Anxiety Disorders Flashcards
What is generalised anxiety disorder?
Symptoms of anxiety occurring persistently (>6 months), with symptoms not confined to a specific situation or object
What sex is generalised anxiety disorder most common in?
F>M
What are the 5 classifications of anxiety symptoms?
Psychological arousal
Autonomic arousal
Muscle tension
Hyperventilation
Sleep disturbance
Give psychological arousal symptoms of anxiety
Fearful anticipation
Irritability
Sensitivity to noise
Poor concentration
Worrying thoughts
Give GI autonomic arousal symptoms of anxiety
Dry mouth
Swallowing difficulties
Dyspepsia
Nausea
Wind
Frequent loose motions
Give respiratory autonomic arousal symptoms of anxiety
Tight chest
Difficulty inhaling
Give cardiovascular autonomic arousal symptoms
Palpitations
Missed beats
Chest pain
Give genitourinary autonomic arousal symptoms
Frequency/urgency of micturition
Amenorrhoea
Dysmenorrhea
Erectile failure
Give CNS autonomic arousal symptoms of anxiety
Dizziness
Sweating
Give the muscle tension symptoms of anxiety
Tremor
Headache
Muscle pain
Give the hyperventillation symptoms of anxiety
Causing CO2deficit e.g. hypocapnia
Numbness tingling in extremities may lead to carpopedal spasm
Give the sleep disturbance symptoms of anxiety
Initial insomnia
Frequent waking
Nightmares and night terrors
What are the psychiatric differential diagnoses of generalised anxiety disorder?
Depression
Schizophrenia
Dementia
Substance misuse
What are the physical differential diagnoses of generalised anxiety disorder?
Thyrotoxicosis
Pheochromocytoma
Hypoglycaemia
Asthma
Arrhythmia’s
What is the low-intensity management of generalised anxiety disorder?
Counselling
- Clear plan of management
- Explanation and management
- Avoid caffeine, alcohol and exercise
Relaxation training
- Group or individual, DVD, tapes or clinician led
Symptomatic Relief
- B Blockers
What is the high-intensity management of generalised anxiety disorder?
Cognitive behavioural therapy
Antidepressants
What is obsessive compulsive disorder (OCD)?
Recurrent obsessional thoughts and/or compulsive acts present on most days for at least two successive weeks, causing distress or interference with daily activities
What sex is OCD more common in?
M=F
What are obsessional thoughts?
Intrusive thoughts/images that are unpleasant and distressing, inconsistent with their typical views and values, but recognised as their own thoughts
What are compulsive acts?
Repeated and pointless behaviours/rituals to prevent anxiety
What are overt compulsions?
Repeating something physically
What are covert compulsions?
Repeating something mentally
How is OCD managed?
General measures
- Education and explanation
- Involve partner/family
Cognitive behaviour therapy
- Exposure and response prevention
- Examination of evidence to weaken convictions
SSRI
Psychosurgery
Give differential diagnoses of OCD
Depression
Obsessive compulsive personality disorder
Tourette’s syndrome
Schizophrenia
What is post traumatic stress disorder?
Delayed and/or protracted reaction to a stressor of exceptional severity (would distress anyone), after 4 weeks of the event
What sex is PTSD most common?
F>M
2:1
What events can cause PTSD?
Combat
Natural or human-caused disaster
Rape
Assault
Torture
Witnessing any of the above
What vulnerability factors can increase the risk of PTSD?
Mood disorder
Previous trauma especially as child
Lack of social support
Female
What protective factors can decrease the risk of PTSD?
Higher education
Social group
Good paternal relationship
Susceptibility partly genetic
What are the 3 key elements to a PTSD reaction?
Hyper-arousal
Re-experiencing a phenomena
Avoidance of reminders
Give hyper-arousal symptoms of PTSD
Persistent anxiety
Irritability
Insomnia
Poor concentration
Give the re-experiencing symptoms of PTSD
Intensive intrusive images
Flashbacks when awake
Nightmares during sleep
Give the avoidance symptoms of PTSD
Emotional numbness
Cue avoidance
Recall difficulties
Diminishes interests
How is PTSD managed?
Survivors of disasters screened at one month
Mild symptoms ‘watchful waiting’ and review further month
Trauma-focused CBT if more severe symptoms
Eye movement desensitisation and reprocessing
Risk of dependence with any sedatives but patient may prefer medication e.g. SSRI or TCA
What can cause phobic anxiety disorder?
Genetics
Psychological factors and life events
Premorbid personality: Shyness in social phobia
Comorbid anxiety disorders, depression, substance misuse, OCD
Give types of phobic anxiety disorders?
Agoraphobia
Specific phobias
Social phobia
What is agoraphobia?
Fear of leaving home, where escaping would be difficult
What is social phobia?
Inappropriate anxiety in situation where person feels observed or could be criticised (restaurants, shops, queues, public speaking)
How does phobic anxiety disorder present?
Phobic avoidance
Anticipatory anxiety
Same core features as GAD
Blushing tremor: Social phobia
What is panic disorder?
Recurrent unforeseen panic attacks followed by at least a month of worrying of another attack
What is a panic attack?
Recurrent unpredictable attacks of severe anxiety, reaching intense fear and panic within 10 minutes
How do panic attacks present?
Palpitations
Sweating
Tremors
SOB
Choking sensation
Impending doom
Dizziness
Nausea
Give causes of generalised anxiety disorder?
Genetic predisposition
Anxious-avoidant personality trait
Co-morbid depressive disorder
Traumatic life experiences
Chronic health condition
History of alcohol dependence
History of substance misuse
What is the first line therapy for OCD?
Exposure and response prevention
What is acute stress reaction/disorder?
GAD symptoms that occur int he first 4 weeks of being exposed to a stressful or traumatic event
How is acute stress disorder managed?
Trauma-focused cognitive-behavioural therapy (CBT)
Benzodiazepines
- Used with caution for acute symptoms
