders
Anxiety Types
- Panic Attack
- Agoraphobia
- Panic Disorder (+/- agoraphobia)
- Specific Phobia
- OCD
- PTSD
- Acute Stress Disorder
- Generalised Anxiety Disorder
- Anxiety disorder due to a general medical condition
- Substance induced anxiety disorder.
Anxiety Disorders
Panic Attack Definition
A sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks individuals may experience sympathetic over activation (SoB, palpitations, chest pain) chocking, and the fear of losing control.
Anxiety Disorders
Agoraphobia Definition
Anxiety about or avoidance of places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of a Panic Attack or panic-like symptoms.
Anxiety Disorders
Panic Disorder Definition
Recurrent unexpected Panic Attacks about which there is persistent concern. (This may be accompanied by agoraphobia and high medical utilisation).
Anxiety Disorders
Panic Disorder Management
Non-pharmacological - Education - CBT Pharmacological 1st Line - SSRIs - SNRI 2nd line - TCAs - Benzodiazepines - Irreversible MAOIs
Initiation of treatment can increase anxiety which resolves over a few days.
Can be lessened with lower initial doses or short term administration of benzodiazepine.
Anxiety Disorders
Panic Attack Management
Isolated attack
- Non-pharmacological
- Support and stress management for patients and families
Anxiety Disorders
Panic Attack Criteria
at least 4/13 of the following developing abruptly and reaching a peak with in 10 minutes
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of SoB or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Chills or hot flushes
- Paresthesias (numbness or tingling sensation)
- De-realisation (feelings of unreality) or depersonalisation (being detached from ones self)
- Fear of losing control or ‘going crazy’
- Sense of impending death
Anxiety Disorders
Panic Disorder Criteria
Requires all of the following
- Recurrent unexpected panic attacks.
- Significant maladaptive change in behaviour related to the attacks.
- Disturbance is not attributed to physiological effects of a substance or another medical condition
- Disturbance is not better described by another mental disorder (can’t have a particular trigger that would classify it as one of the specific anxiety disorders)
Anxiety Disorders
Panic Disorder Criteria
Requires all of the following
- Recurrent unexpected panic attacks.
- Significant maladaptive change in behaviour related to the attacks.
- Disturbance is not attributed to physiological effects of a substance or another medical condition
- Disturbance is not better described by another mental disorder (can’t have a particular trigger that would classify it as one of the specific anxiety disorders)
Anxiety Disorders
Specific Phobia
Clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour.
Anxiety Disorders
Social Phobia
Clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviour.
Anxiety Disorders
Obsessive Compulsive Disorder
Obsession (which cause marked anxiety or distress) and/or compulsions (which serve to neutralise anxiety)
Anxiety Disorders
Post-Traumatic Stress Disorder
Re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with trauma.
Anxiety Disorders
Acute Stress Disorder
- Similar to PTSD, but occurs immediately in the aftermath of an extremely traumatic event.
- Not longer than 4 weeks from the event.
Anxiety Disorders
Generalised Anxiety Disorder
At least 6 months of persistent and excessive anxiety and worry.
Anxiety Disorders
Anxiety disorder due to a general medical condition
Time-limited, persist for 6 months once stressor ends.
Anxiety Disorders
Selective Mutism
Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g. at school) despite speaking in other situations
Anxiety Disorders
Social Anxiety Disorder
Clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviour.
Anxiety Disorders
Body Dismorphic Disorder
One or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
Anxiety Disorders
Hoarding Disorder
Persistent difficulty discarding or parting with possessions, regardless of their actual value.
Anxiety Disorders
Trichotillomania
(Hair-pulling Disorder)
Repeated pulling out of one’s hair, resulting in hair loss
Anxiety Disorders
Excoriation Disorder
(Skin-Picking)
Recurrent skin picking resulting in skin lesions
Anxiety Disorders
Reactive Attachment Disorder
A consistent pattern of inhibited, emotionally withdrawn behaviour toward adult caregivers
Anxiety Disorders
Disinhibited Social Engagement Disorder
A pattern of behaviour in which a child actively approaches and interacts with unfamiliar adults
Anxiety Disorders
Adjustment Disorder
The development of emotional and behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
Anxiety Disorders
Criteria of OCD
- Either obsessions or compulsions
* Obsessions are defined by:
* Unwanted recurrent thoughts that cause marked anxiety or distress.
* Attempts to ignore or suppress such thoughts neutralise them with some other thought or action (i.e. by performing compulsion)* Compulsions are defined by: * Repetitive behaviours or mental acts to perform in response to an obsession or according to rules that must be applied rigidly. * The behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive. * These are time consuming ( >1 hour/day) or interfere with functioning.
Anxiety Disorders
Management of OCD
Non-Pharmacological
* CBT: Exposure-response prevention
Pharmacological
- 1st Line
- SSRIs
- 2nd Line
- TCAs - clomipramine (SEs - seizures and increased QT interval)
Anxiety Disorders
Criteria of PTSD
- Exposure to actual or threatened death, serious injury, or sexual violence
* Including direct experience, witness, learning of trauma to close member or repeated exposure to the details of a traumatic event.- Presence of intrusion symptoms associated with the traumatic events, beginning after the traumatic event occurred
- Recurrent memories, dreams, dissociative reactions/flashbacks, distress to stimuli or marked physiological stress.
- Persistent avoidance of stimuli associated with the traumatic events, beginning after the traumatic event occurred
- Maladaptive behaviours
- Increased arousal and reactivity associated with the traumatic event
- > 1 month
- Social impairment
- Presence of intrusion symptoms associated with the traumatic events, beginning after the traumatic event occurred
Anxiety Disorders
PTSD Management
Non-PharmacologicalPsychotherapy
- Eye movement desensitisation and reprocessing
- CBT with exposure therapy
PharmacologicalAntidepressants
* SSRIs
Debriefing is no longer indicated
Anxiety Disorders
Criteria of Generalised Anxiety Disorder
- Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)
- The individual struggle to control the worry
- 3+ of the following 6 symptoms (1 in children)
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
- Causes impairment in functioning and not due to a substance or a medical condition
Anxiety Disorders
Management of Generalised Anxiety Disorder
Non-PharmacologicalPsychotherapy
- CBT
- Acceptance and commitment therapy
Pharmacological
- Antidepressants
- SSRIs
- Benzodiazapines
- Diazepam
