Anxiety Disorders Flashcards
What is the prevalence of anxiety disorders?
- Combined 1 year prevalence of 12-17%.
- Generally under diagnosed in primary care or recognised years after onset
What is the 1 year prevalence, age of onset and sex ratio of the following disorders
-Generalised anxiety disorder
Panic disorder
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
Social phobia?
Specific phobia?
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
PTSD?
OCD?
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
Genetic factors
- What are the 2 most heritable anxiety disorders?
- What % of those affected have a 1st degree relative with the same diagnosis?
- Panic disorder and OCD
- 33%
-There is an association between generalised anxiety disorder and relatives who alcohol abuse
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?
- Panic disorder and serotonin levels
- OCD is associated with hypersensitivity of some serotonin receptors
Social and psychological factors
-What is essential to diagnose PTSD?
-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
Course and prognosis
What is the prognosis of generalised anxiety disorder?
Generalised anxiety disorder
- Likely to be chronic
- Fluctuating, worse in times of stress
What is the prognosis of panic disorders?
- 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
What is the prognosis of social phobia?
Specific phobias?
- 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
What is the prognosis of PTSD?
- 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
What is the prognosis of OCD?
- Chronic fluctuating course with worsening symptoms during times of stress
- 15% of pts show a progressive deterioration in functioning
The experience of anxiety consists of what 2 interrelated components?
- 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
There are 2 specific patterns of pathological anxiety what are they?
- Generalised anxiety
- Paroxysmal anxiety
Generalised anxiety
- How severe is it?
- How long does each episode last for?
- What is it associated with?
- 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
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?
- 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)
Phobic disorders
-What are they associated with?
What is agoraphobia?
-How closely related is this with panic disorder?
-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
What is social phobia?
- 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
What are Specific phobias?
-Fear of certain situations where. The most common in decreasing prevalence are situational, natural environment, blood/medical, animals, others (chocking, illness, aids ect)
what are Non-situational anxiety disorders?
What is a generalised anxiety disorder?
-What are the 3 key elements suggested by the ICD-10?
-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
What is a panic disorder?
- 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
What psychiatric conditions does anxiety occur secondary to?
- 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
OCD
What are obsessions?
- 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
What are compulsions?
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
What is the ICD 10 criteria for OCD?
- 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)
Obsessions and compulsions can be features of other psychiatric disorders. What do these include?
- 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
Management and treatment
What medication is used 1st line?
- 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
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?
- Restlessness and an inital increase in anxiety
- Benzodiazepines can be helpful because of their anxiolytic effects
Psychological treatment
- What has proven efficacy in most anxiety disorders?
- What diagnosis is it 1st line for?
- CBT, it often has a synergistic effect with medication
- Its is 1st line for specific phobias which may involve systemic desensitisation, flooding or modelling
What pharmacotherapy and psychotherapy is used for the following anxiety disorders?
Generalised
Generalised Pharmacotherapy -1st line; SSRI/SNRI -2nd line: TCA -treatment resistant; benzodiazepines Psychotherapy -CBT -Psychodynamic relaxation
Panic/agoraphobia
and
Social anxiety
Pharmacotherapy
- 1st line; SSRI/SNRI
- 2nd line: TCA
- Treatment resistant; MAOIs, benzodiazepines
Psychotherapy
-CBT
Specific anxiety
Pharmacotherapy
-Not standard treatment
Psychotherapy
-CBT
OCD
Pharmacotherapy
- 1st line SSRI
- 2nd line clomipramine (TCA)
- Treatment resistant; antipsychotics
Psychotherapy
- CBT
- Family therapy
PTSD
Pharmacotherapy
- 1st line; SSRI
- 2nd line: TCA
- Treatment resistant: MAOI
Psychotherapy
- Desensitisation
- CBT
- Psychodynamic
