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Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

What are the psychological symptoms of anxiety?

A 
Worry
Panic
Problems with concentration
Hypervigilance
Health worries
Derealisation/personalisation
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2
Q

What are the physical symptoms of anxiety?

A

Acute-heart racing, sweating, tremor, dizziness, SOB, chest pain, nausea, feeling of choking, lump in throat, difficulty swallowing
Chronic- muscle pains, weakness

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3
Q

What are the behavioural symptoms of anxiety?

A

Checking

Seeking reassurance

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4
Q

What is globus hystericus?

A

The experience of not being able to swallow, or eat, typically associated with anxiety and/or conversion disorder

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5
Q

What is panic disorder characterised by?

A

Recurrent unexpected surges of severe anxiety (panic attacks), with varying degrees of anticipatory anxiety between attacks

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6
Q

What are panic attacks?

A

Discrete periods of intense fear along with physical and psychological anxiety symptoms
Reach peak within 10 mins and last around 30-45 mins

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7
Q

When do 50% of all mental disorders start before?

A

Before 14yo

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8
Q

When do 50% of all anxiety disorders start before?

A

Before 11yo

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9
Q

What are the key features of generalised anxiety disorder (GAD)?

A

Excessive and inappropriate worrying that is persistent (more than a few months)
Not restricted to particular circumstances
Patients have physical anxiety symptoms + psychological symptoms
Often co-morbid with major depression, panic disorder, phobic anxiety, health anxiety and OCD

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10
Q

What are the autonomic arousal symptoms of GAD?

A

Palpitations or pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Dry mouth (not due to medication or dehydration)

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11
Q

What are the symptoms concerning chest and abdomen of GAD?

A

Difficulty breathing
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress

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12
Q

What are the symptoms concerning brain and mind of GAD?

A

Feeling dizzy, unsteady, faint or light headed
Feelings that objects are unreal (derealisation), or that one’s self is distant or not there (depersonalisation)
Fear of losing control, going crazy, or passing out
Fear of dying

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13
Q

What are the general symptoms of GAD?

A

Hot flushes or cold chills

Numbness or tingling sensations

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14
Q

What are the symptoms of tension of GAD?

A

Muscle tension or aches and pains
Restlessness and inability to relax
Feeling keyed up, or on edge, or of mental tension
A sensation of a lump in the throat, or difficulty swallowing

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15
Q

What are the other non-specific symptoms of GAD?

A

Exaggerated response to minor surprises or being startled
Difficulty in concentrating, or mind going blank, because of worrying or anxiety
Persistent irritability
Difficulty getting to sleep because of worrying

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16
Q

What do most people develop after having panic attacks?

A

A fear of having further attacks which leads to avoidance or significant personal distress

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17
Q

What do two thirds of people with panic disorder develop?

A

Agoraphobia: fear in places or situations from which escape might be difficult in which help may not be available
Situations include being in a crowd, outside the home or using public transport

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18
Q

What is social phobia characterised by?

A

Marked, persistent or unreasonable fear of being observed or evaluated negatively by other people, in social or performance situations
Associated with physical and psychological anxiety symptoms
Feared situations are avoided or endured with distress

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19
Q

What are the common physical symptoms of social phobia?

A

Blushing
Fear of vomiting
Urgency or fear of micturition or defecation

20
Q

What are specific phobias characterised by?

A

Characterised by excessive or unreasonable
fear of (and is restricted to) single people,
animals, objects, or situations (for example,
dentists, spiders, lifts, flying, seeing blood)

21
Q

In specific phobias what are the most commonly feared objects or situations?

A 
Animals, birds, insects
Heights, thunder, flying
Small enclosed spaces
Sight of blood or injury, injections
Dentists and hospitals
22
Q

Name some phobias and describe them

A

Ephebiphobia – fear of young people / youths
Oneirogmophobia – fear of wet dreams
Coulrophobia – fear of clowns
Triskaidekaphobia – fear of number 13
Arachibutyrophobia – fear of peanut butter
sticking to the roof of your mouth

23
Q

What is PTSD characterised by?

A

A history of exposure to trauma (actual or threatened death, serious injury, or threats
to the physical integrity of the self or others) which is
associated with: a response of intense fear, helplessness or horror

24
Q

What develops later on in PTSD?

A

– Intrusive symptoms (such as recollections, flashbacks or
dreams)
– Avoidance symptoms (for example efforts to avoid activities or thoughts associated with the trauma)
– Negative alterations in cognitions and mood
– Hyper-arousal symptoms (including disturbed sleep,
hypervigilance and an exaggerated startle response)

25
Q

What is health anxiety characterised by?

A

Excessive or disproportionate preoccupations with having or acquiring a serious illness
Associated with excessive health related behaviours, high levels of alarm about personal health status

26
Q

What is OCD characterised by?

A

Recurrent obsessive ruminations, images or impulses, and/or recurrent physical or mental rituals
Symptoms are distressing, time consuming, cause interference with social and occupational function

27
Q

What are some common obsessions of OCD?

A

Contamination, accidents, and religious or sexual matters

28
Q

What are some common rituals of OCD?

A

Washing, checking, cleaning, counting and touching

29
Q

How can obsessions be described?

A

Ego-dystonic- products of own mind, but patient experiences them as alien
Outwith own control

30
Q

What is an effective relaxant in social situations?

A

Alcohol, can lead to alcohol abuse in 20%

31
Q

For many people, what is most effective in anxiety treatment?

A

Combination therapy

32
Q

When should benzodiazepines be used?

A

Avoided except for specific occasions- flights, weddings etc

33
Q

What are most antidepressants also?

A

Anxiolytics

34
Q

What is extinction?

A

If we have exposure to the stimulus but the anxiety is manageable and we don’t avoid it, we slowly learn that the stimulus doesn’t signal fear and the anxiety lessens

35
Q

What is graded exposure?

A

Involves counter conditioning- the same stimuli are eventually associated with calmness and control
Effective
Involves building a hierarchy of feared stimuli and reaching the person relaxation in order to manage anxiety

36
Q

What is flooding?

A

Involves full exposure to the feared stimulus and staying with it until fear reduces
The fear may spontaneously reoccur

37
Q

What are the principles of CBT?

A

Fundamentally, CBT suggests that underlying thoughts (e.g. “I’m a bad person”) affect emotions (e.g. low mood) which then affects behaviour
By involving the patient in questioning/testing their thoughts, you can influence their behaviour and emotions

38
Q

What is the link between mood and cognitive change?

A

More likely that cognitive change is a consequence of mood change

39
Q

What is used in the treatment of OCD?

A

Medication- SSRIs, Clomipramine
Augmentation with antipsychotics (Risperidone, aripiprazole)
Some anticonvulsants (Lamotrigine)
Psychological- ERP >20 hours (first line over drugs)
CBT

40
Q

What are the basic principles of ERP?

A

By repeatedly keeping our anxiety in ‘check’, we provide powerful reinforcement for the avoidant behaviour; thus sustaining it
Conversely, by increasing exposure (in a controlled way) to the feared stimulus, we can develop habituation to the anxiety

41
Q

What is the treatment for GAD?

A

Medication- SSRI, SNRI, Pregablin

Psychological- Guided self help, CBT, relaxation

42
Q

What is the treatment for social phobia?

A

Medication- Most SSRIs, Venlafaxine/Phenelzine, Some benzos-broma/clonazepam, anticonvulsants-gabapentin, pregabalin
Psychological- CBT with emphasis on exposure, cognitive restructuring, social skills training

43
Q

What is the treatment for a specific phobia?

A

Medications- SSRIs (only if anxiety is moderate-severe and hasn’t responded to behavioural therapy)
Psychological- Exposure therapy (graded, flooding (less popular))

44
Q

What is the treatment for panic disorder +- agoraphobia?

A

Medication- All SSRIs, some TCAs (clomipramine, imipramine), Venlafaxine, Some anticonvulsants (gabapentin, valproate)
Psychological- CBT, graded exposure (if agoraphobia is present)

45
Q

What is the maintenance treatment duration for various anxiety disorders?

A 
GAD (≥ 18 months)
Panic disorder (≥ 6 months)
Social phobia (≥ 6 months)
PTSD (≥ 12 months)
OCD (≥ 12 months)

Psychiatry (29 decks)

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