Anxiety Disorders Flashcards
GAD
DSM
Excessive anxiety and worry, occurring more days than not, for ≥6 months, about a number of events or activities. Finds it difficult to control the worry. Causes significant distress or impairment in areas of functioning ≥3 of the following for ≥6 months: - restlessness - easily fatigued - difficulty concentrating - irritability - muscle tension - sleep disturbances
GAD
Investigations
TFT (rule out hyperthyroidism)
Urine drug screen
ECG/Echo
GAD
Management
Stress management
CBT
Pharmacotherapy: SSRI (first choice), SNRI (duloxetine, venlafaxine), TCA, benzodiazepines (short-term only during crisis)
Agoraphobia
DSM
Fear or anxiety about ≥2 of the following situations:
- using public transport
- being in open spaces
- being in closed spaces
- standing in line or being in a crowd
- being outside of the home alone
The individual avoids these situations as they believe that help may not be available if they develop panic-like symptoms or embarrassing symptoms
These situations are actively avoided or endured with intense fear or anxiety.
Typically lasts ≥6 months
Agoraphobia
Management
SSRIs (first line), benzodiazepines, MAOIs, TCAs
CBT, family therapy, insight-oriented psychotherapy
Panic Attacks
Symptoms
Palpitations, accelerated heart rate Sweating Trembling/shaking SOB Feelings of choking Chest pain/discomfort Nausea/abdominal distress Dizziness, light-headedness Chills/heat sensations Paresthesias Derealisation or depersonalisation Fear of losing control Fear of dying
Panic Disorder
DSM
Recurrent unexpected panic attacks
At least 1 of the attack has been followed by ≥1 month of ≥1 of the following:
- persistent concern or worry about additional panic attacks
- significant maladaptive change in behaviour in relation to the attacks
Panic Disorder
Management
Psychological - education, CBT
Pharmacotherapy: SSRI, venlafaxine, TCA, MAOI, benzodiazepines
Obsessive Compulsive Disorder
DSM
Presence of obsessions, compulsions or both.
The OC are time-consuming or cause clinically significant distress or impairment in social, occupations or other important areas of functioning.
Obsessions
Recurrent and persistent thoughts, urges or images that are experienced as intrusive and unwanted .
The individual attempts to ignore or suppress such thoughts, urges or images, or to neutralise them with some other thought or action (i.e. by performing a compulsion).
Compulsions
Repetitive behaviours or mental acts that the individual feels driven 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
OCD
Management
Psychological - CBT (exposure to the cues or triggers and prevention of rituals)
Pharmacotherapy - SSRI, clomipramine (TCA)
PTSD
DSM
Exposure to actual or threatened death, serious injury or sexual violence.
Persistent avoidance of stimuli associated with the event.
Negative alterations in cognition and mood associated with the event
Alterations in arousal and reactivity associated with the event
Duration of disturbances >1 month
Presence of one or more of the following symptoms after the traumatic event:
- recurrent, involuntary and intrusive distressing memories
- recurrent distressing dreams related to the event
- dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the event was recurring
- intense or prolonged psychological distress/reactions at exposure to cues that resemble an aspect of the event
Acute stress disorder
Symptoms of PTSD but within one month of the incident occurring
