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Anxiety disorders Flashcards

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1
Q

What is the epidemiology of anxiety disorders?

A

About 15% prevalence

Higher prevalence in females

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2
Q

What are the brain loci associated with anxiety disorders?

A

Median frontal cortex
Amygdala
Hippocampus

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3
Q

What is the core feature of panic disorder?

A

Recurrent and severe panic attacks:

Sudden episodes of intense fear or discomfort accompanied by physical and cognitive symptoms

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4
Q

What is a broad description of a panic attack?

A

Panic attacks are overwhelming feelings of fear and discomfort. They reach peak intensity in about 10 mins and last for about half an hour

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5
Q

What features are required to diagnose a panic attack?

A 
At least 4 of the following 
Palpitations
Sweating
Trembling / shaking
Shortness of breath
Choking
Chest pain or discomfort
Nausea or abdominal distress
Dizziness
Chills or heat sensations
Paraesthesia
Derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
Fear of losing control or 'going crazy'
Fear of dying
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6
Q

What are the cognitive symptoms of a panic attack?

A

Derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
Fear of loosing control or going crazy
Fear of dying

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7
Q

What are the important measures of severity of a panic disorder?

A

Frequency of attacks

Intensity of symptoms

Level of function between attacks

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8
Q

What is the definition of agoraphobia?

A

Fear of situations where escape may be difficult or help would not be available in the event of having panic symptoms or other embarrassing symptoms.

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9
Q

What are some common situations that evoke an agoraphobic avoidance response?

A 
Using public transport
Being in open spaces
Being in enclosed public spaces
Standing in line or being in a crowd
Being outside of the home alone
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10
Q

What is the epidemiology of panic disorder?

A

Prevalence is about 2.5%

Median age of onset is 20-24

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11
Q

What is the core feature of social anxiety disorder?

A

Marked fear or anxiety of social or performance situations where the patient may be scrutinised by others.

Anticipatory anxiety preceding these situations.

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12
Q

What are the somatic features of social anxiety?

A 
Blushing
Speech block
Sweating
Palpitations 
Trembling 
Muscle tension
Twitching
Leg weakness
Breathing difficulties
Stomach discomfort
Diarrhoea
Feeling of faintness
Buzzing or ringing in the ears
Dry mouth
Hot / cold flushes
Headache
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13
Q

What is the epidemiology of social anxiety disorder?

A

Prevalence is around 4%

Median age of onset is 14

Twice as prevalent in females

Males more likely to seek help

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14
Q

What is a general description of a specific phobia?

A

Irrational fear and avoidance of specific objects or situations

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15
Q

What are the main categories of phobic stimuli associated with specific phobias?

A

Animals (spiders, dogs)
Natural environment (heights, storms, water)
Blood, injection, or injuries
Situations (aeroplane, lifts)

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16
Q

What is a general description of generalised anxiety disorder?

A

Generalised and persistent feelings of anxiety that are driven by worries about a number of everyday events or activities such as work, academic performance, the welfare of family members, etc.

It takes the form of anxious anticipation of impending catastrophe and is uncontrollable and out of proportion to the feared event.

17
Q

What are some psychological symptoms of generalised anxiety disorder?

A 
Restlessness
Difficulty concentrating
Feeling that mind has gone blank
Irritability
Depersonalisation 
Derealisation
Sleep disturbances
18
Q

What are some physical symptoms of generalised anxiety disorder?

A 
Fatigability
Muscle tension
Autonomic arousal
Shortness of breath
Chest pain
Stomach discomfort
Dry moth
Paraesthesia
Dizziness
Light-headedness
19
Q

What do you need to diagnose generalised anxiety disorder?

A

Symptoms need to be present for 6 months

Worries should encompass a number of activities

At least three of the following (one in children):

  1. Restlessness
  2. Fatigability
  3. Difficulty concentrating
  4. Irritability
  5. Muscle tension
  6. Sleep disturbance
20
Q

What is the epidemiology of generalised anxiety disorder?

A

Around 3% of adults have it

Females twice as likely

Diagnosis peaks at 35-45

21
Q

What are some screening questions for GAD, social anxiety, panic disorder, and specific phobia?

A

In the past few months have you had worries about things in your life?

Is it hard to control or stop the worry?

A panic attack is a sudden surge of fear or anxiety, which can come on for no apparent reason. Have you experienced this before? If so, how often?

Can you identify objects, places, or social situations that make you feel very anxious?

22
Q

What is the difference between generalised social anxiety and non-generalised social anxiety?

A

Generalised social anxiety extends across numerous social situations

non-generalised social anxiety is specific to one or just a few social situations

23
Q

What is the management for Generalised anxiety disorder?

A
  1. Psychological interventions are first line. This includes psychoeducation and CBT
  2. Pharmacotherapy
    SSRI (first line):
    Escitalopram 10mg (up to 20mg); or
    Paroxetine 10mg (up to 60mg)

If no response to SSRI use an SNRI:
Duloxetine 30mg or Venlafaxine 75mg

TCAs if there is no response: (imipramine 25mg)

If still no improvement:
Buspirone 5mg orally

Last resort:
Diazepam 2-5mg

24
Q

What SSRIs are used in Generalised anxiety disorder, and what are their dosages?

A 
Escitalopram 10mg (up to 20mg)
Paroxetine 10mg (up to 60mg)
Other SSRIs are not TGA approved:
Citalopram 10mg (up to 40mg)
Fluoxetine 10mg (up to 80mg)
Fluvoxamine 50mg (up to 300mg)
Sertraline 25mg (up to 200mg)
  • ** Pram’s and Tine’s - 10mg
  • ** Line - 25mg
  • ** Amine -50mg
25
Q

What is the management of generalised SOCIAL anxiety disorder

A
  1. Psychological interventions (psychoeducation and CBT) are first line, but many patients will not adequately respond.
2. pharmacotherapy 
SSRI:
Escitalopram 10mg (up to 20mg); or
Paroxetine 10mg (up to 60mg); or
Sertraline 25mg (up to 200mg)

If no response to SSRI:
Venlafaxine 75mg

26
Q

What is the management of non-generalised SOCIAL anxiety disorder

A
  1. Psychological interventions (psychoeducation and CBT)
  2. Pharmacotherapy
    Propranolol 10-40mg taken prior to triggering social situation
27
Q

What is the management of panic disorder?

A
  1. Psychotherapy (psychoeducation and CBT)
  2. Pharmacotherapy
    SSRI:
    Escitalopram 10mg (up to 20mg); or
    Paroxetine 10mg (up to 60mg)

If SSRI does not work use SNRI:
Venlafaxine 75mg

If venlafaxine does not work use TCA:
Clomipramine 50-75mg; or
Imipramine 50-75mg

28
Q

What is the management of specific phobias?

A

Pharcotherapy has almost no place in the management of specific phobia.

The only acceptable use is where there is a need to manage a specific phobia (such as claustrophobia for MRI)
In this case use a single dose of diazepam.

Psych matrix (49 decks)

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