Anxiety disorders Flashcards
List some of the physical symptoms of anxiety
Sweating, hot flushes, cold chills Trembling Muscle tension Dizziness and lightheadedness Sensation of choking/ lump in the throat Palpitations Nausea
List some of the behavioural symptoms of anxiety
Avoidance Exaggerated responses to minor surprises or being startled Difficulty getting to sleep Excessive use of alcohol and drugs Irritability
List some of the cognitive symptoms of anxiety
Agitation Poor concentration Derealisation Depersonalisation Hypervigillence Hypochondria Preference for order and routine
Describe the general management plan for anxiety disorders and phobias
Exercise/ meditation/ relaxation therapy
CBT
SSRIs (first line) - other antidepressants 2nd line
Pregabalin
B-blockers and benzodiazepines for symptom control
It is good practice to try and avoid benzodiazepines, but sometimes they are necessary.
Give some examples where their use may be indicated
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.
Higher doses of antidepressants are required for anxiety disorders than for depression. T/F
TRUE
Describe generalised anxiety disorder (GAD)
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
What are the criteria for diagnosis of GAD?
Long lasting (most days for at least 6 months)
Not controllable
Causes significant impairment of function
Describe panic disorder
Recurrent unpredictable attacks of severe anxiety, not anxious the rest of the time
More common in younger patients
50% also have agoraphobia
What are the key signs and symptoms of panic disorder?
Palpitations
Chest pain
Choking sensation
Feelings of unreality
Secondary fears of dying, losing control or going mad
How can panic attacks be triggered in susceptible individuals and what will a PET scan show?
By infusion of lactate or by rebreathing air (increased C02)
PET scan shows increased metabolism which is suggestive of panic disorder
What are the 3 main types of phobia?
Agoraphobia
Specific phobia
Social phobia
What management option is important for specific phobias?
Behavioural therapy - graded exposure and desensitisation
Are social phobias more or likely to occur in small or large social settings?
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)
What are some of the key signs and symptoms of social phobias?
Blushing and shaking
Fear of vomiting
Urgency/ fear of micturition or defecation
Most people with OCD experience at least one major depressive episode. T/F?
TRUE
Describe the obsessional thoughts and compulsive acts which are indicative of OCD
Ideas, images and thoughts which are unpleasant, resisted and ego-dystonic
Repeated rituals which are not enjoyable or functional
What are the criteria for diagnosis of OCD?
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
What are the most common obsessions in OCD?
Checking
Counting
Contamination
What diagnosis are important to rule out in patients presenting with anxiety symptoms?
Depression
Hyperthyroidism
How does CBT work?
Helps the individual to identify thoughts and behaviours that reinforce and perpetuate anxiety.
Describe the management plan for OCD
CBT
Antidepressants (SSRIs/ clomipramine - tricyclic)
Antipsychotics
What is meant by centrifugal and centripetal disasters?
Centrifugal - the people don’t know each other
Centripetal - disaster in a community
What is meant by type 1 and type 2 trauma?
Type 1 trauma
- Single unexpected incident
Type 2 trauma
- Repetitive trauma, ongoing abuse e.t.c
Describe tonic immobility, a freeze response to anxiety/ fear
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
Which anxiety disorder has the highest association with suicide?
PTSD
What percentage of patients with PTSD have a comorbid psychiatric condition?
80%
What are some of the signs and symptoms of PTSD?
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
How long must symptoms be present for a diagnosis of PTSD?
At least 1 month
What is the treatment for PTSD?
CBT
EMDT (eye movement desensitisation and reprocessing)
Medications
What is meant by anxiety disorder ‘in context’ vs ‘in extent’?
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
Which part of the brain is responsible for re-experiencing traumatic memories?
Hippocampus
What is the role of GABA?
what ions does it affect
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.
How do benzodiazepines work? Where do they bind?
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.
Which area of the brain is responsible for integrating sensory and cognitive information?
Amygdala
Which area of the brain is responsible for increasing cortisol levels in times of stress?
Hypothalamus
Which area of the brain is responsible for re-experiencing traumatic events?
Hippocampus
Which circuit in the brain is responsible for the emotion of fear and which is responsible for worry?
Amygdala centred circuit is responsible for fear
Cortico-striatal-thalamic circuit is responsible for worry
Benzodiazepines are fairly safe in overdose.. What drug can be used to reverse their effect?
Flumazenil
Patients on lorazepam should be switched to a different drug before attempting withdrawal. T/F
True
Are benzodiazepines associated with anterograde or retrograde amnesia?
Anterograde amnesia (inability to make new memories)
What is the most effective drug for OCD?
Clomipramine (tricyclic) - however it is used second line after SSRIs/ SNRIs due to side effects
Which anxiety disorder has significant co-morbidity with schizophrenia, eating disorders and tourette’s?
OCD
