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Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

What will an individuals reaction to stress depend upon?

A
  • A balance between their cognitive ability to understand any percieved threat and their perceived ability to cope
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2
Q

What are the two stress models relating to coping?

A
  • Problem focussed
    • Where efforts are directed toward modifying stressor. Preparation, studying or interview practice
  • Emotion focussed
    • Modify emotional reaction. Mental defence mechanisms eg Denial. Relaxation training
    • Take a sedative drug.
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3
Q

What are the symptom groups for anxiety?

A

Fight or flight response

  • Psychological arousal
  • Autonomic Arousal
  • Muscle Tension
  • Hyperventilation
  • Sleep Disturbance
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4
Q

In what ways can we experience psychological arousal?

A
  • Fearful Anticipation
  • Irritability
  • Sensitivity to noise
  • Poor concentration
  • Worrying Thoughts
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5
Q

In which way does automonic arousal effect:

GI

Resp

CVS

Urinary

CNS

A
  • Gastrointestinal
    • Dry Mouth
    • Swallowing difficulties
    • Dyspepsia, nausea and wind
    • Frequent loose motions
  • Respiratory
    • Tight chest, difficulty inhaling
  • Cardiovascular
    • Palpitations/Missed beats
    • Chest pain
  • Genitourinary
    • Frequency/urgency of micturition
    • Amenorrhoea/ Dysmenorrhoea
    • Erectile failure
  • CNS
    • Dizziness and sweating
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6
Q

What are the three main symptoms of stress?

A
  • Muscle Tension
    • Tremor
    • Headache
    • Muscle pain
  • Hyperventilation
    • Causing CO2 deficit hypocapnia
    • Numbness tingling in extremities may lead to carpopedal spasm
    • Breathlessness
  • Sleep Disturbance
    • Initial insomnia
    • Frequent waking
    • Nightmares and night terrors
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7
Q

Please explain Phobic Anxiety Disorders and General Anxiety Disorder:

A
  • Both these sets of disorders have same core anxiety symptoms but they EITHER occur in particular circumstances:
  • PHOBIAS
    • Agoraphobia
    • Social phobia
    • Specific (Isolated) Phobias

OR Occur persistently

  • GENERALISED ANXIETY DISORDER (GAD)
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8
Q

Explain in more depth GAD:

A

Generalised Anxiety Disorder

“In general terms GAD for instance is caused by a stressor acting on a personality predisposed to the disorder by a combination of genetic factors and environmental influences in childhood.”

  • Persistent (several months) symptoms not confined to a situation or object.
  • All the symptoms of human anxiety mentioned earlier can occur
    • Psychological arousal
    • Autonomic Arousal
    • Muscle Tension
    • Hyperventilation
    • Sleep Disturbance
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9
Q

DDx for anxiety:

A
  • Psychiatric Conditions
    • Depression
    • Schizophrenia
    • Dementia
    • Substance Misuse
  • Physical Conditions
    • Thyrotoxicosis
    • Phaeochromoctoma
    • Hypoglycaemia
    • Asthma and or Arrhythmias
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10
Q

Which NICE clinical guideline is used for anxiety?

A

113

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11
Q

What is the general management for GAD?

A
  • Counselling
    • Clear Plan of Management
    • Explanation and education
    • Advice re caffeine, alcohol, exercise etc.
  • Relaxation training
    • Group or individual
    • DVDs, tapes or clinician led
  • Medication
    • Sedatives have high risk dependency
    • Antidepressants SSRI or TCA
  • Cognitive Behavioural Therapy
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12
Q

Please explain in more depth Cognitive Behavioural Therapy (CBT) for Anxiety Disorders:

A
  • Our emotional response to a situation will depend on our cognitive processing of it.
  • Identifying errors, reprocessing and reassessing responsibility are key elements
  • Patients tend to find this intuitively sensible
  • Maintaining remission appears superior to drug therapy
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13
Q

What are the specidfic 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 or situation “anticipatory anxiety”
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14
Q

What are three important phobic anxiety disorders?

A
  • Specific Phobias
  • Social Phobia
  • Agoraphobia
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15
Q

What is social phobia?

A
  • Inappropriate anxiety in situation where person feels observed or could be criticised
    • Restaurants
    • Shops or any queues
    • Public speaking
  • Symptoms are any of the anxiety cluster mentioned above but blushing and tremor predominate
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16
Q

How can we manage social phobia?

A
  • Cognitive Behavioural Therapy addressing the groundless fear of criticism. CBT challenges
    • Negative views of self
    • “Safety barriers”
    • Unrealistically high standards
    • Excessive self monitoring
  • Education and advice
  • Medication SSRI antidepressants
17
Q

What are the core features of OCD?

A

Obsessive Compulsive Disorder

  • Recurrent obsessional thoughts and or compulsive acts
18
Q

Explain the obsessive thoughts in OCD?

A
  • Ideas, images or impulses
  • Occurring repeatedly not willed
  • Unpleasant and distressing (often the antithesis of personality type)
  • Obscene
  • Violent or senseless
  • Recognised as the individual’s own thoughts
  • Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist
19
Q

Explain the compulsive acts in OCD?

A
  • Stereotypical behaviours repeated again and again
  • Not enjoyable
  • Not helpful i.e. do not result in useful activity
  • Often viewed by sufferer as
  • preventing some harm to self or others; “magical undoing”
  • Viewed as pointless and resisted with key anxiety symptoms accompanying resistance
20
Q

What is the epidemiology of OCD?

A
  • Overall one year prevalence is 2%
  • Equally affects men and women
  • Aetiological Theory
  • Genetic e.g. gene coding for 5HT receptors
  • 5 HT function abnormalities
21
Q

What is the general management of OCD?

A
  • General measures
    • Education and explanation
    • Involve partner/family
  • Serotonergic Drugs
    • SSRI eg Fluoxetine
    • Clomipramine
  • Cognitive Behavioural Therapy (CBT)
    • Exposure and response prevention
    • Examination of evidence to weaken convictions
  • Psychosurgery
22
Q

What is PTSD and what traumatic events can illicit it?

A
  • Delayed and or protracted reaction to a stressor of exceptional severity” (would distress anyone)
    • Combat
    • Natural or human-caused disaster
    • Rape
    • Assault
    • Torture
    • Witnessing any of the above
23
Q

What are the three key elements to a reaction for PTSD?

A
  1. Hyperarousal
  2. Re-experiencing phenomena
  3. Avoidance of reminders
24
Q

What is hyperarousal? related to PTSD?

A
  • Persistent anxiety
  • Irritability
  • Insomnia
  • Poor concentration
25
Q

What does re-experiencing phenomona mean? related to PTSD

A
  • Intense intrusive images
    • Flashbacks when awake
    • Nightmares during sleep
26
Q

What does avoidance mean in relation to PTSD?

A
  • Emotional numbness
  • Cue avoidance
  • Recall difficulties
  • Diminishes interests
27
Q

Aetiology of PTSD?

A
  • Nature of stressor
    • Life threatening and degree of exposure generally confers greater risk however
      • Vulnerability factors
        • Mood disorder
        • Previous trauma especially as child
        • Lack of social support
        • Female
        • Protective factors (examples)
        • Higher education and social group
        • Good paternal relationship
  • Susceptibility partly genetic
28
Q

What is the management of PTSD?

A
  • Survivors of disasters screened at one month
  • Mild symptoms “watchful waiting” and review further month
  • Trauma-focused CBT if more severe symptoms
  • Eye Movement Desensitisation and Reprocessing
  • Risk of dependence with any sedatives but patient may prefer medication SSRI or TCA

Psychiatry (24 decks)

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