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PSYCHIATRY > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

List some of the physical symptoms of anxiety

A 
Sweating, hot flushes, cold chills 
Trembling 
Muscle tension 
Dizziness and lightheadedness 
Sensation of choking/ lump in the throat 
Palpitations 
Nausea
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2
Q

List some of the behavioural symptoms of anxiety

A 
Avoidance 
Exaggerated responses to minor surprises or being startled 
Difficulty getting to sleep 
Excessive use of alcohol and drugs 
Irritability
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3
Q

List some of the cognitive symptoms of anxiety

A 
Agitation 
Poor concentration 
Derealisation 
Depersonalisation 
Hypervigillence 
Hypochondria 
Preference for order and routine
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4
Q

Describe the general management plan for anxiety disorders and phobias

A

Exercise/ meditation/ relaxation therapy

CBT

SSRIs (first line) - other antidepressants 2nd line

Pregabalin

B-blockers and benzodiazepines for symptom control

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5
Q

It is good practice to try and avoid benzodiazepines, but sometimes they are necessary.

Give some examples where their use may be indicated

A

Patient is extremely anxious and can’t function

E.g can’t get on public transport

E.g very agoraphobic and wants to leave the house for an important event e.g daughter’s wedding.

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6
Q

Higher doses of antidepressants are required for anxiety disorders than for depression. T/F

A

TRUE

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7
Q

Describe generalised anxiety disorder (GAD)

A

Chronic fluctuating course, not restricted to any environmental circumstances

Usually have insight

More common in younger patients and females

Always worrying irrational and may specifically have worries about the patient or a relative having an accident

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8
Q

What are the criteria for diagnosis of GAD?

A

Long lasting (most days for at least 6 months)

Not controllable

Causes significant impairment of function

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9
Q

Describe panic disorder

A

Recurrent unpredictable attacks of severe anxiety, not anxious the rest of the time

More common in younger patients

50% also have agoraphobia

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10
Q

What are the key signs and symptoms of panic disorder?

A

Palpitations

Chest pain

Choking sensation

Feelings of unreality

Secondary fears of dying, losing control or going mad

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11
Q

How can panic attacks be triggered in susceptible individuals and what will a PET scan show?

A

By infusion of lactate or by rebreathing air (increased C02)

PET scan shows increased metabolism which is suggestive of panic disorder

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12
Q

What are the 3 main types of phobia?

A

Agoraphobia
Specific phobia
Social phobia

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13
Q

What management option is important for specific phobias?

A

Behavioural therapy - graded exposure and desensitisation

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14
Q

Are social phobias more or likely to occur in small or large social settings?

A

Small

E.g turning up to a packed lecture might be ok (little attention on you) whereas turning up to clinical skills may not (fear of being put on the spot/ scrutinised)

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15
Q

What are some of the key signs and symptoms of social phobias?

A

Blushing and shaking

Fear of vomiting

Urgency/ fear of micturition or defecation

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16
Q

Most people with OCD experience at least one major depressive episode. T/F?

A

TRUE

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17
Q

Describe the obsessional thoughts and compulsive acts which are indicative of OCD

A

Ideas, images and thoughts which are unpleasant, resisted and ego-dystonic

Repeated rituals which are not enjoyable or functional

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18
Q

What are the criteria for diagnosis of OCD?

A

Symptoms must be present most days for at least 2 weeks

Obsessions must be the individual’s own thoughts and not hallucinations

Resistance must be present

Rituals must not be enjoyable

Thoughts/ acts must be repetitive

19
Q

What are the most common obsessions in OCD?

A

Checking

Counting

Contamination

20
Q

What diagnosis are important to rule out in patients presenting with anxiety symptoms?

A

Depression

Hyperthyroidism

21
Q

How does CBT work?

A

Helps the individual to identify thoughts and behaviours that reinforce and perpetuate anxiety.

22
Q

Describe the management plan for OCD

A

CBT

Antidepressants (SSRIs/ clomipramine - tricyclic)

Antipsychotics

23
Q

What is meant by centrifugal and centripetal disasters?

A

Centrifugal - the people don’t know each other

Centripetal - disaster in a community

24
Q

What is meant by type 1 and type 2 trauma?

A

Type 1 trauma
- Single unexpected incident

Type 2 trauma
- Repetitive trauma, ongoing abuse e.t.c

25
Q

Describe tonic immobility, a freeze response to anxiety/ fear

A

Involuntary state of profound motor inhibition

Occurs in many sexual assault cases

Decreased vocalisation, intermittent eye contact, rigidity and paralysis

Unresponsiveness to pain

Enhances survival because predators are less likely to have interest in an immobile and unresponsive victim

26
Q

Which anxiety disorder has the highest association with suicide?

A

PTSD

27
Q

What percentage of patients with PTSD have a comorbid psychiatric condition?

A

80%

28
Q

What are some of the signs and symptoms of PTSD?

A

Intrusive phenomena (nightmares, flashbacks e.t.c)

Low self esteem and self blame

Hyperarousal (sleep disturbance, poor concentration, hypervigilence e.t.c)

Depersonalisation and derealisation

Somatisation

29
Q

How long must symptoms be present for a diagnosis of PTSD?

A

At least 1 month

30
Q

What is the treatment for PTSD?

A

CBT

EMDT (eye movement desensitisation and reprocessing)

Medications

31
Q

What is meant by anxiety disorder ‘in context’ vs ‘in extent’?

A

Anxiety disorder in context = anxiety in response to situations which are not usually anxiety provoking

Anxiety disorder in extent = anxiety is more extreme than normal

32
Q

Which part of the brain is responsible for re-experiencing traumatic memories?

A

Hippocampus

33
Q

What is the role of GABA?

what ions does it affect

A

Main inhibitory neurotransmitter

When bound to its receptor it allows passage of Cl- ions to produce hyperpolarisation. This makes is less likely that a neurone will fire an action potential and thus has an inhibitory effect.

34
Q

How do benzodiazepines work? Where do they bind?

A

Benzodiazepines enhance the effects of GABA

They bind to a site which is separate from the GABA binding site and thus have a positive allosteric effect when both GABA and benzos are bound.

35
Q

Which area of the brain is responsible for integrating sensory and cognitive information?

A

Amygdala

36
Q

Which area of the brain is responsible for increasing cortisol levels in times of stress?

A

Hypothalamus

37
Q

Which area of the brain is responsible for re-experiencing traumatic events?

A

Hippocampus

38
Q

Which circuit in the brain is responsible for the emotion of fear and which is responsible for worry?

A

Amygdala centred circuit is responsible for fear

Cortico-striatal-thalamic circuit is responsible for worry

39
Q

Benzodiazepines are fairly safe in overdose.. What drug can be used to reverse their effect?

A

Flumazenil

40
Q

Patients on lorazepam should be switched to a different drug before attempting withdrawal. T/F

A

True

41
Q

Are benzodiazepines associated with anterograde or retrograde amnesia?

A

Anterograde amnesia (inability to make new memories)

42
Q

What is the most effective drug for OCD?

A

Clomipramine (tricyclic) - however it is used second line after SSRIs/ SNRIs due to side effects

43
Q

Which anxiety disorder has significant co-morbidity with schizophrenia, eating disorders and tourette’s?

A

OCD

PSYCHIATRY (11 decks)

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