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Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Models of stress

A

Biomechanical “engineering” - someone can only take so much stress and eventually reaches breaking point

Medicophysicolegal - event causes stress -> stress response -> physiological adaptation to stressor, prolonged exposure -> exhaustion

Psychological - transactional

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2
Q

Features of psychological stress model

A

Interactive
An individual’s reaction to stress will depend on balance between their cognitive processing of any perceived threat and perceived ability to cope

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3
Q

Types of coping

A

Problem focused - where efforts are directed toward modifying a stressor, preparation, studying etc.

Emotion focused - modify emotional reaction, mental defence mechanism e.g. denial, relaxation training

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4
Q

Symptoms groups of anxiety

A 
Psychological arousal 
Autonomic arousal 
Muscle tension 
Hyperventilation 
Sleep disturbance
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5
Q

Symptoms oa psychological arousal

A 
Fearful anticipation
Irritability 
Sensitivity to noise
Poor concentration
Worrying thoughts
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6
Q

GI symptoms of autonomic arousal

A

Dry mouth
Difficulty swallowing
Dyspepsia, nausea, wind
Frequent loose stools

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7
Q

Respiratory symptoms of autonomic arousal

A

Tight chest

Difficulty breathing

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8
Q

CVS symptoms of autonomic arousal

A

Palpitations
Missed beats
Chest pain

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9
Q

GU symptoms of autonomic arousal

A

Frequency/urgency of micturition
Amenorrhoea/dysmenorrhoea
Erectile failure

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10
Q

CNS symptoms of autonomic arousal

A

Dizziness

Sweating

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11
Q

Muscle tension symptoms

A

Tremor
Headache
Muscle pain

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12
Q

Hyperventilation symptoms

A

O2 deficit hypocapnia
Numbness/tingling in extremities, may lead to carpopedal sapsms
Breathlessness

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13
Q

Sleep disturbance symptoms

A

Initial insomnia
Frequent wakening
Nightmares and night terrors

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14
Q

What are phobic and general anxiety disorders?

A

Both have the same core anxiety symptoms but they either occur in particular circumstances e.g. phobias or occur persistently e.g. generalised anxiety disorder

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15
Q

Features of generalised anxiety disorder

A

Persistent (several months) of symptoms, not confined to a situation or object
All of the symptoms of human anxiety can occur

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16
Q

Differential diagnoses for anxiety

A

Psychiatric

  • depression
  • schizophrenia
  • dementia
  • substance misuse

Physical

  • thyrotoxicosis
  • phaeochromocytoma
  • hypoglycaemia
  • asthma/arrhythmias
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17
Q

Epidemiology of GAD

A

One year prevalence around 3% in US

Women > men

18
Q

Aetiology of GAD

A

No clear line between normal anxiety and anxiety disorders
In general terms, GAD is caused by a stressor acting on a personality predisposed to the disorder by a combination of genetic factors and environmental influences in childhood

19
Q

Management of GAD

A

Counselling

  • clear plan of management
  • explanation and education
  • advice re caffeine, alcohol, exercise etc.

Relaxation training

  • group or individual
  • DVDs/tapes/clinical led

Medication

  • sedatives high risk dependency so not recommended
  • antidepressants can successfully treat - SSRI or TCA

Cognitive behavioural therapy
- identifying errors, reprocessing and reassessing responsibility

20
Q

Features of phobic anxiety disorders

A

Same core features as GAD
Only in specific circumstances
Person behaves to avoid these circumstances - phobic avoidance
Sufferer also experiences anxiety if there is a perceived threat of encountering the feared object/situation - anticipatory anxiety

21
Q

What are the clinical important syndromes of anxiety disorders?

A

Specific phobias
Social phobias
Agoraphobia

22
Q

Features of social phobia

A

Inappropriate anxiety in a situation where a person feels observed or could be criticised e.g. restaurants, shops, queues
Symptoms are any of the anxiety cluster, but blushing and tremor predominate

23
Q

Management of social phobia

A

CBT addressing the groundless fear of criticism
Education and advice
Medication - SSRI

24
Q

What does CBT challenge?

A

Negative views of self
Safety barriers
Unrealistically high standards
Excessive self-monitoring

25
Q

Core features of obsessive compulsive disorder

A

Experience of recurrent obsessional thoughts and/or compulsive acts

26
Q

Features of obsessional thoughts

A

Ideas, images or impulses
Occurring repeatedly, not willed
Unpleasant and distressing e.g. obscene, violent
Recognised as the individual’s own thoughts
Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist

27
Q

Features of compulsive acts or rituals

A

Stereotypical behaviours repeated again and again
Not enjoyable
Not helpful
Often viewed by sufferer as preventing some harm to self or others or viewed as pointless and resisted with key anxiety symptoms accompanying resistance

28
Q

Epidemiology of OCD

A

2% overall one year prevalence

M = F

29
Q

Aetiology of OCD

A

Genetic e.g. gene coding for 5HT receptors

5HT function abnormalities

30
Q

Management of OCD

A

Good history and MSE, exclude treatable depressive illness
General measures - education and explanation, involve partner/family
Serotonergic drugs e.g. fluoxetine, clomipramene
CBT - exposure and response prevention
Psychosurgery - very rare circumstances

31
Q

What is post-traumatic stress disorder?

A

Delayed and/or protracted reaction to a stressor of exceptional severity

32
Q

Causes of PTSD

A 
Combat
Natural or man-made disaster
Rape 
Assault
Torture
Witnessing of the above
33
Q

What are the 3 key elements to reaction causing PTSD?

A

Hyperarousal
Re-experiencing phenomena
Avoidance of reminders

34
Q

Features of hyperarousal

A

Persistent anxiety
Irritability
Insomnia
Poor concentration

35
Q

Causes of re-experiencing phenomena

A

Intense intrusive images
Flashbacks when awake
Nightmares

36
Q

Features of avoidance

A

Emotional numbness - anhedonia, avoidance of activities/situations
Cue avoidance
Recall difficulties
Diminished interests

37
Q

Prevalence of PTSD

A

1-4% one year prevalence

38
Q

Aetiology of PTSD

A

Depends on nature of stressor - life-threatening and degree of exposure generally confers greater risk
Susceptibility is partly genetic

39
Q

What are the vulnerability factors of PTSD?

A

Mood disorder
Previous trauma, especially as a child
Lack of social support
Female

40
Q

What are the protective factors of PTSD?

A

Higher education and social group

Good paternal relationship

41
Q

Management of PTSD

A

NICE Guidance
Survivors of disasters screened at one months
Mild symptoms - watchful waiting and review at one further month
Trauma-focussed CBT if more severe symptoms
Eye movement desensitisation and reprocessing
Risk of dependence with any sedatives but patients may prefer medication - SSRI, TCA

Psychiatry (21 decks)

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