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Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Describe the stress response

A
  1. Stressor (stimulus) sent to amygdala where emotional processing takes place
  2. Interpretation in amygdala
  3. Amygdala signals hypothalamus
  4. Hypothalamus signals adrenal cortex via sympathetic system
  5. Adrenals secrete adrenaline
  6. Once adrenaline levels subside, hypothalamus activates HPA axis –> CRH and ACTH released
  7. These hormones cause adrenal glands to secrete cortisol
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2
Q

What differentiates pathological anxiety from physiological anxiety?

A

More prolonged

Occurs when there is no threat

Focus of attention is not the external threat, but the physiological response itself (ex. increased heart rate)

Severe distress and difficulty in daily activities

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3
Q

Classification of Anxiety Disorders

A
  1. Generalised Anxiety Disorder
  2. Panic Disorder
  3. Agoraphobia
  4. Social Phobia
  5. Specific Phobia
  6. OCD
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4
Q

Buzzword = “free floating”

A

Generalised anxiety disorder

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5
Q

Characteristics of Generalised Anxiety

A

Excessive, uncontrolled, irrational worry about everyday things that is out of proportion to the actual source of the worry

Not restricted to any particular environmental circumstance

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6
Q

Diagnostic Criteria of Generalised Anxiety (DSM)

A

A. Anxiety for more days than not over 6 months
B. Not controllable
C. Significant distress/impairment of social & occupational functioning
D. Not due to substance misuse or other medical condition

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7
Q

Symptoms of generalised anxiety

A 
Restlessness; feeling keyed up or on the edge
Persistent nervousness
Light-headedness
Easily fatigued
Irritability
Trouble sleeping (of any kind) 
Palpitations
Muscle tension
Nausea, vomiting, epigastric discomfort
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8
Q

Epidemiology of Generalised Anxiety

A

Age: 20 to 40
Gender: 2:1::F:M
Comobordity: depression, substance abuse

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9
Q

Treatment of Generalised Anxiety

A

Cognitive Behavioural Therapy

SSRIs/SNRIs

Pregabalin

Benzodiazepene (short term only

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10
Q

What are panic attacks?

A

Period of intense fear of some kind of catstrophe occurring
Cluster of typical symptoms that develop rapidly
Last a few mins
May occur in all anxiety disorders

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11
Q

What is Panic Disorder?

A

Recurrent panic attacks that take place unexpectedly
Not due to substance misuse or other medical condition
Not specific to a particular setting

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12
Q

Dominant symptoms of Panic Disorder

A 
Sudden onset palpitations
Choking
Chest pain
Feelings of unreality (depression, depersonalisation) 
Fear of an impending medical emergency

NOTE: rule out hyperthyroid symptoms
Commonly presents with agoraphobia

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13
Q

Epidemiology of panic disorder

A

Age: late adolescence to age 30
Comorbidity: agoraphobia, anxiety disorder, depression, substance abuse
Higher prevalence in cardiology clinic

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14
Q

Aetiology of Panic Disorder

A
  1. Genetic
  2. Biochemical - imbalance in neurotransmitter activity in the brain
  3. Cognitive hypothesis- patients with panic disorder more often have fears concerning physical symptoms
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15
Q

Treatment of Panic Disorder

A

CBT
SSRI/SNRI
Pregabalin
Benzodiazepine (short term)

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16
Q

What are the 3 types of phobias

A

a) simple/specific phobia
b) social phobia
c) Agoraphobia

17
Q

Features of phobic anxiety disorders (3)

A
  1. Specific circumstances only
  2. Avoidance of circumstances that provoke anxiety
  3. Anticipatory anxiety - prospect of encountering a particular situation
18
Q

What is agoraphobia?

A

Anxiety symptoms in an unfamiliar situation, from which they cannot escape or in which they perceive they have little control

Leads to avoidance of those situation

19
Q

Clinical features of agorahobia

A

Anxious when away from home, crowds, social situations
Anticipatory anxiety
Avoidance of those situations
Anxious thoughts - fainting and loss of control
panic attacks
depression
depersonalisation

20
Q

What is social phobia?

A

Inappropriate anxiety in social settings which lead to the desire for escape or avoidance

Fear of social scrutiny and public humiliation

21
Q

Social phobia vs agoraphobia?

A

Agoraphobia - big setting/crowd

Social phobia - small social setting

22
Q

Clinical features of social phobia

A

Specific concerns - insight that they are irrational
Avoidance
Anticipatory anxiety
Blushing and trembling
Fear of vomiting
Urgency/fear of micturition or defecation

23
Q

Onset of social phobia

A

Late adolescence

24
Q

Aetiology of social phobia

A
  1. exaggerated normal concerns
  2. Parenting styles
  3. Childhood experiences
25
Q

Treatment of social phobia

A
  1. CBT
  2. SSRI/SNRI
  3. Benzodiazepene (short term)
26
Q

Onset of agoraphobia

A

Peak - 20, but bimodal

15-30 and 70- 80 years of ago

27
Q

Clinical course of agoraphobia

A

1st episode: unexplained panic attack in a crowded place and patient will hurry home
Repetition of this episode in the same setting leads to agoraphobia

28
Q

What is Specific Phobia?

A

Inappropriately anxious in the presence of a particular object/situation

29
Q

Clinical features of specific phobia

A

exposure to stimulus - anxiety response/panic attack

Patient recognises fear is unreasonable

30
Q

Treatment of social phobia

A
  1. Behavioural therapy - exposure
    i. Graded exposure/systematic desensitisation
    ii. Add in CBT (if necessary)
  2. SSRI/SNRI (if required)
31
Q

What is OCD?

A

Obsessions and/or compulsions that the patient feels driven to perform according to specific rules in order to prevent an imagined dreaded event

32
Q

Criteria/Features of OCD

A

Obsessive symptoms and compulsive acts must be present for atleast 2 weeks AND be a source of distress or interference in activities

Obsessions must be individual’s own thoughts
Resistance must be present
Rituals are unpleasant
Obsessional thoughts/impulses/images are repetitive

33
Q

Epidemiology of OCD

A

onset: mean age - 20

No gender bias

34
Q

Aetiology of OCD

A

Familial, but no genes identified

35
Q

Comorbidity of OCD

A 
Schizophrenia
Tourettes and other tic disorders
Body dysmorphic disorder
Eating disorder
Trichtillomania
36
Q

Treatment of OCD

A

CBT

SSRIs/Clomipramine

Psychiatry (15 decks)

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