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Mood disorders, suicide and self harm > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

What is the prevalence of anxiety disorders?

A
  • Combined 1 year prevalence of 12-17%.

- Generally under diagnosed in primary care or recognised years after onset

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2
Q

What is the 1 year prevalence, age of onset and sex ratio of the following disorders
-Generalised anxiety disorder

Panic disorder

A

Generalised anxiety disorder

  • 2.8% 1 year prevalence
  • Onset; childhood to late adulthood
  • Sex ratio 2-3:1

Panic disorder +/- agoraphobia

  • 3.9% 1 year prevalence
  • Onset: late adolescence to mid 30s
  • Sex ratio; 2-3:1
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3
Q

Social phobia?

Specific phobia?

A

Social phobia

  • 3.7% one year prevalence
  • Onset; mid-teens
  • Sex ratio; equal

Specific phobia

  • 4.4% one year prevalence
  • Onset; childhood to adolescence
  • Sex ratio; 2:1
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4
Q

PTSD?

OCD?

A

PTSD

  • 3.6% one year prevalence
  • Any age - after trauma
  • Sex ratio; 2:1

OCD

  • 2.1% one year prevalence
  • Adolescence to early
  • Sex ratio; equal
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5
Q

Genetic factors

  • What are the 2 most heritable anxiety disorders?
  • What % of those affected have a 1st degree relative with the same diagnosis?
A
  • Panic disorder and OCD
  • 33%

-There is an association between generalised anxiety disorder and relatives who alcohol abuse

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6
Q

Biological factors
What specific disorders may defects in the neurotransmitter system such as abnormal receptors contribute to?

What is associated with hypersensitivity of serotonin receptors?

A
  • Panic disorder and serotonin levels

- OCD is associated with hypersensitivity of some serotonin receptors

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7
Q

Social and psychological factors

-What is essential to diagnose PTSD?

A

-A significant traumatic event
Psychosocial stressors may precede the onset of
symptoms in other anxiety disorders. Anxiety disorders may be predominantly psychological in origin and are a
consequence of inappropriate thought processes and overestimations of
danger (hence why CBT is an effective treatment

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8
Q

Course and prognosis

What is the prognosis of generalised anxiety disorder?

A

Generalised anxiety disorder

  • Likely to be chronic
  • Fluctuating, worse in times of stress
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9
Q

What is the prognosis of panic disorders?

A
  • 50% of pts symptom free in 3 years
  • 33% have chronic symptoms, distressing enough to reduce their quality of life
  • Panic attacks are central to the development of agoraphobia which usually develops within 1 year after the onset of recurrent panic attacks
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10
Q

What is the prognosis of social phobia?

Specific phobias?

A
  • Usually chronic
  • Many adults can have long periods of remission
  • Life stressors may exacerbate symptoms

Specific phobias

  • Less likely to remit if developed in childhood
  • Less is known about these
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11
Q

What is the prognosis of PTSD?

A
  • 50% recover fully in 3 months
  • 33% will have severe-moderate symptoms in the long term
  • The severity, duration and proximity of a pts exposure to the trauma are the most important prognostic indicators
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12
Q

What is the prognosis of OCD?

A
  • Chronic fluctuating course with worsening symptoms during times of stress
  • 15% of pts show a progressive deterioration in functioning
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13
Q

The experience of anxiety consists of what 2 interrelated components?

A
  • Thought of being apprehensive, nervous or frightened and the awareness of a physical reaction to anxiety
  • -The experience of anxiety may then lead to a change of behaviour and particularly the avoidance of the real and imagined threat
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14
Q

There are 2 specific patterns of pathological anxiety what are they?

A
  • Generalised anxiety

- Paroxysmal anxiety

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15
Q

Generalised anxiety

  • How severe is it?
  • How long does each episode last for?
  • What is it associated with?
A
  • Mild to moderate in severity
  • Lasts for hours to days or longer
  • No association with a specific external threat or situation but rather an excessive worry/apprehension about normal life events
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16
Q

Paroxysmal anxiety

  • What is its onset like
  • How severe and what does it present as in its severest form ?
  • How long do episodes last for?
  • What symptoms are they be accompanied by?
  • How can the classification be further divided?
A
  • Abrupt onset, occurs in discreet episodes
  • Severe; severest from presents as panic attacks
  • Episodes last less than an hour are intense and have a short time between onset and peak
  • Autonomic symptoms (tachycardia, palpitations ect), can lead the pt to think they are dying, repeating the cycle
  • Into episodes without a stimulus (panic disorder) and episodes with an external threat (phobia disorders)
17
Q

Phobic disorders
-What are they associated with?

What is agoraphobia?
-How closely related is this with panic disorder?

A

-A prominent avoidance of a feared situation which can take the form of a panic attack

Agoraphobia? the fear of public places or crowded spaces where escape is not easy, especially if concerned about having a panic attack
-95% of pts with agoraphobia may have/had panic disorder

18
Q

What is social phobia?

A
  • The fear of situation where the pt may come under scrutiny by others leading to their humiliation or embarrassment
  • Can also take the form of an isolated fear such as public speaking
19
Q

What are Specific phobias?

A

-Fear of certain situations where. The most common in decreasing prevalence are situational, natural environment, blood/medical, animals, others (chocking, illness, aids ect)

20
Q

what are Non-situational anxiety disorders?
What is a generalised anxiety disorder?
-What are the 3 key elements suggested by the ICD-10?

A

-Anxiety disorders that are not restricted to any specific situation or circumstance

Generalised anxiety disorder

  • Excessive worry about minor matters on most days for about 6 months
  • Apprehension, motor tension, autonomic over activity
21
Q

What is a panic disorder?

A
  • Panic attacks that occur at random and are not restricted to any particular situation
  • They are so distressing that pts develop a fear of having these attacks
  • Between attacks pts are relatively free of anxiety
22
Q

What psychiatric conditions does anxiety occur secondary to?

A
  • Many conditions including; anorexia
  • Somatisation
  • Hypochondria
  • Delusional beliefs
  • Depression
  • OCD

Depression and anxiety are linked, either one can lead to another.
-They are etiologically related, its vital to consider which came 1st and treat appropriately

-Rule out organic causes 1st

23
Q

OCD

What are obsessions?

A
  • Involuntary thought, images or impulses that are recurrent, intrusive, unpleasant and distressing
  • They enter the mind against conscious resistance and are recognised as being a product of the pts own mind
24
Q

What are compulsions?

A

Repetitive mental operations or physical acts that the pt feels propelled to perform to reduce anxiety through the belief that something terrible will happen if they do not
-These are ridiculously excessive or not realistically connected to the event or

25
Q

What is the ICD 10 criteria for OCD?

A
  • Obsessions or compulsions preset for at least 2 successive weeks and are a source of distress or interfere with the pts functioning
  • They are acknowledged as coming from the pts own mind
  • The obsessions are unpleasantly repetitive
  • At least one thought or act is resisted unsuccessfully (chronically the pt may no longer resist)
  • A compulsive act is not in itself pleasurable (excluding relief of anxiety)
26
Q

Obsessions and compulsions can be features of other psychiatric disorders. What do these include?

A
  • Depression; 20 % of these pts have obsessions or compulsions which resolve with treatment. Over 66% of pts experience a depressive episode in their lifetime
  • Other anxiety disorders
  • Eating disorders
  • Schizophrenia
  • Habit and impulse control disorders
  • Anankastic personality disorder
  • Hypochondria
27
Q

Management and treatment

What medication is used 1st line?

A
  • SSRIs are 1st line treatment for most anxiety disorders due to proven efficacy and tolerable S.Es
  • Venlafaxine also has proven efficacy in generalised anxiety disorders
  • TCAs are 2nd line due to having a less tolerable S.E profile
  • Clomipramine (TCA) has proven efficacy in OCD

-MAOIs are effective but not considered 1st line due to their S.Es and risk of addiction

28
Q

What may occur in the 1st few days to hamper compliance with the above drugs?
-What drug can be helpful in the 1st few weeks of treatment?

A
  • Restlessness and an inital increase in anxiety

- Benzodiazepines can be helpful because of their anxiolytic effects

29
Q

Psychological treatment

  • What has proven efficacy in most anxiety disorders?
  • What diagnosis is it 1st line for?
A
  • CBT, it often has a synergistic effect with medication

- Its is 1st line for specific phobias which may involve systemic desensitisation, flooding or modelling

30
Q

What pharmacotherapy and psychotherapy is used for the following anxiety disorders?

Generalised

A 
Generalised 
Pharmacotherapy
-1st line; SSRI/SNRI
-2nd line: TCA
-treatment resistant; benzodiazepines
Psychotherapy
-CBT
-Psychodynamic relaxation
31
Q

Panic/agoraphobia
and
Social anxiety

A

Pharmacotherapy

  • 1st line; SSRI/SNRI
  • 2nd line: TCA
  • Treatment resistant; MAOIs, benzodiazepines

Psychotherapy
-CBT

32
Q

Specific anxiety

A

Pharmacotherapy
-Not standard treatment
Psychotherapy
-CBT

33
Q

OCD

A

Pharmacotherapy

  • 1st line SSRI
  • 2nd line clomipramine (TCA)
  • Treatment resistant; antipsychotics

Psychotherapy

  • CBT
  • Family therapy
34
Q

PTSD

A

Pharmacotherapy

  • 1st line; SSRI
  • 2nd line: TCA
  • Treatment resistant: MAOI

Psychotherapy

  • Desensitisation
  • CBT
  • Psychodynamic

Mood disorders, suicide and self harm (17 decks)

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