Collective term for disorders that are/have: - Characterised by distress - Non-organic in nature - Discrete onset - No delusions/hallucinations

Anxiety Disorders Flashcards by Charlotte Smith

Define neurosis

Collective term for disorders that are/have:

Characterised by distress
Non-organic in nature
Discrete onset
No delusions/hallucinations

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Define anxiety

An unpleasant emotional state involving subjective fear and somatic symptoms.

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Is anxiety normal? If yes, when does it become pathological?

Yes - becomes pathological when excessive or inappropriate

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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

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What is the most common anxiety disorder?

Specific phobia

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List 8 symptoms of neuroses

Feeling of impending doom
Irritability
Palpitations
Chest pain
Hyperventilation
“Butterflies”
N+V
Diarrhoea
Tremor
Headache

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Name 5 medical conditions associated with anxiety

Hyperthyroidism
Hypoglycaemia
Cushing's
COPD
HF
Cancer

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What medicinal drugs may cause anxiety?

Thyroxine
Steroids
Adrenaline

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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

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Define panic disorder

Anxiety disorder characterised by recurrent, episodic, severe panic attacks which are unpredictable and not restricted to specific situations

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What is a panic attack?

Period of intense fear accompanied by characteristic symptoms such as palpitations.
Develops rapidly, and eases within around 30 minutes.

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List 4 RFs for panic disorder

FHx
Life events
Age 20 - 30
White
Female
Psych hx
Asthma
Smoking

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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

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Give 3 key features you would elicit from the hx that would lead you to think of panic disorder

Episodic
Unpredictable
Intense

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List 2 investigations you would do in panic disorder

Bloods - FBC, TFTs, glucose

- ECG

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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

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Define Generalised Anxiety Disorder

Syndrome of ongoing, uncontrollable, widespread worry about events/thoughts the patient recognises a excessive/inappropriate

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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

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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