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Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Describe generalised anxiety disorder

A

Generalised persistent excessive anxiety or worry about a number of events that the individual finds difficult to control lasting at least 3 weeks (ICD10) or six months (DSM5)

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2
Q

What are the symptoms of generalised anxiety disorder ?

A

Nervousness, trembling, palpitations, dizziness, muscle tensions, epigastric discomfort, sleep problems

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3
Q

What is the prevalence of GAD?

A

9%

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4
Q

When does GAD usually start?

A

20-40 years old

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5
Q

What percentage of patients with GAD have another psychiatric disorder?

A

90%

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6
Q

Describe panic disorder

A

Recurrent episodic panic attacks, unpredictable and not restricted to any particular situation

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7
Q

What is the prevalence of panic disorder?

A

2-3%

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8
Q

What percentage of people with panic disorder have agoraphobia?

A

Up to 67%

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9
Q

What can trigger a panic attack in susceptible individuals?

A

Lactate infusion

Re-breathing air

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10
Q

What are the symptoms of panic disorder?

A

Discrete periods of intense fear, impending doom or discomfort, palpitations, tachycardia, SOB, trembling, chest pain, nausea, dizziness, chills, hot flushes, fear of dying

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11
Q

What is agoraphobia?

A

Characterised by fear and avoidance of places or situations from which escape may be difficult or in which help may not be available in the event of having panic attack

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12
Q

What is agoraphobia often secondary to?

A

Panic disorder

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13
Q

What situations do people with agoraphobia tend to avoid?

A
  • crowds
  • public places
  • travelling away from home
  • travelling alone
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14
Q

How to people deal with agoraphobia?

A

Avoid situations
Online shopping
Alcohol

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15
Q

Describe specific phobias

A

Marked persistent fear that is excessive or unreasonable caused by the person of a specific object/situation

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16
Q

How are phobias treated?

A

Behavioural therapy - exposure and CBT

SSRIs/SNRIs

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17
Q

What is social anxiety?

A

Persistent fear of one or more social/performance situations in which the person is exposed or under scrutiny. Fear of being embarrassed or humiliated usually in small social settings

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18
Q

What are the symptoms of social anxiety?

A

Blushing/shaking, fear of vomiting, urgency or fear of micturition or defection

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19
Q

How is social anxiety treated?

A

CBT, self help, exposure, social skills training, SSRIs

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20
Q

What are obsessional thoughts?

A

Ideas, images or impulses entering the mind in a stereotyped way - recognised as the patients own thoughts but unpleasant resisted and ego dystonic

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21
Q

What are compulsive acts?

A

Repeated rituals or stereotyped behaviours, not enjoyable or functional. Recognised as pointless and resistance may diminish over time.

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22
Q

How long must symptoms be present for to diagnose OCD?

A

Present most days for at least 2 weeks and is a source of distress and interference with activities

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23
Q

What is the mean age of onset of OCD?

A

20 years old

24
Q

What percentage of OCD patients experience a major depressive episode?

A

60-90%

25
Q

Describe the neurobiology of OCD

A

Abnormality of the portico-striatothalamic circuit which mediates social behaviour
Inability to suppress inappropriate acts
Abnormalities in the basal ganglia and frontal cortex

26
Q

Where in the brain does fear originate?

A

Amygdala centred circuit

27
Q

Where in the brain does worry originate?

A

Cortico-striatal-thalamic cortical circuit

28
Q

Which part of the brain is responsible for affect of fear?

A

Anterior cingulate/orbitofrontal cortex

29
Q

Where in the brain does avoidance come from?

A

Periaqueductal gray

30
Q

Which parts of the brain cause the autonomic and endocrine reaction?

A

Hypothalamus - increases cortisol

Locus coeruleus - increases HR/BP

31
Q

Which part of the brain is responsible for re-experiencing and memory?

A

Hippocampus

32
Q

Describe the action of GABA

A

Main inhibitory transmitter that reduces the activity of neurons in the amygdala and CSTC

33
Q

What is the effect of benzodiazepines on GABA?

A

Enhances GABA action

34
Q

Which receptor do benzodiazepines act on?

A

GABA A

35
Q

Describe the pharmacokinetic action of benzodiazepines

A

Bind to a separate site and increase affinity of receptor to GABA and enhances the effect - positive allosteric modulation allows more chloride to pass through (preventing depolarisation)

36
Q

Name three benzodiazepines

A

Lorazepam
Diazepam
Chlordiazepam

37
Q

What are the pharmacological effects of benzodiazepines?

A

Reduce anxiety, hypnosis/sedation, muscle relaxant, anti-convulsant, anterograde amnesia

38
Q

State the clinical uses of benzodiazepines

A

Acute anxiety, hypnosis, alcohol withdrawal, mania, delirium, status epileptics, before minor surgeries

39
Q

What are the side effects of benzodiazepines?

A 
Tolerance 
Dependence 
Paradoxical aggression 
Anterograde amnesia and impaired coordination 
Respiratory depression
40
Q

What can be used to treat respiratory depression caused by benzodiazepines?

A

Flumazenil

41
Q

Describe benzodiazepine withdrawal

A

Marked anxiety, shakiness, abdominal cramps, perceptual disturbance, delusions, depression, restlessness,
Extreme - hypertension, seizures, psychosis, tachycardia

42
Q

Why does withdrawal from benzodiazepines occur?

A

Chronic treatment reduced response to GABA due to decrease density of benzodiazepine receptors

43
Q

Describe the technique used to prevent withdrawal when someone is stopping benzodiazepines

A
  1. Transfer patient to equivalent dose of diazepam/chlordiazepoxide
  2. Reduce dose every 2-3 weeks by 2/2.5 mg and maintain until symptoms improve
  3. Reduce dose further in smaller steps
  4. Stop completely this can take 4 weeks to a year
44
Q

Why can pregabalin be used to treat anxiety?

A

Calcium channel blocker and GABA enhancer used when unresponsive to other treatment

45
Q

What is the use of beta blockers in anxiety?

A

Symptomatic relief

46
Q

What is the treatment for GAD?

A
  1. Psychoeducation/self help
  2. CBT or SSRI (consider 2 week benzodiazepine)
  3. SNRI (duloxetine, venlafaxine)
  4. Pregabalin
  5. Combination of CBT and drug treatment
47
Q

How long do anti-depressants take to work?

A

12 weeks but if no response after 4 weeks then response is unlikely

48
Q

How long should GAD treatment be continued for?

A

18 months

49
Q

Describe the treatment for panic disorder

A
  1. Self help
  2. CBT or SSRI if no benefit from CBT
  3. Tricyclics
50
Q

What drugs should not be used in panic disorder?

A

Benzodiazepines
Sedating anti-histamines
Propranolol, buspirone, bupropion

51
Q

How long should treatment of panic disorder be?

A

6 months

52
Q

Describe the treatment for OCD

A
  1. CBT or ERP
  2. More intensive psychological therapy or SSRI
  3. Consider dose increase after 4-6 weeks
  4. SSRI plus CBT and ERP
  5. Clomipramine
  6. Antipsychotic or clomipramine plus citalopram
53
Q

Which SSRIs should be used in OCD?

A

Fluoxetine
Sertraline
Citalopram
Paroxetine

54
Q

How long should effective OCD treatment be continued for?

A

1 year

55
Q

Describe the treatment for social anxiety

A
  1. Individual CBT
  2. SSRI (escitalopram or sertraline)
  3. SSRI and CBT
  4. Alternative SSRI or SNRI (venlafaxine)
  5. MAOI (moclobemide)
56
Q

What alternative SSRIs can be used to treat social anxiety?

A

Fluvoxamine

Paroxetine

57
Q

When should SSRI treatment be reviewed?

A

12 weeks

Psychiatry (18 decks)

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