Anxiety Disorders Flashcards
Define neurosis
Collective term for disorders that are/have:
- Characterised by distress
- Non-organic in nature
- Discrete onset
- No delusions/hallucinations
Define anxiety
An unpleasant emotional state involving subjective fear and somatic symptoms.
Is anxiety normal? If yes, when does it become pathological?
Yes - becomes pathological when excessive or inappropriate
How are anxiety disorders classified according to ICD-10?
1) Phobic anxiety disorders - agoraphobia/social phobia/specific phobia
2) Other anxiety disorders - GAD, panic disorder
3) Stress/trauma-related disorders - PTSD, acute stress reaction, adjustment
4) OCD
What is the most common anxiety disorder?
Specific phobia
List 8 symptoms of neuroses
- Feeling of impending doom
- Irritability
- Palpitations
- Chest pain
- Hyperventilation
- “Butterflies”
- N+V
- Diarrhoea
- Tremor
- Headache
Name 5 medical conditions associated with anxiety
Hyperthyroidism Hypoglycaemia Cushing's COPD HF Cancer
What medicinal drugs may cause anxiety?
Thyroxine
Steroids
Adrenaline
How does general anxiety disorder differ from most of the other anxiety disorders?
GAD - anxiety present all the time - not situation-specific
Most others situation-specific
Define panic disorder
Anxiety disorder characterised by recurrent, episodic, severe panic attacks which are unpredictable and not restricted to specific situations
What is a panic attack?
Period of intense fear accompanied by characteristic symptoms such as palpitations.
Develops rapidly, and eases within around 30 minutes.
List 4 RFs for panic disorder
- FHx
- Life events
- Age 20 - 30
- White
- Female
- Psych hx
- Asthma
- Smoking
Outline the ICD-10 criteria for diagnosis of panic disorder
- Recurrent panic attacks, not consistently associated with a specific situation/occur spontaneously
- Panic attack starts abruptly, peaks within 10 mins, and rarely persists >1 hour
- At least 1 autonomic symptom
Give 3 key features you would elicit from the hx that would lead you to think of panic disorder
- Episodic
- Unpredictable
- Intense
List 2 investigations you would do in panic disorder
- Bloods - FBC, TFTs, glucose
- ECG
Outline the management of panic disorder
Bio: 1st-line = SSRIs 2nd-line = TCA NOT BZDs Psych - CBT, self-help If 2 treatments failed, refer to psych
Define Generalised Anxiety Disorder
Syndrome of ongoing, uncontrollable, widespread worry about events/thoughts the patient recognises a excessive/inappropriate
What constitutes ICD-10 diagnosis of GAD?
Prominent tension, worry and feelings of apprehension lasting at least 6 months
At least 4 somatic symptoms, including 1 autonomic, e.g. palpitations
List some aetiological factors in GAD
Genetics
Neurochemical - dysfunction of ANS, alterations in GABA, serotonin, NA
Stressful life events
Substance abuse
List some RFs for GAD
- Genetics
- Anankastic personality type
- Low SES
- Stressful life events
- Chronic illness
What are the classic clinical features of GAD?
"WATCHERS" - Worry - excessive/uncontrollable Autonomic hyperactivity Tension/tremor Concentration difficulty Hyperventilation Energy loss Restlessness Sleep disturbance
What should you cover in a GAD hx?
- Generally anxious person/worrier?
- Sleep
- Memory/concentration
- Somatic symptoms
- Screen for depression/substance misuse
List some DDx for GAD
- Other anxiety disorders
- Depression
- Anxious PD
- Schizophrenia
- Too much caffeine
- Organic
Outline the NICE guidelines for management of GAD
1) Psychoeducation and active monitoring
2) Low intensity psych interventions, e.g. self-help or group therapy
3) High intensity psych interventions, e.g. CBT,
OR Drug treatment -
1st line = SSRI, preferably Sertraline
2nd line = SNRI - Venlafaxine or Duloxetine
3rd line = Pregabalin
NO BENZOS
Define “phobia”
Intense, irrational fear of an object, situation, place or person, that is recognised as excessive or illogical
What are the 3 main phobic disorders?
- Agoraphobia
- Social phobia
- Specific phobia
Define agoraphobia
Fear of 2 of:
- Crowds
- Public spaces, especially where escape is difficult
- Travelling alone/away from home
Define social phobia
Fear of social situations which may lead to humiliation, criticism or embarrassment
What is a specific phobia?
Fear restricted to specific object/situation
Which phobic condition commonly co-exists with panic disorder?
Agoraphobia
How does a specific phobia normally begin?
Usually due to an event in early life. Possibly a role for learned behaviour from parent/sibling
What are the clinical features specific to phobic disorders?
Same as other neuroses, plus:
- Anticipatory anxiety
- Inability to relax
- Urge to avoid situation
What key features in a hx would distinguish a phobia from GAD?
Phobia:
- Anxiety in specific situations
- Anticipatory anxiety
- Attempted avoidance
How would you distinguish panic disorder from a phobia?
Panic disorder - spontaneous, unpredictable
Phobia - situation-specific, predictable
Outline the NICE guidelines for management of the 3 major neuroses
- Agoraphobia: Graded exposure +/- SSRIs - Social phobia: CBT +/- SSRI/SNRI - Specific phobia: Exposure therapy Short-term BZDs for emergencies, e.g. flying
What are the 3 conditions linked to trauma/stress?
1) Acute stress reaction
2) Adjustment disorder
3) PTSD
Define “acute stress reaction”
Abnormal reaction to sudden, stressful events
What are the key features of an acute stress reaction?
- Rapid onset - within 1 hour of exposure to exceptional mental or physical stressor, e.g. RTC, death of partner
- Lasts <3 days (self-limiting)
- Symptoms of anxiety, plus narrowed attention, disorientation/aimless wandering, social withdrawal, feeling dazed
What is adjustment disorder?
Range of abnormal psychological responses to life adversity. Results in significant distress, plus impairment of social functioning
What are the key features of adjustment disorder?
- Identifiable non-catastrophic stressor
- Onset within 1 month of stressful event
- Lasts <6 months
How do you manage adjustment disorder?
Supportive psychotherapy +/- anxiolytics or antidepressants
What features characterise abnormal grief?
- Delayed onset
- Greater intensity of symptoms
- > 6 months
Define PTSD
Intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event, e.g. murder, terrorism, tsunami, serious RTC
What underpins the aetiology of PTSD?
Failure to process emotions/memories such that memories persist in intrusive form
What are the key clinical features of PTSD?
- Reliving - flashbacks, memories, nightmares
- Avoidance of similar situations
- Hyperarousal
- Emotional numbing - anhedonia, negative thoughts
Outline the ICD-10 criteria for PTSD diagnosis
- Exposure to stressful event
- Persistent remembering/reliving
- Avoidance of similar situations
- Inability to recall some important aspects of event
- Increased arousal
Occurs within 6 months of end of event
Outline the management of PTSD
- If still within 3 months of trauma, watchful waiting if mild +/- trauma-focussed CBT. RISK ASSESS.
- If symptoms still present >3 months later -
trauma-focussed psych intervention - CBT or EMDR, plus Mirtazipine or similar
