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JR - Mental Health > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Define neurosis

A

Collective term for disorders that are/have:

  • Characterised by distress
  • Non-organic in nature
  • Discrete onset
  • No delusions/hallucinations
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2
Q

Define anxiety

A

An unpleasant emotional state involving subjective fear and somatic symptoms.

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3
Q

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

A

Yes - becomes pathological when excessive or inappropriate

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4
Q

How are anxiety disorders classified according to ICD-10?

A

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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5
Q

What is the most common anxiety disorder?

A

Specific phobia

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6
Q

List 8 symptoms of neuroses

A
  • Feeling of impending doom
  • Irritability
  • Palpitations
  • Chest pain
  • Hyperventilation
  • “Butterflies”
  • N+V
  • Diarrhoea
  • Tremor
  • Headache
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7
Q

Name 5 medical conditions associated with anxiety

A 
Hyperthyroidism
Hypoglycaemia
Cushing's
COPD
HF
Cancer
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8
Q

What medicinal drugs may cause anxiety?

A

Thyroxine
Steroids
Adrenaline

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9
Q

How does general anxiety disorder differ from most of the other anxiety disorders?

A

GAD - anxiety present all the time - not situation-specific

Most others situation-specific

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10
Q

Define panic disorder

A

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

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11
Q

What is a panic attack?

A

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

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12
Q

List 4 RFs for panic disorder

A
  • FHx
  • Life events
  • Age 20 - 30
  • White
  • Female
  • Psych hx
  • Asthma
  • Smoking
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13
Q

Outline the ICD-10 criteria for diagnosis of panic disorder

A
  • 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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14
Q

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

A
  • Episodic
  • Unpredictable
  • Intense
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15
Q

List 2 investigations you would do in panic disorder

A
  • Bloods - FBC, TFTs, glucose

- ECG

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16
Q

Outline the management of panic disorder

A 
Bio:
1st-line = SSRIs
2nd-line = TCA
NOT BZDs
Psych - CBT, self-help
If 2 treatments failed, refer to psych
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17
Q

Define Generalised Anxiety Disorder

A

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

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18
Q

What constitutes ICD-10 diagnosis of GAD?

A

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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19
Q

List some aetiological factors in GAD

A

Genetics
Neurochemical - dysfunction of ANS, alterations in GABA, serotonin, NA
Stressful life events
Substance abuse

20
Q

List some RFs for GAD

A
  • Genetics
  • Anankastic personality type
  • Low SES
  • Stressful life events
  • Chronic illness
21
Q

What are the classic clinical features of GAD?

A 
"WATCHERS" -
Worry - excessive/uncontrollable
Autonomic hyperactivity
Tension/tremor
Concentration difficulty
Hyperventilation
Energy loss
Restlessness
Sleep disturbance
22
Q

What should you cover in a GAD hx?

A
  • Generally anxious person/worrier?
  • Sleep
  • Memory/concentration
  • Somatic symptoms
  • Screen for depression/substance misuse
23
Q

List some DDx for GAD

A
  • Other anxiety disorders
  • Depression
  • Anxious PD
  • Schizophrenia
  • Too much caffeine
  • Organic
24
Q

Outline the NICE guidelines for management of GAD

A

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

25
Q

Define “phobia”

A

Intense, irrational fear of an object, situation, place or person, that is recognised as excessive or illogical

26
Q

What are the 3 main phobic disorders?

A
  • Agoraphobia
  • Social phobia
  • Specific phobia
27
Q

Define agoraphobia

A

Fear of 2 of:

  • Crowds
  • Public spaces, especially where escape is difficult
  • Travelling alone/away from home
28
Q

Define social phobia

A

Fear of social situations which may lead to humiliation, criticism or embarrassment

29
Q

What is a specific phobia?

A

Fear restricted to specific object/situation

30
Q

Which phobic condition commonly co-exists with panic disorder?

A

Agoraphobia

31
Q

How does a specific phobia normally begin?

A

Usually due to an event in early life. Possibly a role for learned behaviour from parent/sibling

32
Q

What are the clinical features specific to phobic disorders?

A

Same as other neuroses, plus:

  • Anticipatory anxiety
  • Inability to relax
  • Urge to avoid situation
33
Q

What key features in a hx would distinguish a phobia from GAD?

A

Phobia:

  • Anxiety in specific situations
  • Anticipatory anxiety
  • Attempted avoidance
34
Q

How would you distinguish panic disorder from a phobia?

A

Panic disorder - spontaneous, unpredictable

Phobia - situation-specific, predictable

35
Q

Outline the NICE guidelines for management of the 3 major neuroses

A 
- Agoraphobia:
Graded exposure +/- SSRIs
- Social phobia:
CBT +/- SSRI/SNRI
- Specific phobia:
Exposure therapy
Short-term BZDs for emergencies, e.g. flying
36
Q

What are the 3 conditions linked to trauma/stress?

A

1) Acute stress reaction
2) Adjustment disorder
3) PTSD

37
Q

Define “acute stress reaction”

A

Abnormal reaction to sudden, stressful events

38
Q

What are the key features of an acute stress reaction?

A
  • 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
39
Q

What is adjustment disorder?

A

Range of abnormal psychological responses to life adversity. Results in significant distress, plus impairment of social functioning

40
Q

What are the key features of adjustment disorder?

A
  • Identifiable non-catastrophic stressor
  • Onset within 1 month of stressful event
  • Lasts <6 months
41
Q

How do you manage adjustment disorder?

A

Supportive psychotherapy +/- anxiolytics or antidepressants

42
Q

What features characterise abnormal grief?

A
  • Delayed onset
  • Greater intensity of symptoms
  • > 6 months
43
Q

Define PTSD

A

Intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event, e.g. murder, terrorism, tsunami, serious RTC

44
Q

What underpins the aetiology of PTSD?

A

Failure to process emotions/memories such that memories persist in intrusive form

45
Q

What are the key clinical features of PTSD?

A
  • Reliving - flashbacks, memories, nightmares
  • Avoidance of similar situations
  • Hyperarousal
  • Emotional numbing - anhedonia, negative thoughts
46
Q

Outline the ICD-10 criteria for PTSD diagnosis

A
  • 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
47
Q

Outline the management of PTSD

A
  • 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

JR - Mental Health (16 decks)

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