Anxiety disorders Flashcards
what is the epidemiology of anxiety disorder?
2:1 F:M
Apart from PTSD which is more common in men
list the anxiety disorder in their order of prevalence?
- Specific phobia
- Social phobia
- PTSD
- Generalised anxiety disorder
- Panic
- Agoraphobia - without panic
- OCD
whats the icd10 criteria for agroaphobia?
The uniting fear in agoraphobia is of being unable to
easily escape to a safe place (usually home). Agoraphobia
includes fear of open places and fear of situations that are
confined and difficult to leave without attracting attention.
The overwhelming urge is to return home to safety.
These situations can include open spaces, public transit, shopping centers, or simply being outside their home.
Fear of travelling from home/alone
what are the theories outlining the aetiology of anxiety disroders?
- Genetics;
- Fhx increases risk
- People with high neuroticism scores are more
likely to experience anxiety, guilt, depression, and anger - Life events and childhood adversity
- Neurochemical
- the fact that drugs targetting NA, GABA and serotonin
are successful in treating anxiety is evidence that
these factors are implicated - Behaviour and cognitive theoriess
- classical conditioning pair neutal stimulus to
frightening one
- negative reinforcement: escaping from a fearful
stimulus relieves anxiety so maintains the fear
response as not facing fears
- cognitive theories : worrying thoughts = automatically
repeated = causes and maintains anxiety
- attachment theories : insecurely attached children
become anxious adults
what is the icd-10 diagnostic criiteria for anxiety - GAD?
updated 05/21
A period of at least six months with prominent tension, worry and feelings of apprehension, about every-day events and problems
Anxiety is not triggered by a specific stimulus - its continuous and generalized (‘free-floating’).
At least four symptoms out of the following list of items must be present, of which at least one from items 1 is from Autonomic arousal symptoms;
palpitations or pounding heart, or accelerated heart rate
sweating
trembling or shaking
dry mouth (not owing to medication or dehydration)
other sx in systems;
- chest and abdo
- GI
- brain
- general
- tension/motor eg tremor and inability to rest
see lass
what are the differentials for anxiety?
• Hyperthyroidism
• Substance misuse:
– intoxication (e.g. amphetamines)
– withdrawal (e.g. benzodiazepines, alcohol).
• Excess caffeine.
• Depression: anxiety is a common feature of depression
—and depression complicates anxiety.
Diagnose mixed anxiety and
depressive disorder if there are low-level depressive and
anxiety symptoms present equally together, neither of
which justifies diagnosis alone. if full-blown depression and GAD are present, diagnose them both.
• Anxious (avoidant) personality disorder: from late
adolescence onwards, the patient describes themselves
as ‘an anxious person’, with no recent major increase
in anxiety levels.
• Dementia: anxiety may be an early feature of this.
• Schizophrenia: in early schizophrenia, anxiety may
occur before delusions and hallucinations are evident
what is the icd10 diagnostic criteria for phobic anxiety disorders
intermittent anxiety occurs in specific
but quite ordinary circumstances.
Patients characteristically
avoid feared situations and the seriousness of the
phobia depends on the resultant disability
what can improve agoraphobia?
The presence of a dependable companion (or sometimes a car) increases range and makes otherwise avoided
situations bearable.
in which scenarios may a suffere of agoraphobia be symptom free?
If the patient is successfully avoidant of all triggers,
they might currently experience little or no anxiety. Ask
about the past.
ddx for agoraphobia?
- Depression can cause social withdrawal and is commonly
comorbid with agoraphobia. - Social phobia: the fear here is of scrutiny or humiliation.
- Obsessive–compulsive disorder: time-consuming
rituals can confine people to their home. - Schizophrenia: patients may stay at home because of
social withdrawal or as a way of avoiding perceived
persecutors.
what is the epidemiology of social phobia?
late teens
men and women equally affected.
what are the symptoms in social phobia?
The core fear in social phobia is of being scrutinized or criticized by other people, and patients often worry that they will embarrass themselves in public.
They tolerate an anonymous crowd, UNLIKE
agoraphobic patients, but small groups (e.g. dinner
parties, board meetings) feel very intimidating.
There are sometimes specific worries, such as eating in public.
Self-medication with alcohol or drugs perpetuates the
problem as it offers psychological avoidance.
Patients complain most about embarrassing symptoms, e.g. blushing,
trembling, sweating, and urinary frequency.
what are the differentials for social phobia?
- Shyness: some people are naturally shy and feel
uncomfortable in social situations. In social phobia,
there is overt fear. - Agoraphobia: the need to get somewhere safe is
more important than the fear of scrutiny. - Anxious (avoidant) personality disorder: there is a
lifelong history of disabling shyness and anxiety. - Poor social skills/autistic spectrum disorders
(e.g. Asperger’s syndrome): people who are socially
awkward will not show good social skills when
relaxed—they remain awkward. - Benign essential tremor: this tremor is familial, worse
in social situations, and responds to benzodiazepines
and alcohol. There are no other features of anxiety - Schizophrenia/psychosis: patients may avoid social
situations because of paranoia or because they have
delusions that they are being watched. Patients with
social phobia recognize that their fears are exaggerated.
what is a specific phobia? define it
These phobias are restricted to a single, specific situation
(e.g. spiders = arachnophobia).
a fear that is out of proportion to the stimulus
icd-10 criteria for panic disorder?
Anxiety is intermittent and with NO OBVIOUS TRIGGER
—it comes ‘out of the blue’.
A panic attack is a sudden attack of extreme (‘100%’) anxiety with accompanying
physical symptoms, such as:
- breathing difficulties/choking feelings
- chest discomfort/tightness, palpitations, tingling
fears that they will die, lose control, become incontinent, or go mad. These
thoughts provoke further panic until the patient gains
reassurance or engages in safety behaviours.
For a diagnosis of panic disorder, there must be recurrent
panic attacks (preferably several within a month).
In between episodes, the person should be relatively
free of anxiety.
episodic paroxysmal anxiety is aka?
panic attack
name some examples of safety behaviours that can be adopted in panic disorder?
calling an ambulance, taking aspirin.
Panic attacks are
self-limiting, lasting no more than 30 minutes, although
this can feel never-ending
name some ddx for panic disorders?
- Other anxiety disorder: especially GAD and
agoraphobia. - Depression: if depressive symptoms preceded the
panic attacks or the criteria for depressive disorder
are fulfilled, the diagnosis of depression takes
precedence. - Alcohol or drug withdrawal can cause severe anxiety
that may be mistaken for panic attacks. - Organic causes: exclude cardiovascular and respiratory disease
what ivx would you conduct for panic disorder in order?
- A good history and physical examination. Rule out organic causes:
alcohol, drug withdrawal
urine drug screen
Bloods: TFTs - rule out hyperthyroid
————-above is what lecture said.————-
- Rating scales of anxiety include the
Beck Anxiety Inventory
HADS (Hospital Anxiety and Depression Scale)
These can assess severity or provide
baseline ‘scores’ against which to measure treatment
response.
- Social and occupational assessments for effect on
quality of life. - Collateral history.
how is panic disorder managed according to NICE?
Acutely:
Reassure and brown bag for breathing
Benzodiazepines in emergency situation
Mild to moderate
- individual non-facilitated self-help (eg CBT)
OR - individual facilitated self-help
-> follow up every 1-2 months
Moderate to severe panic disorder (with or without agoraphobia):
1. CBT (1-2 weekly for 4 months) OR
2. Antidepressant SSRI
(if long-standing or the person has not benefitted from psychological intervention)
- if a combination of medication and psych intervention has been tried but failed;
refer to mental health services
which antidepressants can be used in panic disorder?
Escitalopram,
citalopram
sertraline,
paroxetine and venlafaxine
so ssris and snris
monitor for suicidal thoughts etc
what is the purpose of CBT in panic disorder?
what elements are included?
educates patient that their symptoms mean panic not perish, ie are not a sign pn catastrophe
help them to not misinterpret their symptoms
elements included
exposure therapy:
trying to get patient ‘used to a fear’ through desensitisation.
goal is to stay in situation until anxiety has subsided
step by step approach
what other drugs but antidepressants can be useful in panic attack?
beta-blockers for adrenergic symptoms
prognosis of panic disorder?
1/3 recover
1/3 partial improvement
1/3 poor qol, considerable disability
