Anxiety Disorders Flashcards
when is anxiety a health problem?
If the response is exaggerated, lasts for more than 3 weeks and if it interferes with daily life.
Which gender and by how much is anxiety more common?
2x in females
What is neurosis?Asides from anxiety and depression give 3 other symptoms.
Maladaptive psychological symptoms, not due to organic causes or psychosis, usually precipitated by stress. Can also show: Fatigue, insomnia, irritability, worry, obsessions and compulsions, and somatisation
Give 5 cognitive, 6 somatic and 2 behavioural symptoms of anxiety.
Cognitive:
Agitation, lowered concentration, insomnia, excessive concern, repetitive thoughts and activities.
Somatic:
Tension, tremor, butterflies in stomach, hyperventilation, tingling in hands and chest pain, headaches, sweating, nausea, feeling faint, palpitations, lump in throat.
Behavioural: seeking reassurance, avoiding.
What is needed for an ICD 10 diagnosis of GAD?
6 month history of worry/ anxiety about everyday situations.
4 present of:
Autonomic symptoms
Chest/abdomen symptoms, tension symptoms (muscle tension, aches, restlessness)
General symptoms (tingling, numbness, hot flushes)
and
Criteria for panic disorder, hypochondriasis and OCD not met.
What is thought to be the causes of anxiety?
Genetic predisposition, stress, life events
Give 4 psychological treatments for anxiety.
Listen! (explain there is no fatal disease, that anxiety in itself causes no harm)
Regular exercise
Meditation (mindfulness) (i.e. self help in mild disease)
CBT (best!)
Hypnosis.
What is 1st, 2nd/3rd line medical treatment for anxiety?
1st: SSRI (any).
2nd or 3rd: venlafaxine or TCA.
Drugs are if CBT doesn’t’ work/not wanted
When would benzodiazepines or antipsychotics be indicated?
Benzos: Sparingly for acute distress and agitation. If trials of several other medicines have had no effect then longer term may be reasonable.
Antipsychotics: generally reserved for acute distress.
When can B blockers be used?
For somatic symptoms. They do not help any cognitive symptoms!
What is panic disorder? what do u treat it with?
Frequent, discrete panic attacks. Treat with CBT SSRI.
What is OCD characterised by?
Obsessions and compulsions.
What are compulsions normally a response to?
A response to dealing with the stress of the obsession.
Can often be resisted but if chronic, patient may not be able to.
What % of people experience OCD?
2-3%
Give two regions in the brain implicated in OCD.
Orbitofrontal cortex, caudate
Give a therapy and two medications used to treat in OCD
CBT.
Clomipramine (a TCA) and SSRIs can help
What are phobic disorders?
A group of disorders in which anxiety is experienced predominantly in certain, well-defined situations that are not dangerous.
When do phobias become a disorder?
When they cause marked distress and/or significantly affect functioning
What is: Agoraphobia, social phobia and simple phobias
Agoraphobia: intense, irrational fear of venturing out into open spaces or situations in which help/escape may not be available should excessive anxiety develop.
Social phobia: where we may be minutely observed, there is fear of scrutiny by others. May be blushing, shaking or need to go to the toilet
Simple phobia: Numerous, restricted to specific situations (i.e. arachnophobia)
Give 2 therapies and 2 medications that can be used in conjunction for phobias.
Therapies: Behavioural therapy, CBT.
Medications: SSRIs, TCAs and pregabalin can be used In conjunction.
What is an adjustment disorder?
‘Normal depression’
Subjective distress and emotional disturbance, usually interfering with social functioning and performance, that would not have arisen without a stressor. I.e. Abnormally excessive responses to life stresses.
What is the difference between an adjustment disorder and a normal reaction to stress?
In normal reactions to stress, functioning is not impaired
What is an acute stress reaction? How does it get better?
Transient reaction to stress lasting hours-days. Dissociation (a daze) then a mix of anxiety, anger, confusion.
Gets better by itself.
If symptoms become chronic, give 2 things an acute stress reaction could be?
Adjustment disorder (<1 month), PTSD (<6 months)
Give 4 common symptoms of PTSD
1) Vivid flashbacks and nightmares with automatic arousal, often precipitating anxiety
2) avoidance of things associated with the event
3) sleep and concentration problems
4) easy startling
What are 3 disorders common alongside PTSD?
Depression, alcohol and drug misuse, anger.
How long can it take symptoms to appear in PTSD? Why may this be?
Several months to years
Due to there often being denial or suppression of the memory.
What type of event is more likely to cause PTSD?
Caused by any exceptionally stressful, life-threatening or catastrophic event/situation.
More likely with intentional acts of violence rather than natural events/accidents
What is the risk for men and women respectively for PTSD?
8% for men, 20% for women after a traumatic experience.
Give an area of the brain involved in PTSD
Anterior cingulate area, lowered amygdala threshold to fear
Give 3 therapies that are effective in PTSD
What medications can be used and when are they indicated?
Trauma focussed CBT, eye movement desensitisation and reprocessing, hypnotherapy.
Medicine is 2nd line to therapy, can be used in combination. SSRIs, amitriptyline, mirtazapine and SGA can be used.
What is the prognosis of PTSD?
About 50% recovered within a year, but depends on the severity of event, coping mechanisms and secondary problems from the event
