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
Describe the general management of Phobic Disorders
Avoidance of Anxiety Inducing Substances (Alcohol, Caffeine)
Screen for Co Morbidities (Substance Misuse, Personality Disorder)
Name the two main psychological interventions for Specific Phobias
CBT
Graduated Exposure
What is the first line Pharmacological management of Phobic Disorders
SSRIs (Sertraline or Escitalopram)
2nd and 3rd line include SNRIs and Moclobamide
Define Panic Disorder
Recurrent, episodic severe panic attacks which are unpredictable and not related to a certain circumstance
Give three risk factors for Panic Disorder
Family History
Major life events
Female
How does a Panic Attack normally present
Peaks within 10 minutes and rarely persists longer than an hour
Describe the ICD10 diagnosis of Panic Disorder
A - Recurrent panic attacks not associated with specific situations/objects
B - Discrete episode of intense fear, starts abruptly, Atleast one episode of autonomic arousal
Describe the pharmacological management of Panic Disorder
First line is SSRIs
If no improvement after 12 weeks - TCAs (Imipramine etc)
Describe the non pharmacological management of Panic Disorder
CBT
Self help methods (Bibliotherapy, Support Groups)
Define PTSD
Intense delayed prolonged reaction following exposure to an exceptionally traumatic event
Define Abnormal Bereavement
Delayed onset, more intense and prolonged (>6m)
Define Acute Stress Reaction
Abnormal reaction to a sudden stressful event
Define Adjustment Disorder
When adapting to new circumstances causes significant distress and impairment in social functioning
What are the 5 stages of grief
Denial Anger Bargaining Depression Acceptance
The aetiology of PTSD is thought to be a combination of a severe traumatic event and an element of pre existing vulnerability, describe the cognitive theory.
Failure to process emotionally charged events causes memories to persist in an unprocessed form
Give three Pre Trauma risk factors for PTSD
History of mental illness
Low socioeconomic background
Childhood abuse
PTSD must occur within 6 months of the event, describe the four categories
Reliving the situation
Avoidance
Hyperarousal
Emotional Numbing
What happens in ‘Reliving the Situation’ in PTSD?
Flashbacks
Vivid Memories
Nightmares
What happens in ‘Avoidance’ in PTSD?
Avoiding reminders of trauma
Excess rumination
Inability to recall
What happens in ‘Hyperarousal’ in PTSD?
Irritability or outbursts
Difficulty concentrating
Difficulty sleeping
What happens in ‘Emotional Numbing’ in PTSD?
Negative thoughts about oneself
Detachment from others
Describe the ICD10 criteria for PTSD
A - Exposure to stressful event
B - Persistent remembering
C - Actual/Preferred avoidance of stimulus
D - Inability to recall important aspects, increased psychological sensitivity and arousal
Describe the expected Appearance, Behaviour, Speech and Mood of someone with PTSD
A and B - Hypervigilant, Startled Response
Speech - Slow and Trembling
Mood - Anxious
Thought - Pessimistic/Reliving event
Describe the expected Perception,Cognition and Insight of a PTSD patient
Perception - No hallucinations, may have illusions
Cognition - Poor attention and Concentration
Insight - Good
Describe two questionnaires to give a patient with suspected PTSD
Trauma Screening
Post Trauma Diagnostic Scale
Describe the management of PTSD where symptoms are present within THREE MONTHS of trauma
Watchful waiting
Trauma focussed CBT
Short term drugs for sleep management (eg Zopiclone)
Describe the management of PTSD where symptoms are present within THREE to SIX MONTHS of trauma
Trauma focussed psychological intervention (such as CBT or EMDR)
Consider drug treatment such as Paroxetine or Mirtazepine if little benefit to psych therapy/patient doesn’t want to engage/comorbid depression
Define OCD
Recurrent obsessional thoughts or compulsive acts
Define Obsessions
Unwanted intrusive thoughts or urges that repeatedly enter the patients mind
Define Compulsions
Repetitive stereotyped behaviours or mental acts that a person feels driven to perform
Describe three biological theories behind OCD
Reduced serotonin and abnormalities of frontal cortex and basal ganglia
Genetic Element
PANDAS (Childhood Group A Beta Haemolytic Strep Disorder)
Describe a Psychoanalytic and Behavioural theory behind OCD
Filling the mind with obsessional thoughts in order to prevent undesirable ideas from entering
Operant Conditioning
Describe the ICD10 Criteria for Diagnosis of OCD
A - Obsessions and Compulsions present most days for two weeks
B - Obsessions being contamination/excess fear of harm/excess concern of order and Compulsions being Checking/Cleaning/Counting
C - Cause distress and interfere with social/individual functioning
Describe the four clinical features of OCD
- Failure to resist
- Originate from patients own mind
- Repetitive and Distressing
- Carrying out the obsession/compulsion is not enjoyable but reduces anxiety
What questionnaire could be used for OCD patients?
Yale Brown Obsessive Compulsive Scale
Describe the non pharmacological management of OCD
CBT and ERP
Patients are exposed to the stimulus causing the anxiety and prevented from performing the action
Name two pharmacological managements for OCD
SSRIs (Fluoxetine, Sertraline)
Clomipramine
Define Somatoform Disorders
Symptoms are suggestive of a physical disorder but in the absence of a physiciological illness
Repeatedly seek medical attention when it has failed to benefit them
Define Dissociative Disorder
Unpleasant/stressful events are converted to symptoms
Describe the Social Aetiology(I.e. benefits of sick role behaviour) for patients with Somatoform Disorders
Primary Gain - Relief from stressful interpersonal expectations
Secondary Gain - Attention/Care/Financial Reward from others
Describe the Biological and Psychological Aetiology for patients with Somatoform Disorders
Biological - Possible implication of Neuroendocrine Genes
Psychological - High association with PTSD/Physical and Sexual Abuse
Describe the two processes occurring in Dissociate Disorder
Dissociation - Separating off certain memories from normal consciousness
Conversion - Distressing events transformed into physical symptoms
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Amnesia
Partial or complete memory loss for recent traumatic/stressful event
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Fugue
Unusual physical journey away from surroundings followed by amnesia for this period
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Stupor
Reduction/Absence of voluntary movements/speech with normal tone
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Movement Disorder
Unable to perform movements under voluntary control
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Convulsions
Sudden unexpected spasmodic movements resembling epilepsy without LOC
Describe the ICD10 criteria of Somatisation (Briquets) Disorder
A - Two years of unexplainable physical symptoms
B - Preoccupation with symptoms causing physical distress and constantly seeking medical attention
C - Continuous refusal to accept reassurance
D - 6 or more physical symptoms
Define Hyperchondriacal Disorder
Misinterprets normal bodily sensations which leads to non delusional preoccupation that they have a serious disease
Define Dysmorphophobia
Excess preoccupation with barely noticeable/imagined defects
Define Somatoform Autonomic Dysfunction
Symptoms are related to autonomic nervous system
Resp - Psychogenic Ventilation
GI - IBS
CVS - Da Costa’s Syndrome
Any Somatoform disorder is likely a diagnosis of exclusion, however give three factors that may point towards this diagnosis
Previous Mental Health Issues
Symptoms in Multiple Body Systems
Vague Symptoms
Give two differential diagnoses for Somatoform Disorders
Malingering (Patient seeks advantageous consequences of being diagnosed with medical condition)
Munchausen’s (Individual wishes to adopt sick role for emotional gain
Describe the management of Somatoform Disorder
Antidepressants and Physical Exercise
CBT
Coping Strategies