Anxiety Disorders Flashcards
What are the associated physical responses to anxiety?
↑ HR, ↑BP, ↑RR, nausea, muscle tingling
What is a panic attack? (ICD 10)
- A discrete episode of intense fear or discomfort
- Starts abruptly
- Reaches a maximum within a few minutes and lasts at least some minutes
- At least 4 specific symptoms of anxiety
Anxiety symptoms involving mental state?
- Feeling dizzy/ unsteady/faint/ lightheaded
- Derealisation= feeling that objects are not real or depersonalistaion= feeling that people are not real
- Fear of losing control/going crazy/ passing out/dying
What are the autonomic arousal symptoms of anxiety?
- Palpitations/ Pounding heart/ Increased HR
- Sweating
- Trembling/ Shaking
- Dry mouth
What are the symptoms that involve the chest
and abdomen?
• Difficulty breathing/ Feeling of choking/ Chest pain or
discomfort
• Nausea or abdominal distress
What are the general symptoms of anxiety?
• Hot flushes/ cold chills/ numbness/ tingling
What are the 6 types of anxiety conditions?
- Phobic Anxiety disorders
- Other Anxiety disorders
- Obsessive Compulsive disorder
- Reactions to severe stress and adjustment disorders
- Dissociative (conversion) disorders
- Somatoform disorders
Types of phobic anxiety disorders?
- Agoraphobia
- Social phobia
- Specific (isolated) phobias
Types of other anxiety disorders?
- Panic disorder [episodic paroxysmal anxiety]
* Generalized anxiety disorder
Types of reactions to severe stress and adjustment disorders?
- Acute stress reaction
- Post-traumatic stress disorder
- Adjustment disorders
Types of dissociative (conversion) disorders?
Amnesia, fugue, stupor, motor, convulsions, trance & possession states, anaesthesia and sensory loss
Types of somatoform disorders?
- Somatisation disorder
* Hypochondriacal disorder
How do you classify generalised anxiety disorder?
A period of at least 6 months with prominent tension, worry and feelings of apprehension about everyday events and problems
How do you classify panic disorder?
• Recurrent attacks of severe anxiety (panic)= panic attacks
• Not restricted to any particular situation or set of
circumstances
• Unpredictable.
• Dominant symptoms include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealisation).
• 4 panic attacks in 4 weeks, lasting min-10min
sudden onset
What is agoraphobia and mean age of onset? (ICD 10)
Cluster of phobias embracing: • fears of leaving home, • entering shops, • crowds and public places • travelling alone in trains, buses or planes.
- Panic disorder is a frequent feature of both present and past episodes.
- Depressive and obsessional symptoms, and social phobias are also commonly present as subsidiary features.
- Avoidance of the phobic situation is often prominent
- Some agoraphobics experience little anxiety because they are able to avoid their phobic situations.
20-35 years F>M
What is social phobia and mean age of onset? (ICD 10)
- Fear of scrutiny by other people leading to avoidance of social situations.
- More pervasive social phobias are usually associated with low self-esteem and fear of criticism.
- May present as a complaint of blushing, hand tremor, nausea, or urgency of micturition
- the patient sometimes being convinced that secondary manifestation of their anxiety is the primary problem.
- Symptoms may progress to panic attacks.
Adolescence F>M
What are specific phobias and mean age of onset? (ICD 10)
- Phobias restricted to highly specific situations e.g. animals, heights, dentistry, or the sight of blood or injury.
- triggering situation is discrete but contact with it can evoke panic
Childhood F=M
Psychological treatments for anxiety?
- Self Help
- Cognitive Behaviour Therapy (CBT)
- Applied relaxation
- Psycho education
- Exposure (systematic desensitisation)
Medical treatments for anxiety?
•SSRIs
•Beta blockers can help with peripheral symptoms eg
tremor
•Benzodiazepines best avoided apart from in very short term e.g to help someone with fear of flying fly home to a funeral
What are the essential features of OCD?
The essential feature is recurrent obsessional thoughts and compulsive acts.
What are some good questions to ask to assess OCD?
- Do you wash or clean a lot?
- Do you check things a lot?
- Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
- Do your daily activities take a long time to finish?
- Are you concerned about putting things in a special order or are you very upset by mess?
What is the treatment for OCD?
• Psychotherapy
• CBT
• ERP exposure & response prevention
• Repeated graded exposure to anxiety provoking
stimuli
• Drug treatment
• SSRI (fluoxetine, sertraline)
• TCA (clomipramine)
Combined psychotherapy & drug treatment generally better than each alone
What is PTSD?
Experience life threatening or catastrophic event, likely to cause “pervasive distress in almost anyone eg disaster, serious accident,torture, rape, witnessing death etc
Onset usually follows trauma with a latency period of 1-6 months
What is the treatment for PTSD?
- Trauma focused CBT
- Repeated graded exposure
- Testimony based techniques
- EMDR (Eye movement desensitisation and reprocessing)
- Antidepressant (paroxetine or mirtazepine)
What are the characteristics and treatment of dissociative disorder?
Disorder of physical function usually under voluntary
control eg inability to walk
Difficult/Rehab/physio
What are the characteristics and treatment of somatoform disorders?
Repeated presentation of physical symptoms eg pain
Difficult/CBT/SSRI
What are the characteristics and treatment of hypochondriasis?
Fear or worry about developing a disorder
CBT/SSRI
