Anxiety disorders Flashcards
1) How is anxiety often first recognised?
2) Who is more commonly affected by anxiety disorders?
3) Name the 4 categories of aetiology for anxiety.
1) Anxiety is often first recognised by its physical symptoms.
2) Anxiety disorders tend to affect women roughly twice as much as men.
3) Genetics, early experiences and life events, neurochemical theories and behavioural and cognitive theories.
1) People with high neuroticism scores are more likely to experience what feelings?
2) What have twin studies of anxiety shown overlap between?
3) What childhood experiences can predispose to anxiety?
4) What types of life events are especially prone to being a predisposition to anxiety?
5) With regards to genetics, who have higher rates of anxiety disorders?
1) Anxiety, guilt, depression, anger and feelings of being easily overwhelmed by minor frustrations.
2) Depression and GAD.
3) Childhood adversity.
4) Life events can trigger anxiety disorders, especially if they are experienced as threatening (e.g. possible redundancy).
5) Relatives of people with anxiety disorders have higher rates of these disorders than the general population.
1) Which 3 neurotransmitters are thought to be dysregulated in anxiety disorders?
2) Why are these neurotransmitters thought to be implicated in the cause of anxiety disorders?
3) Which 3 classes of drugs can be used for anxiety symptoms?
1) Serotonin, NA and GABA.
2) Because they are the target of drugs that can successfully combat anxiety symptoms.
3) SSRIs (serotonin), TCAs (NA) and BDZs (GABA).
Name 4 behavioural and cognitive theories of anxiety disorders.
1) Classical conditioning: repeated pairing of a neutral stimulus with frightening one results in a fear reaction to the neutral stimulus.
2) Negative reinforcement: behaviours that relieve anxiety are repeated. This prevents habituation, so escaping a fearful stimulus maintains the fear response.
3) Cognitive theories: worrying thoughts are repeated in an automatic way which both induces and maintains the anxiety response.
4) Attachment theory: The quality of attachment between children and parents affects their confidence as adults (insecurely attached children become anxious adults).
1) Briefly describe the basis of generalised anxiety disorder.
2) How long do GAD symptoms need to be present before a diagnosis can be made?
3) Describe the basis of phobic anxiety disorders.
4) What do severe cases of GAD also have?
1) Anxiety is not triggered by a specific stimulus but instead is continuous and free-floating. Life is a worry where past mistakes and future imagined catastrophes occupy the mind ceaselessly.
2) Symptoms must be present for at least 6 months, although the intensity may fluctuate.
3) Intermittent anxiety occurs in specific but quite ordinary circumstances.
4) Severe cases have panic attacks as well.
Name 7 differential diagnoses for generalised anxiety disorders.
1) Hyperthyroidism: look for goitre, tremor, tachycardia, weight loss, arrhythmia and exophthalmos.
2) Substance misuse: intoxication (amphetamines) and withdrawal (BDZs/ alcohol).
3) Excess caffeine.
4) Depression: anxiety is a common feature of depression and depression complicates anxiety.
5) Anxious (avoidant) personality disorder: from late adolescence onwards, the patient describes themselves as an anxious person, with no major recent increase in anxiety levels.
6) Dementia: anxiety may be an early feature of this.
7) Schizophrenia: anxiety may occur before delusions and hallucinations are evident.
1) What do patients with phobic anxiety disorder characteristically do?
2) What is agoraphobia?
3) State 3 common problem situations for agoraphobics.
4) Describe the onset of agoraphobia.
5) If full blown depression and GAD are present, what would you diagnose?
6) What would you diagnose if there are low level depressive and anxiety symptoms present equally together, neither of which justify diagnosis alone?
1) Avoid feared situations.
2) Fear of being unable to easily escape to a safe place. It is fear of open spaces and fear of situations that are confined and difficult to leave without attracting attention.
3) travelling on trains, planes or buses/ queuing/ supermarkets/ large crowds/ parks/ sitting in the middle row of the cinema.
4) Onset is commonly in the 20’s or mid-thirties and may be gradual or precipitated by a sudden panic attack.
5) Diagnose them both.
6) Mixed anxiety and depressive disorder.
List 4 differential diagnoses for agoraphobia.
1) Depression: can cause social withdrawal and is commonly co-morbid with agoraphobia.
2) Social phobia: the fear here is of scrutiny of humiliation.
3) OCD: time-consuming rituals can confine people to their home.
4) Schizophrenia: patients may stay at home because of social withdrawal or as a way of avoiding perceived persecutors.
1) What is social phobia?
2) Describe the onset of social phobia.
3) What is a main difference between social phobia and agoraphobia?
4) What do patients with social phobia complain about the most?
1) The core fear in social phobia is of being scrutinised or criticised by other people and patients often worry that they will embarrass themselves in public.
2) Onset is normally in the late teens, with men and women affected equally.
3) Patients with social phobia will tolerate an anonymous crowd, unlike agoraphobic patients, but find small groups very intimidating. In social phobia, there are sometimes specific worries such as eating in public.
4) Embarrassing symptoms such as blushing, trembling, sweating and urinary frequency.
Give 6 differential diagnoses for social phobia.
1) Shyness: some people are naturally shy and and feel uncomfortable in social situations. In social phobia, there is overt fear.
2) Agoraphobia: the need to get somewhere safe is greater than the fear of scrutiny.
3) Anxious (avoidant) personality disorder: there is a lifelong history of disabling shyness and anxiety.
4) Poor social skills/ autism spectrum disorder: people who are socially awkward will not show good social skills when relaxed - they remain awkward.
5) Benign essential tremor: familial and worse in social situations and responds to BDZs and alcohol. No other features of anxiety.
6) Schizophrenia/ psychosis: patients may avoid social situations because of paranoia or because they have delusions that they are being watched. Patients with social phobia will recognise that their fears are exaggerated.
1) What are specific phobias?
2) When do specific phobias often develop?
3) What do specific phobias result in?
4) What can blood, needle and injury phobias cause?
5) What should you do with needle phobic patients before commencing venipuncture?
1) These are phobias which are restricted to a single, specific situation.
2) They often develop during childhood but can sometimes begin later, usually after a frightening experience.
3) Avoidance and in severe cases, disability.
4) A strong vasovagal reaction leading to bradycardia and low BP.
5) Lay patients flat before taking blood.
1) What is panic disorder also known as?
2) Describe what happens during panic disorder.
3) What is a panic attack?
1) Episodic paroxysmal anxiety.
2) Anxiety is intermittent and without an obvious trigger - it comes ‘out of the blue’.
3) A sudden attack of extreme (100%) anxiety with accompanying physical symptoms.
List 5 symptoms that patients suffering a panic attack might experience.
1) Breathing difficulties/ choking feelings.
2) Chest discomfort/ tightness.
3) Palpitations
4) Tingling or numbess in the hands/ feet/ around the mouth.
5) Depersonalisation/ derealisation.
6) Shaking
7) Dizziness/ faints
8) Sweating
1) What does a patient suffering a panic attack commonly feel?
2) What are safety behaviours?
3) How long do panic attacks usually last for?
4) What needs to occur in order for panic disorder to be diagnosed?
1) They commonly fear that they will die, lose control, become incontinent, or go mad.
2) Actions that are adopted to avert catastrophe that a patient may engage in to provide reassurance.
3) They are self-limiting and usually last no more than 30 minutes.
4) There must be recurrent panic attacks (preferably several within a month) and in between episodes, the patient should be relatively free of anxiety.
What 4 investigations will you need to carry out in a patient with suspected anxiety?
1) Good Hx and physical examination will establish whether an organic cause is likely and may prompt further investigations.
2) Rating scales: Beck anxiety inventory and the HADS. These can assess severity and provide baseline scores against which to measure treatment response.
3) Social and occupational assessments for effects of quality of life.
4) Collateral Hx.
Name 5 management strategies used in the initial help phase of management for patients with anxiety.
1) Advice and reassurance: might be enough to prevent early or mild symptoms from worsening. Psychoeducation helps patients to understand their illness.
2) Basic counselling: addresses the patient’s worries.
3) A problem solving approach: can help to identify and deal with stressors.
4) Self-help material: CBT based books and computer programmes. Encourage people to rely on their natural supports such as friends, family and faith groups.
5) Relaxation techniques and breathing exercises: taught in person or using manuals/ tapes and must be mastered whilst calm.
1) What is the idea behind relaxation techniques and breathing exercises?
2) What is the aim of CBT in treating anxiety disorders?
3) How does CBT often begin in patients with anxiety?
4) What do subsequent CBT sessions for anxiety then focus on?
5) What happens over time with CBT for anxiety patients?
1) Reciprocal inhibition as it is not possible to both panic and relax at the same time, so practised relaxation can negate panic.
2) CBT aims to reduce the patients expectation of threat and the behaviours that maintain threat-related beliefs.
3) Therapy often starts with education about the physiology of anxiety and techniques for managing arousal, such as relaxation and controlled breathing.
4) They explore the actual likelihood and impact of the anticipated catastrophe.
5) More adaptive coping mechanisms are learnt which replace the u helpful behaviours which once maintained the anxiety.
1) Name the 2 psychological therapies used to treat patients with anxiety disorders.
2) What is the main feature of GAD?
3) Give 2 responses to the worry experienced in GAD.
4) What does CBT for GAD consist of?
1) CBT and exposure therapy.
2) Worry
3) Behavioural responses to worry include avoidance and reassurance seeking.
4) Testing predictions of worry with behavioural experiments and looking at errors in thinking.
1) What might panic disorder be triggered by?
2) What maintains the problem in panic disorder?
3) What does CBT do for patients with panic disorder?
1) Misinterpretation of physical anxiety symptoms as signs of major catastrophe.
2) Safety behaviours are adopted which merely reinforce beliefs. Since no catastrophe occurs, the conclusion is that the remedial behaviour prevented it, maintaining the problem.
3) Educates the patient on the true meaning of their symptoms. It helps them test whether their behaviours really keep them safe and whether their beliefs are true or misinterpretations.
1) When is exposure therapy used as part of the CBT approach?
2) What is habituation?
3) In the absence of actual harm, how long can the body remain extremely anxious for?
4) How is exposure therapy usually delivered?
5) What do repeated attempts at activities in exposure therapy cause?
1) When there are strong elements of avoidance and escape, for example, with phobias.
2) Habituation is ‘getting used to a fear’, so that anxiety decreased until the fear dies out (extinction).
3) A relatively short time (about 45 minutes).
4) Through a gradual approach called ‘desensitisation’. A hierarchy of feared situations is developed, and the patient tackles each step as weekly homework starting with the easiest and working upwards.
5) They cause the anxiety to decrease more quickly each time.
1) In social phobias, what does the patient engage in?
2) What does therapy for social phobias involve?
1) Safety behaviours and excessive self-monitoring to reduce the risk of embarrassment.
2) Dropping ‘safety behaviours’ whilst exposing the patient to social situations in order to challenge their assumptions.
Name 5 classes of drugs that can be used as pharmacological treatment for anxiety.
1) SSRIs: Fluoxetine and Paroxetine which treat many anxiety disorders and may be combined with CBT.
2) TCAs: Clompiramine and Imipramine.
3) Buspirone: Serotonin partial agonist.
4) BDZs.
5) Beta blockers.
1) Describe the doses of SSRIs used for anxiety disorders.
2) When can tricyclic antidepressants be used for anxiety disorders?
3) What class of drug is Buspirone?
4) Why is busiprone not very popular to use for anxiety disorders?
1) Therapeutic doses for anxiety are generally higher than those for depression, and response takes longer (6-8 weeks).
2) They can be used if patients don’t tolerate or respond to SSRIs.
3) Serotonin partial agonist.
4) Although it is non-dependency forming, it is not very popular because if its delayed action and dysphoric side effects.
1) What type of pharmacological treatment are BDZs used for?
2) What is a main negative of use of BDZs in anxiety disorders?
3) What is the maximum time that BDZs can be used for anxiety?
4) GABA transmission in the brain interacts with which receptor?
5) Give the main 3 side effects of BDZs.
1) BDZs can be useful for short-term anxiety treatments.
2) Tolerance builds rapidly and patients become quickly dependent.
3) 2-4 weeks.
4) The GABA-A receptor which is a ligand-gated chloride ion channel.
5) Amnesia, ataxia and respiratory depression, especially in elderly patients with pre-existing respiratory disease.
1) What can beta blockers be used for in anxiety disorders?
2) Why must you take caution when prescribing beta blockers for anxiety?
3) Why is there little use for medications in specific phobias?
4) What is a better prognosis for anxiety disorders associated with?
1) They are sometimes used to treat the adrenergic symptoms that social phobia patients find so disturbing.
2) Because there are many contraindications to beta-blockade.
3) Because there are usually intermittent problems.
4) Early diagnosis and treatment are essential, as the shorter the duration of symptoms, the better the prognosis.
