Anxiety Disorders Flashcards
What is anxiety?
Defined as 6 months of excessive worry about different events with a sense of heightened tension
What are the risk factors of Generalised Anxiety Disorder?
- Gender (female)
- Family history of anxiety
- Physical or emotional stress
- History of physical or emotional trauma
- Other anxiety disorders
What are the causes of Generalised Anxiety Disorder?
- Genetic predisposition
- Stress
- Life events
- Hyperthyroidism
- Cardiac disease
- Medication induced anxiety
What are the medications that may induce anxiety?
- Salbutamol
- Corticosteroids
- Theophylline
- Antidepressants
- Caffeine
What are the clinical features of Generalised Anxiety Disorder?
- Hyperventilation (may present as respiratory alkalosis on ABG)
- Headaches, nausea
- Sweating
- Palpitations
- Poor concentration
- Tension
- Agitation
- Insomnia
- Restlessness
=> Psychological symptoms can manifest as digestive problems
What is the DSM-5 criteria for diagnosis Generalised Anxiety Disorder?
- Excessive anxiety present more days than not for 6 months
- Hard to control anxiety
- Adult - > 3 symptoms present
- Anxiety causes impairment in important daily activities
- Symptoms not linked to medication, drug abuse or condition
- Anxiety not better explained by another medical condition
What is the management of Generalised Anxiety Disorder?
=> Stepwise approach
- Educate on GAD and active monitoring
- Low intensity psychological intervention
- High intensity psychological intervention or drugs
- Special input
=> Drug treatment:
- First line SSRI => Sertraline
What are panic disorders?
Intense fear something bad will happen
More common is females
What are the symptoms of panic disorders?
Symptoms peak in first 12-20 mins and may last for hours
- Fear of death
- Fear of losing control
- Feelings of detachment
- Feeling of choking
- Dizziness
- Dyspnoea
- Nausea
- Sweating
- Chills
- Palpitations
- Chest pain
- Numbness
- Trembling
What is the DSM-5 criteria for diagnosing panic disorders?
- At least 4 of 13 symptoms must be present
- Recurrent, unexpected panic attacks
- Persistent worry and change in behaviour
- Not effects of substance
- Not explained by another disorder
What is the management of panic disorders?
=> Involves psychotherapy (CBT), medication or both
=> Steps of CBT:
- Learn
- Monitor
- Breathing and relaxing exercises
- Change beliefs about severity of attack
- Allow exposure to possible triggers
=> Medication:
- SSRIs first line (if contraindicated or no response in 12 weeks - Imipramine or Clomipramine
- Benzodiazapines
- Anti-seizure medications
What are the 2 main features of OCD?
Obsessions - unwanted recurrent, intrusive thoughts which may cause anxiety
Compulsions - actions to reduce anxiety from obsessions impact daily life
What is the DSM-5 criteria for diagnosing OCD?
- Presence of obsessions, compulsions or both
- Compulsion is time consuming
- Not due to substance o medical condition
- Not better explained by another disorder
What are the causes of OCD?
- Genetic or environmental
- More common in identical twins
- Problems wit serotonin transmission
What is the management of OCD?
CBT or medication (SSRIs)
What are phobias?
Extreme, unreasonable, irrational fear that interferes with daily life
What are the different types of phobias?
- Specific phobias
- Agoraphobias (fear of public places)
- Social phobias
What are the physical symptoms of phobias?
- Sweating
- Trembling
- Increased HR
What are the causes of phobias?
- Traumatic events
- More likely if someone in family has phobia
What is the main management of phobias
CBT
What are the features of PTSD?
- Re-experiencing
- Avoidance
- Hypervigilance
- Emotional numbing
What is the management of PTSD?
- Trauma focussed CBT
- Drugs
=> Drug treatments:
- Generally not first line
- Venlafaxine
- Sertraline
- Severe cases: Risperidone
