Anxiety disorders Flashcards
What is the epidemiology of anxiety disorders?
About 15% prevalence
Higher prevalence in females
What are the brain loci associated with anxiety disorders?
Median frontal cortex
Amygdala
Hippocampus
What is the core feature of panic disorder?
Recurrent and severe panic attacks:
Sudden episodes of intense fear or discomfort accompanied by physical and cognitive symptoms
What is a broad description of a panic attack?
Panic attacks are overwhelming feelings of fear and discomfort. They reach peak intensity in about 10 mins and last for about half an hour
What features are required to diagnose a panic attack?
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
What are the cognitive symptoms of a panic attack?
Derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
Fear of loosing control or going crazy
Fear of dying
What are the important measures of severity of a panic disorder?
Frequency of attacks
Intensity of symptoms
Level of function between attacks
What is the definition of agoraphobia?
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.
What are some common situations that evoke an agoraphobic avoidance response?
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
What is the epidemiology of panic disorder?
Prevalence is about 2.5%
Median age of onset is 20-24
What is the core feature of social anxiety disorder?
Marked fear or anxiety of social or performance situations where the patient may be scrutinised by others.
Anticipatory anxiety preceding these situations.
What are the somatic features of social anxiety?
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
What is the epidemiology of social anxiety disorder?
Prevalence is around 4%
Median age of onset is 14
Twice as prevalent in females
Males more likely to seek help
What is a general description of a specific phobia?
Irrational fear and avoidance of specific objects or situations
What are the main categories of phobic stimuli associated with specific phobias?
Animals (spiders, dogs)
Natural environment (heights, storms, water)
Blood, injection, or injuries
Situations (aeroplane, lifts)
What is a general description of generalised anxiety disorder?
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.
What are some psychological symptoms of generalised anxiety disorder?
Restlessness Difficulty concentrating Feeling that mind has gone blank Irritability Depersonalisation Derealisation Sleep disturbances
What are some physical symptoms of generalised anxiety disorder?
Fatigability Muscle tension Autonomic arousal Shortness of breath Chest pain Stomach discomfort Dry moth Paraesthesia Dizziness Light-headedness
What do you need to diagnose generalised anxiety disorder?
Symptoms need to be present for 6 months
Worries should encompass a number of activities
At least three of the following (one in children):
- Restlessness
- Fatigability
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
What is the epidemiology of generalised anxiety disorder?
Around 3% of adults have it
Females twice as likely
Diagnosis peaks at 35-45
What are some screening questions for GAD, social anxiety, panic disorder, and specific phobia?
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?
What is the difference between generalised social anxiety and non-generalised social anxiety?
Generalised social anxiety extends across numerous social situations
non-generalised social anxiety is specific to one or just a few social situations
What is the management for Generalised anxiety disorder?
- Psychological interventions are first line. This includes psychoeducation and CBT
- 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
What SSRIs are used in Generalised anxiety disorder, and what are their dosages?
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
What is the management of generalised SOCIAL anxiety disorder
- 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
What is the management of non-generalised SOCIAL anxiety disorder
- Psychological interventions (psychoeducation and CBT)
- Pharmacotherapy
Propranolol 10-40mg taken prior to triggering social situation
What is the management of panic disorder?
- Psychotherapy (psychoeducation and CBT)
- 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
What is the management of specific phobias?
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.
