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Psychiatry Summary > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

What are anxiety disorders

A

Anxiety is normal response to threat but can become exaggerated

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2
Q

Epidemiology of anxiety

A

F:M = 2:1

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3
Q

Pathophysiology of anxiety

A

Coping mechanisms of stress – problem or emotion focussed

Flight or fight response

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4
Q

Cause of anxiety

A

Biochemical ‘engineering’

  • ‘Final straw’

Medicophysical model

  • Alarm reaction, physio=logical adaption & stressor if persists

Psychological model

  • Balance between cognitive processing of perceived threat & perceived ability to cope
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5
Q

Presentation of anxiety

A

Psychological arousal

Autonomic arousal

Muscle tension

Hyperventilation

Sleep disturbance

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6
Q

Psychological arousal in anxiety

A

Fearful anticipation

Irritability

Sensitivity to noise

Poor concentration

Worrying thoughts

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7
Q

Autonomic arousal in anxiety

A

GI

  • Dry mouth
  • Swallowing difficulties
  • Dyspepsia, nausea, wind
  • Frequent loose motions

Respiratory - Tight chest, difficulty inhaling

Cardiovascular

  • Palpitations/missed beats
  • Chest pain

Genitourinary

  • Frequent/urgency of micturition
  • Amenorrhoea/dysmenorrhoea
  • Erectile failure, decreased libido

CNS - Dizziness, sweating

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8
Q

Muscle tension in anxiety

A

tremor

headache

muscle pain

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9
Q

Hyperventilation in anxiety

A

causing CO2 deficit hypocapnia

Numbness if extremities -> carpopedal spasm (frequent involuntary movement of hands/feet due to low calcium)

Breathlessness

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10
Q

Sleep disturbance in anxiety

A

Initial insomnia

Frequent waking

Nightmares/terrors

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11
Q

Types of anxiety disorders

A

Generalised anxiety disorder

Phobic anxiety disorders

Post-traumatic stress disorder

Obsessive-compulsive disorder

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12
Q

Differential diagnosis of anxiety

A

Psychiatric conditions

  • Depression
  • Schizophrenia
  • Dementia
  • Substance misuse

Physical conditions

  • Thyrotoxicosis
  • Pheochromocytoma
  • Hypoglycaemia
  • Asthma and/or arrythmias
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13
Q

What is generalised anxiety disorder (GAD)

A

Persistent (several months) anxiety, symptoms not confined to a situation or object

Present most days

Excessive, persistent, unreasonable anxiety

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14
Q

Epidemiology of GAD

A

1-year prevalence of around 4.4%

Women>men

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15
Q

Cause of GAD

A

Stressor acting on a personality predisposed to the disorder by a combination of genetic factors & environmental influences in childhood

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16
Q

Presentation of GAD

A

All symptoms of anxiety can occur

Restlessness, irritability, difficult concentrating

Difficulty sleeping

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17
Q

Differential of GAD

A

Hyperthyroidism

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18
Q

Management of GAD

A

Counselling - advice regarding caffeine, alcohol, exercise etc.

Relaxation training

Medication

  • Antidepressants – SSRIs or TCA
  • Sedatives high risk of dependency

CBT (better remission than medication)

19
Q

What are phobic anxiety disorders

A

Anxiety experienced in specific circumstances or perceived threat of circumstances (anticipatory anxiety)

Person behaves to avoid these circumstances -> phobic avoidance

  • Avoidance differentiates from fear

Fears are normal, phobia interferes with life

20
Q

Epidemiology of phobic anxiety

A

F>M

21
Q

What are phobic anxiety disorders associated with

A
  • Anxiety disorders (OCD)
  • Substance misuse
  • Depression
22
Q

Presentation of phobic anxiety disorders

A

Symptoms of anxiety - at presence or though

Social phobia – blushing & tremor predominate

23
Q

Types of phobic anxiety disorders

A

Specific phobias

Social phobia

Agoraphobia (public spaces)

24
Q

Management of phobic anxiety

A

CBT - gradual exposure

Education & advice

Medication - SSRI

25
Q

What is OCD

A

Experience of recurrent obsessional thoughts and/or impulsive acts

26
Q

Epidemiology of OCD

A

1-year prevalence 2%

M=W

Onset in childhood-early adulthood

27
Q

Pathophysiology of OCD

A

Obsessional thoughts

  • Ideas, images, impulses
  • Occurring repeatedly not willed – very difficult to resist
  • Unpleasant& distressing (often of the antithesis personality type)
  • Recognised as the individuals own thoughts (not a voice)

Key anxiety symptoms arise because or distress of thoughts or attempts to resist

28
Q

Cause of OCD

A

Genetic – gene coding for 5HT receptor

5HT function abnormalities

29
Q

Risk factors of OCD

A

First degree relative

Depression

Tourettes

30
Q

Presentation of OCD

A

Anxiety symptoms – as a result of resistance

Compulsive acts/rituals

  • Stereotypical behaviours repeated again & again
  • Not enjoyable or helpful
  • Often viewed by sufferer as preventing harm to self or others

Interferes with daily life

31
Q

Differential of OCD

A

Obsessive compulsive personality

  • Obsessive thoughts not as strong a feature
  • Not as distressing, their ‘normal’
32
Q

management of OCD

A

Education & explanation

Serotonergic drugs – SSRI (fluoxetine), clomipramine

CBT – exposure & response prevention

Psychosurgery (if treatment resistant)

33
Q

What is PTSD

A

Delayed and/or protracted reaction to a stressor of exceptional severity (that would distress anyone)

Often within 6 months

34
Q

Epidemiology of PTSD

A

1-year prevalence 1-4%

  • Variable due to cultural factors, exposure to disaster

W:M = 2:1

  • Highly associated with sexual assault
35
Q

Cause of PTSD

A

Trigger

  • Combat
  • Natural/human-caused disaster
  • Rape
  • Assault
  • Torture
  • Witnessing any of the above

Genetic component

36
Q

Risk factors for PTSD

A

Mood disorder, other mental health disorder

Previous trauma (especially as child)

Lack of social support

Interpersonal trauma > accidents

Protective factors

  • Higher education & social group
  • Good paternal relationship
37
Q

Presentation of PTSD

A

Hyperarousal

Re-experiencing trauma

Avoidance of reminders

Hypervigilant

38
Q

Pneumonic for remembering presentation of TSD

A

HARD

  • Hypersoursal
  • Avoidance
  • Re-experiencing
  • Distress
39
Q

Hyperarousal in PTSD

A

Persistent anxiety

Irritability, outbursts

Insomnia

Poor concentration

40
Q

Hypervigilant in PTSD

A

Constantly on guard

41
Q

Re-experiencing trauma in PTSD

A

Intrusive imaged - flashbacks when awake, nightmare when asleep

42
Q

Avoidance reminders in PTSD

A

Emotional numbness – detachment to other people

Cue avoidance

Recall difficulties

Diminished interests – not responding to their environment like they normally would, anhedonia

43
Q

management of PTSD

A

Survivors of disasters screen at 1 month

Mild symptoms – ‘watchful waiting’ and review after 1 month

Trauma focused CBT - exposure, group

Eye movement desensitisation & reprocessing

SSRI or TCA

44
Q

Complications of PTSD

A

Associated with depression & anxiety

Alcohol problems/substance misuse due to ‘self medication’

Psychiatry Summary (11 decks)

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