Anxiety Disorders Flashcards
1
Q
Symptoms of anxiety
A
- Chest and abdominal
- Chest pain
- Dizziness
- Rapid breathing/breathlessness
- Heart palpitations
- Increased BP
- Nausea
- Diarrhoea
- Arousal
- Sweating
- Dry mouth
- Difficulty swallowing
- Chills/hot flashes
- Psychological symptoms
- Restlessness
- Sense of dread
- Feeling ‘on edge’
- Difficulty concentration/easily distracted
- Feelings of detachment - derealisation/depersonalisation
- Fear of losing control
- Fear of dying
- Other
- Tremors
- Decreased sex drive
- Irritability
- Increased muscle tension
- Weakness
2
Q
Epidemiology and aetiology of anxiety
A
- Strong association with depression
- 3:2 male:female
- Prevalence varies inversely with income and educational attainment
- Triggers include life events associated with threat or danger
- Aetiology includes biological, psycholofical/behavioural and social factors
3
Q
Phobic disorders
A
- Anxiety provoked by specific situations or objects percieved to be more dangerous than they actually are
- Onset typically in childhood
- Commonly animals/blood/heights
- Most associated with panic attacks
- Management
- Phobic learning history - create new learning history
- Stimulus exposure > anxiety > relaxation > decreased anxiety
- Fear and avoidance hierarchy (write lists and describe feelings)
- Subjective units of distress scale (measure on scale of 1-10)
NB - Social phobia is fear of performance failure and fear of negative evaluation - associated with higher rate of alcohol misuse to boost confidence in social situations.
4
Q
Generalised anxiety disorder
A
- Free floating anxiety often with panic disorder - not restricted to any circumstance, irrational worries, motor tension, autonomic overactivity
- Management includes:
- Drug
- Benzodiszepine
- SSRI
- Beta blockers
- Mirtazapine
- Venlafazine
- Duloxetine
- Non-drug
- Relaxation therapy
- CBT
- Exposure therapy
- Physical exercise
- Drug
5
Q
Panic disorder
A
- Bimodal peak in age of onset - late adolescence and mid-thirties
- Slightly more common in women
- Comorbidity with other mental disorders common
- Presents with several severe attacks of autonomic anxiety within a month, fear of death/suffocating, urgent desire to flee
- Management includes:
- Drug
- SSRI
- Benzo’s not recommended
- Non-drug
- CBT
- Anxiety management and relaxation training
- Drug
6
Q
Agoraphobia
A
- Anxiety manifested by psychological and autonomic symptoms
- Anxiety restricted to at least 2 of the following:
- Crowds
- Public places
- Travelling away from home
- Avoidance of phobic situation
- More common in women
- Age of onset usually early to mid 20s with another peak in 30s
- Typically starts with a panic attack
- Treatment includes SSRIs, ansiolyticsm CBT and behaviour therapy
7
Q
Post-traumatic stress disorder (PTSD)
A
- Delayed and protracted response to a stressful event/situation of an exceptionally threatening nature
- Disorder arises within 6 months of trauma
- Symptoms include repeated reliving of the trauma, nightmares, numbness and emotional detachment, autonomic hyperarousal, hypervigilance and avoidance of activities/situations reminiscent of trauma
- Treat with CBT, EMDR (eye movement desensitisation and reprocessing), high dose SSRIs and TCAs
8
Q
Obsessive-compulsive disorder
A
- Obsessions - recurrent intrusive thoughts, images, ruminations and impulses
- Compulsions - ritualistic motor acts
- Must be ego-syntonic, acknowledged as unreasonable or excessive, and there are attempts to resist
- Experiences cause distress and/or interfere with ADLs
- Treat with CBT (ERP), SSRIs (high dose) and clomipramine
9
Q
Somatoform and dissociative disorder
A
- Somatoform disorder - mental disorder characterised by physical symptoms which cannot be explained by a medical condition (symptoms cannot be consciously fabricated)
- Dissociative disorders involve breakdowns in memory, awareness, identity and/or perception
- Difficult to treat and tend to resolve spontaneously over time
