Anxiety disorders Flashcards
Anxiety is a normal reaction, normal emotion that people experience. True or false?
True
- but it is important to identify when it becomes pathological
What are the 3 groups of symptoms we assess in anxiety (normal) ?
Biological (physical) symptoms
Cognitive symptoms
Behavioural symptoms
Normal anxiety - physical symptoms
Sweating Cold chills Trembling / shaking Muscle tension / aches Numbness / tingling Feeling dizzy / unsteady / faint Dry mouth Difficulty swallowing Sensation of a lump in throat Difficulty breathing Palpitations Chest pain Nausea Abdominal distress
Normal anxiety - cognitive symptoms
Fear of losing control Feeling on edge / tense Difficulty concentrating Feeling that objects are un-real (derealisation) Feeling that you are distant or "not really here" (depersonalisation) Hyper-vigilance Racing thoughts Meta worry Health anxiety
Normal anxiety - behavioural symptoms
Avoidance of certain situations Exaggerated response to minor surprises Difficulty in getting to sleep Excessive use of alcohol/drugs Restlessnesss Irritability
Acute stress leads to increase in ____ and ____
Cortisol and cateholamines
What is the function of cortisol in the stress response?
Acts as to mediate and shut down the stress response
In acute stress, cortisol levels are INCREASED/DECREASED?
Increased
When does normal anxiety become an anxiety disorder?
When anxiety becomes pathological and impairs day to day function.
Anxiety is more extreme than normal.
Anxiety is present in situations that are not normally anxiety provoking
Amygdala centred circuit is involved with FEAR/WORRY?
Fear
- panic, phobias
Name 4 anxiety disorders
Generalised anxiety disorder
Panic disorder
Phobias
OCD
Patient with anxiety that is not restricted to any particular environmental circumstance and is present most of the time. What is the likely diagnosis?
Generalised anxiety disorder
Generalised anxiety disorder - definition
Generalised and persistent anxiety
Not restricted or fixed on one particular thing
Present all/most of the time
Generalised anxiety disorder - cause
Unknown
Not due to substance misuse or any other medical condition
Generalised anxiety disorder - typical age of onset?
between 20-40
Generalised anxiety disorder is more common in which sex?
Females
Generalised anxiety disorder - clinical features
Earlier discussed + Persistent nervousness Fears (e.g. that family member will have a RTA) Sleep disturbance - restless unsatisfied sleep
In GAD, the patient often acknowledges that they don’t need to be anxious about all of these things but they can’t help it. True or false?
True
Generalised anxiety disorder - diagnosis
Must be severe enough to be:
- long lasting (most days for at least 6 months)
- non controllable
- causing significant distress
Generalised anxiety disorder - management
- High intensity CBT OR Drug treatment (SSRI)
- SNRI
- Pregablin
- Combo of CBT + drug
Generalised anxiety disorder - for how many months do you continue treatment for?
18 months
Panic disorder - definition
Recurrent attacks of severe anxiety
There is a reason/trigger for anxiety
Intermittent
Unpredictable
Panic disorder is intermittent. True or false?
True
Panic disorder - age of onset
Adolesence - mid 30s
Panic disorder can be triggered in some people by causing a build up of which substance?
Lactate
Panic disorder - which imaging investigation may be useful?
PET scan
Panic disorder - management
- CBT
- Anti-depressant (SSRI)
- TCA
Panic disorder - how long do you continue treatment for?
6 months
Phobia - definition
Irrational fear of something that is relatively quite normal
Fear in a particular situation that is excessive or unreasonable
What are the 3 types of phobia?
Agoraphobia
Social phobia
Specific phobia
Fear of leaving home, entering shops, crowds and other public places is called?
Agoraphobia
Agoraphobia - who gets it?
Adolescence -> 30s
Agoraphobia is more often a PRIMARY/SECONDARY disorder?
Secondary
Agoraphobia - clinical features
Avoidance of the phobic situation
Specific phobia - definition
Cued by the presence or anticipation of a specific object or situation
- e.g. fear of flying
Specific phobia - who gets it?
Early onset
- early adolescence -> 20s
Specific phobia - clinical features
Exposure to the phobic stimulus provokes an immediate anxiety response.
Normal functioning is impaired by the avoidance, anxious anticipation or distress in the feared situations
Social phobia - definition
Persistent fear of social scrutiny
Fear of embarrassing themselves in public
Social phobia usually occurs in large social settings. True or false?
False
- small social settings
Social phobia - clinical features
Exposure to feared situation provokes anxiety, which may take the form of a situationally bound panic attack
Poor school/employment history
OCD - definition
Recurrent obsessional thoughts and/or compulsive acts
OCD - more likely to occur earlier in males/females?
Males
OCD - obsessional thoughts
Ideas, images or impulses entering the mind
Recognised as the patients own thoughts
But they are unpleasant
eg a woman that is distressed about harming her children
OCD - compulsive acts
Repeated rituals
Recognised as pointless
OCD - common obsessions
Contamination Sexual thoughts (being a paedophile) Fear of harm (door locks are not safe)
OCD - common compulsions
Cleaning, washing
Repeating acts
Order
Hoarding
OCD - obsessions must always be the individuals own thoughts. true or false?
True
OCD - Obsessional symptoms / compulsive acts must be present most days for at least _____ before a diagnosis can be made
2 weeks
OCD - management
- CBT
- SSRI
- SSRI + CBT
- TCA
Which drugs are used to treat anxiety
Benzodiazepines Anti-depressants Buspirone Pregablin Beta blocker
Which beta blocker is used to treat anxiety?
Propranolol
