Anxiety Disorders Flashcards
__?__ is an unpleasant emotional state involving subjective fear, bodily discomfort and physical symptoms.
Anxiety
True or false: Anxiety is always pathological.
False. As demonstrated on the Yerkes-Dodson curve, anxiety can be beneficial up to a plateau of optimal function, beyond which, with increasing anxiety, performance deteriorates.
Anxiety becomes pathological when it interferes with daily life.
A __?__ is a discrete episode of intense fear, impending doom or discomfort accompanied by symptoms such as:
- Palpitations, tachycardia
- Sweating, trembling, breathlessness
- Feeling of choking
- Chest pain/discomfort
- Nausea, dizziness, paraesthesia
Panic attacks
True or false: Having a panic attack is a sign of mental illness.
False.
Isolated panic attacks are common. One attack does not mean the subject has a disorder.
If recurrent panic attacks are interfering with daily life the subject may have panic disorder.
What are the main types of anxiety disorder?
Generalised anxiety disorder
Panic disorder
Phobic anxiety disorders (agoraphobia, social phobia, specific phobias)
OCD
Adjustment disorders (PTSD, acute stress reaction)
__A__ is characterised by generalised, persistent, excessive worrying about events that the individual finds difficult to control, lasting for at least __B__ (according to ICD-10)
A) Generalised anxiety disorder
B) three weeks
One of the key things with GAD is the continuous ‘free-floating’ anxiety that isn’t related to an external stimulus. It’s always there and can be about almost any event.
Other anxiety disorders tend to be episodic, rather than continuous.
__A__ is characterised by recurrent episodic severe panic attacks, which occur unpredictably and are not restricted to any particular situation. These attacks typically last __B__.
A) Panic disorder
B) only a few minutes.
What treatment is recommended for panic disorders?
CBT and SSRI’s are recommended first-line treatments.
Tricyclic antidepressants (imipamine and clomipramine) may be helpful where SSRI’s are ineffective.
True or false: Benzodiazepines are a second treatment for panic disorders.
False.
Benzos are not recommended for the treatment of panic disorders.
Which other anxiety disorder often manifests comorbidly with panic disorder?
Agoraphobia
Fear and avoidance of places and situation from which escape may be difficult. Avoidance of crows, public places, travelling away from home, travelling alone.
__?__ are fears of specific situations or objects. Anxiety is restricted to that object and is often seen as being out of proportion to the situation.
Phobias
__?__ is the fear of being judged or scrutinised by others in a negative way, leading to avoidance.
Social phobia
How are phobiac disorders treated?
For all phobias, CBT is the first-line treatment. A form involving graded exposure is often helpful, but depends on the patient’s engagement.
SSRI’s are also effective for agoraphobia and social phobias.
Specific phobias are generally treated with graded exposure and the very occasional benzodiazepine for a rarely-encountered phobia that the patient has to be exposed to, e.g. flying occasionally.
Which of the anxiety disorders does this history sound like?
A first-year male student reports increasing stress at university. Although historically he has done well academically and appears quite extroverted, the transition to university has been difficult and his grades have been suffering. He is afraid of drawing attention to himself in his classes by asking ‘stupid questions’ and has avoided meeting with his professors and teaching assistants. He experiences particular difficulty in seminars and tutorials, where there is less opportunity to hide than in a lecture theatre. He feels his mouth getting dry and his heart racing when even thinking about trying to get help. He has become more withdrawn, is starting to feel more depressed, and recently began missing classes.
Social phobia
He is afraid of being scrutinised or judged, leading to avoidance.
Presents with physical symptoms and is beginning to interfere with life.
Which sex is more affected by agoraphobia?
Females are more often affected by agoraphobia than males
Which sex is more affected by social phobias?
Females are more often affected by social phobia than males
Which sex is more affected by specific phobias?
Both sexes are equally affected by specific phobias
Which of the following generally presents first during childhood?
A) Agoraphobia
B) Social phobia
C) Specific phobia
Specific phobias generally present first in childhood.
Agoraphobia: 20-35yo
Social phobia: Adolescence
Specific phobias: Childhood
Which anxiety disorder is being described?
Fear of interaction in social situations, fear of being scrutinised. Worse if few people, eating with people.
Social phobia
Which anxiety disorder is being described?
Fear of space (open or closed), difficulty travelling (distance away home) worst in queue, feeling of being trapped,
Better if way out, accompanied e.g. pets Increased risk with panic attacks
Agoraphobia
What is the treatment of choice for anxiety?
CBT
+/- medical treatment: SSRI’s, supportive therapy (betablockers for palpitations/tremor, sleep hygiene or medication)
- *Avoid benzodiazepines where possible**
- only for very short term use if necessary, not for alcohol-dependent patients or those with hepatic impairment.
How does CBT work?
- Define the problem
- Set some goals
- Map (or ‘formulate’) the problem and the progression of the problem.
- Patient monitors and keeps diary to discuss in therapy.
- Therapist and patient identify further problematic thoughts and behaviours and work through them.
- Patient learns that experiencing anxiety is ok and is not dangerous in itself, our response is what matters.
__?__ is characterised by unwelcome, intrusive, persistent thoughts and compulsive acts.
Obsessive compulsive disorders
True or false: Patients with OCD recognise that their obsessive thoughts are their own and usually try to resist them.
True.
What treatments are recommended for OCD?
Psychological:
- CBT
- Exposure and response prevention (ERP; graded exposure to anxiety-provoking stimuli)
Medical:
- Antidepressant: SSRI (fluoxetine, sertraline) or Tricyclic (clomipramine)
Combination therapy generally more effective than one alone.
__?__ can occur following a stressful event, such as serious medical diagnosis or a major accident. A characteristic pattern of symptoms includes: an initial state of ‘daze’ or bewilderment is followed by altered activity (withdrawal or agitation), often with anxiety. These symptoms are transient, often appearing within minutes of the event and usually resolve completely within a few days.
Acute stress reaction
Typical symptoms of __?__ are recurrent intrusive memories (flashbacks) of a traumatic event; sleep disturbance, especially nightmares (usually of the traumatic event) from which the patient awakes in a state of anxiety; symptoms of autonomic arousal (anxiety, palpitations, enhanced startle); emotional blunting, and avoidance of situations that evoke memories of the trauma.
Post-traumatic stress disorder.
Patients may also experience associated depression and suicidal ideation.
What is the ICD-10 definition of PTSD?
Delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature
What is the lifetime prevalence of PTSD?
1-10%
True or false: PTSD usually follows immediately after a traumatic or catastrophic event.
False.
There is usually a latency period of 1 to 6 months.
What is the recommended treatment for PTSD?
NICE recommends trauma-focused CBT
+/- EMDR (eye movement desensitisation and reprocessing
+/- Antidepressant (paroxetine or mirtazepine)
True or false: Around 65% of patients with PTSD will recover within 18 months of starting CBT.
True
__?__ arises in the period of adaptation to a significant life change or stressful life event. Symptoms can include depression, anxiety, poor coping, and anger.
Adjustment disorder
Patients may be more aggressive and prone to excess alcohol use.
For which anxiety disorder are SSRI’s not recommended?
Specific phobias
Behavioural therapy/CBT is recommended but antidepressants show little or no efficacy.
Delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature
PTSD
Treatment: CBT/EMDR/paroxetine
Intrusive thoughts and images and impulses, misinterpreted as significant, with attempts to cancel out via rituals
OCD
Treatment:
CBT/SSRI/clomipramine
Fear of specific object or situation
Specific phobia
Treatment:
Behavioural therapy/CBT (no antidepressant)
Persistent anxiety characterised by worry
Generalised anxiety disorder
Treatment: CBT/SSRI
Fear of negative evaluation by others
Social anxiety/phobia
Treatment: CBT/SSRI
Episodic anxiety characterised by frequent panic attacks, misinterpretation of bodily symptoms
Panic disorder
CBT/SSRI
Fear of “market place”, specific situations eg crowds, leaving house, travel on buses etc
Agoraphobia
Treatment: CBT/SSRI
