Anxiety Disorders Flashcards
Define Neurosis
Psychiatric Disorders characterised by distress
Non Organic with discrete onset
Delusions and Hallucinations are absent
Define Anxiety
Unpleasant Emotional State of subjective fear and somatic symptoms
Define the Yerkes Dodson Law
Anxiety increases Optimum Performance up to a plateau, and then declines
Name the ICD10 classifications of Anxiety Disorders
1 - Phobic related disorders
2 - Other Anxiety Disorders (Panic, GAD)
3 - OCD
4 - Reaction to severe stress and adjustment disorder
Name 5 physical symptoms of Anxiety
CVS - Palpitations Resp - Chest Tightness GI - Loose Stools GU - Increased Micturition Frequency NM - Tremor
Give 5 psychological symptoms of Anxiety
Impending doom Restlessness Poor Concentration Derealisation Depersonalisation
Anxiety can be Paroxysmal or Continuous. Describe Paroxysmal Anxiety.
Situation Dependent - Phobic Anxiety
Situation Independent - Panic Disorder
Anxiety can be Paroxysmal or Continuous. Describe Continuous Anxiety.
GAD
Give 5 conditions related to Anxiety
Hyperthyroid Phaeochromocytoma Cushings Eating Disorders Schizophrenia
Define Generalised Anxiety Disorder
Syndrome of ongoing, uncontrollable widespread worry about many thoughts or events that the patient recognised as excessive and inappropriate.
Symptoms present most days for at least 6 months
Describe the genetic aetiology of Anxiety
5 fold increase if GAD in first degree relative
Describe the neurophysiological causes of GAD
Autonomic Nervous System Dysfunction
Exaggerated activity of Amygdala and Hippocampus
Alterations of GABA/NA/Serotonin
Describe some social risk factors for GAD
Divorced
Single Parent
Low Socioeconomic Status
Domestic Violence
The clinical features of GAD can be remembered by the mnemonic ‘WATCHERS’. Define it
Worry, Autonomic hyperactivity, Tension in muscles, Concentration difficulty, Headache, Energy Loss, Restlessness, Startled easily
Describe the ICD10 diagnostic criteria for GAD
A - Period of at least 6 months of prominent tension, worry, feeling of apprehension
B - Four of the physical symptoms with atleast one being excess autonomic arousal
Describe the expected Appearance, Speech and Mood for a patient with GAD (MSE)
Appearance - worried face with burrowed brow, sweaty
Speech - trembling, slow rate
Mood - Anxious
Describe the expected Thought, Perception, Cognition and Insight for a patient with GAD (MSE)
Thought - Repetitive worrying thoughts
Perception - No Hallucinations
Cognition - Poor memory and reduced concentration
Insight - May or may not have insight
Give two organic differentials for GAD
Hyperthyroidism
Hypoglycaemia
Name 3 Questionnaires used for GAD
GAD7
Becks Depression Inventory
HAD Scale
What is the first line management for GAD?
Low Intensity Psychological interventions such as Psychoeducational Groups
What is the Second Line management for GAD?
Combination of CBT and SSRI (Sertraline - continued for atleast a year)
Name three other medications that can be used for GAD
SNRIs - Venlafaxine
Pregabalin
Benzodiazepines (Short Term)
Name three social interventions for Generalised Anxiety Disorder
Self Help Methods
Support Groups
Exercise Encouragement
Define Phobia
Intense/irrational fear of an object/situation/place that is recognised as excessive or unreasonable
Define Agoraphobia
Fear of public places from which immediate escape in the case of a panic attack would be difficult
What is Social Phobia?
The fear of social situations as they are perceived to lead to humiliation/criticism/embarrassment
Describe the aetiology of Agoraphobia
Maintained by anxiety and avoidance which prevents deconditioning and sets up viscous cycle
Describe the aetiology of Social Phobia
Usually begins in late adolescence as people are concerned about the impression they make
Describe the aetiology of specific phobias
Conditioning early in life either from own frightening experience or learnt from parents
Describe two biological and two psychological features of specific phobias
Biological : Tachycardia, Vasovagal
Psychological: Inability to relax, fear of dying
Describe the ICD10 diagnosis of Agoraphobia
A - Marked fear and subsequent avoidance of two of crowds/public places/travelling alone
B - Atleast two symptoms of anxiety in feared situations
C- Significant emotional distress that is excessive or unreasonable
D - Symptoms restricted to feared situation
Describe the ICD10 diagnosis of Social Phobias
A - marked fear of being focus of attention
B - Atleast two symptoms of anxiety plus blushing/fear of vomit/urgency
C - Significant emotional distress
D - Symptoms are excessive/unreasonable
E- Symptoms restricted to feared situation
Describe the ICD10 diagnosis of Specific Phobias
A - Marked fear/avoidance of situations
B - Symptoms of Anxiety in feared situation
C - Significant emotional distress that’s excessive or unreasonable
D - symptoms restricted to feared situation
Describe the differences between phobic anxiety and GAD
PA occurs in specific situations
PA has anticipatory anxiety
PA has attempted avoidance
Name two potential questionnaires for patients with phobic disorder
Social Phobia Inventory
Liebowitz Social Anxiety Scale