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Year 4 Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

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1
Q

Define Neurosis

A

Psychiatric Disorders characterised by distress
Non Organic with discrete onset
Delusions and Hallucinations are absent

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2
Q

Define Anxiety

A

Unpleasant Emotional State of subjective fear and somatic symptoms

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3
Q

Define the Yerkes Dodson Law

A

Anxiety increases Optimum Performance up to a plateau, and then declines

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4
Q

Name the ICD10 classifications of Anxiety Disorders

A

1 - Phobic related disorders
2 - Other Anxiety Disorders (Panic, GAD)
3 - OCD
4 - Reaction to severe stress and adjustment disorder

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5
Q

Name 5 physical symptoms of Anxiety

A 
CVS - Palpitations
Resp - Chest Tightness
GI - Loose Stools
GU - Increased Micturition Frequency
NM - Tremor
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6
Q

Give 5 psychological symptoms of Anxiety

A 
Impending doom
Restlessness
Poor Concentration
Derealisation
Depersonalisation
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7
Q

Anxiety can be Paroxysmal or Continuous. Describe Paroxysmal Anxiety.

A

Situation Dependent - Phobic Anxiety

Situation Independent - Panic Disorder

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8
Q

Anxiety can be Paroxysmal or Continuous. Describe Continuous Anxiety.

A

GAD

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9
Q

Give 5 conditions related to Anxiety

A 
Hyperthyroid
Phaeochromocytoma
Cushings
Eating Disorders
Schizophrenia
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10
Q

Define Generalised Anxiety Disorder

A

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

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11
Q

Describe the genetic aetiology of Anxiety

A

5 fold increase if GAD in first degree relative

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12
Q

Describe the neurophysiological causes of GAD

A

Autonomic Nervous System Dysfunction
Exaggerated activity of Amygdala and Hippocampus
Alterations of GABA/NA/Serotonin

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13
Q

Describe some social risk factors for GAD

A

Divorced
Single Parent
Low Socioeconomic Status
Domestic Violence

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14
Q

The clinical features of GAD can be remembered by the mnemonic ‘WATCHERS’. Define it

A

Worry, Autonomic hyperactivity, Tension in muscles, Concentration difficulty, Headache, Energy Loss, Restlessness, Startled easily

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15
Q

Describe the ICD10 diagnostic criteria for GAD

A

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

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16
Q

Describe the expected Appearance, Speech and Mood for a patient with GAD (MSE)

A

Appearance - worried face with burrowed brow, sweaty
Speech - trembling, slow rate
Mood - Anxious

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17
Q

Describe the expected Thought, Perception, Cognition and Insight for a patient with GAD (MSE)

A

Thought - Repetitive worrying thoughts
Perception - No Hallucinations
Cognition - Poor memory and reduced concentration
Insight - May or may not have insight

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18
Q

Give two organic differentials for GAD

A

Hyperthyroidism

Hypoglycaemia

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19
Q

Name 3 Questionnaires used for GAD

A

GAD7
Becks Depression Inventory
HAD Scale

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20
Q

What is the first line management for GAD?

A

Low Intensity Psychological interventions such as Psychoeducational Groups

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21
Q

What is the Second Line management for GAD?

A

Combination of CBT and SSRI (Sertraline - continued for atleast a year)

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22
Q

Name three other medications that can be used for GAD

A

SNRIs - Venlafaxine
Pregabalin
Benzodiazepines (Short Term)

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23
Q

Name three social interventions for Generalised Anxiety Disorder

A

Self Help Methods
Support Groups
Exercise Encouragement

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24
Q

Define Phobia

A

Intense/irrational fear of an object/situation/place that is recognised as excessive or unreasonable

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25
Q

Define Agoraphobia

A

Fear of public places from which immediate escape in the case of a panic attack would be difficult

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26
Q

What is Social Phobia?

A

The fear of social situations as they are perceived to lead to humiliation/criticism/embarrassment

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27
Q

Describe the aetiology of Agoraphobia

A

Maintained by anxiety and avoidance which prevents deconditioning and sets up viscous cycle

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28
Q

Describe the aetiology of Social Phobia

A

Usually begins in late adolescence as people are concerned about the impression they make

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29
Q

Describe the aetiology of specific phobias

A

Conditioning early in life either from own frightening experience or learnt from parents

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30
Q

Describe two biological and two psychological features of specific phobias

A

Biological : Tachycardia, Vasovagal

Psychological: Inability to relax, fear of dying

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31
Q

Describe the ICD10 diagnosis of Agoraphobia

A

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

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32
Q

Describe the ICD10 diagnosis of Social Phobias

A

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

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33
Q

Describe the ICD10 diagnosis of Specific Phobias

A

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

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34
Q

Describe the differences between phobic anxiety and GAD

A

PA occurs in specific situations
PA has anticipatory anxiety
PA has attempted avoidance

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35
Q

Name two potential questionnaires for patients with phobic disorder

A

Social Phobia Inventory

Liebowitz Social Anxiety Scale

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36
Q

Describe the general management of Phobic Disorders

A

Avoidance of Anxiety Inducing Substances (Alcohol, Caffeine)

Screen for Co Morbidities (Substance Misuse, Personality Disorder)

37
Q

Name the two main psychological interventions for Specific Phobias

A

CBT

Graduated Exposure

38
Q

What is the first line Pharmacological management of Phobic Disorders

A

SSRIs (Sertraline or Escitalopram)

2nd and 3rd line include SNRIs and Moclobamide

39
Q

Define Panic Disorder

A

Recurrent, episodic severe panic attacks which are unpredictable and not related to a certain circumstance

40
Q

Give three risk factors for Panic Disorder

A

Family History
Major life events
Female

41
Q

How does a Panic Attack normally present

A

Peaks within 10 minutes and rarely persists longer than an hour

42
Q

Describe the ICD10 diagnosis of Panic Disorder

A

A - Recurrent panic attacks not associated with specific situations/objects
B - Discrete episode of intense fear, starts abruptly, Atleast one episode of autonomic arousal

43
Q

Describe the pharmacological management of Panic Disorder

A

First line is SSRIs

If no improvement after 12 weeks - TCAs (Imipramine etc)

44
Q

Describe the non pharmacological management of Panic Disorder

A

CBT

Self help methods (Bibliotherapy, Support Groups)

45
Q

Define PTSD

A

Intense delayed prolonged reaction following exposure to an exceptionally traumatic event

46
Q

Define Abnormal Bereavement

A

Delayed onset, more intense and prolonged (>6m)

47
Q

Define Acute Stress Reaction

A

Abnormal reaction to a sudden stressful event

48
Q

Define Adjustment Disorder

A

When adapting to new circumstances causes significant distress and impairment in social functioning

49
Q

What are the 5 stages of grief

A 
Denial
Anger
Bargaining
Depression
Acceptance
50
Q

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.

A

Failure to process emotionally charged events causes memories to persist in an unprocessed form

51
Q

Give three Pre Trauma risk factors for PTSD

A

History of mental illness
Low socioeconomic background
Childhood abuse

52
Q

PTSD must occur within 6 months of the event, describe the four categories

A

Reliving the situation
Avoidance
Hyperarousal
Emotional Numbing

53
Q

What happens in ‘Reliving the Situation’ in PTSD?

A

Flashbacks
Vivid Memories
Nightmares

54
Q

What happens in ‘Avoidance’ in PTSD?

A

Avoiding reminders of trauma
Excess rumination
Inability to recall

55
Q

What happens in ‘Hyperarousal’ in PTSD?

A

Irritability or outbursts
Difficulty concentrating
Difficulty sleeping

56
Q

What happens in ‘Emotional Numbing’ in PTSD?

A

Negative thoughts about oneself

Detachment from others

57
Q

Describe the ICD10 criteria for PTSD

A

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

58
Q

Describe the expected Appearance, Behaviour, Speech and Mood of someone with PTSD

A

A and B - Hypervigilant, Startled Response
Speech - Slow and Trembling
Mood - Anxious
Thought - Pessimistic/Reliving event

59
Q

Describe the expected Perception,Cognition and Insight of a PTSD patient

A

Perception - No hallucinations, may have illusions
Cognition - Poor attention and Concentration
Insight - Good

60
Q

Describe two questionnaires to give a patient with suspected PTSD

A

Trauma Screening

Post Trauma Diagnostic Scale

61
Q

Describe the management of PTSD where symptoms are present within THREE MONTHS of trauma

A

Watchful waiting
Trauma focussed CBT
Short term drugs for sleep management (eg Zopiclone)

62
Q

Describe the management of PTSD where symptoms are present within THREE to SIX MONTHS of trauma

A

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

63
Q

Define OCD

A

Recurrent obsessional thoughts or compulsive acts

64
Q

Define Obsessions

A

Unwanted intrusive thoughts or urges that repeatedly enter the patients mind

65
Q

Define Compulsions

A

Repetitive stereotyped behaviours or mental acts that a person feels driven to perform

66
Q

Describe three biological theories behind OCD

A

Reduced serotonin and abnormalities of frontal cortex and basal ganglia
Genetic Element
PANDAS (Childhood Group A Beta Haemolytic Strep Disorder)

67
Q

Describe a Psychoanalytic and Behavioural theory behind OCD

A

Filling the mind with obsessional thoughts in order to prevent undesirable ideas from entering

Operant Conditioning

68
Q

Describe the ICD10 Criteria for Diagnosis of OCD

A

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

69
Q

Describe the four clinical features of OCD

A
  • Failure to resist
  • Originate from patients own mind
  • Repetitive and Distressing
  • Carrying out the obsession/compulsion is not enjoyable but reduces anxiety
70
Q

What questionnaire could be used for OCD patients?

A

Yale Brown Obsessive Compulsive Scale

71
Q

Describe the non pharmacological management of OCD

A

CBT and ERP

Patients are exposed to the stimulus causing the anxiety and prevented from performing the action

72
Q

Name two pharmacological managements for OCD

A

SSRIs (Fluoxetine, Sertraline)

Clomipramine

73
Q

Define Somatoform Disorders

A

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

74
Q

Define Dissociative Disorder

A

Unpleasant/stressful events are converted to symptoms

75
Q

Describe the Social Aetiology(I.e. benefits of sick role behaviour) for patients with Somatoform Disorders

A

Primary Gain - Relief from stressful interpersonal expectations
Secondary Gain - Attention/Care/Financial Reward from others

76
Q

Describe the Biological and Psychological Aetiology for patients with Somatoform Disorders

A

Biological - Possible implication of Neuroendocrine Genes

Psychological - High association with PTSD/Physical and Sexual Abuse

77
Q

Describe the two processes occurring in Dissociate Disorder

A

Dissociation - Separating off certain memories from normal consciousness

Conversion - Distressing events transformed into physical symptoms

78
Q

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Amnesia

A

Partial or complete memory loss for recent traumatic/stressful event

79
Q

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Fugue

A

Unusual physical journey away from surroundings followed by amnesia for this period

80
Q

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Stupor

A

Reduction/Absence of voluntary movements/speech with normal tone

81
Q

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Movement Disorder

A

Unable to perform movements under voluntary control

82
Q

There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Convulsions

A

Sudden unexpected spasmodic movements resembling epilepsy without LOC

83
Q

Describe the ICD10 criteria of Somatisation (Briquets) Disorder

A

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

84
Q

Define Hyperchondriacal Disorder

A

Misinterprets normal bodily sensations which leads to non delusional preoccupation that they have a serious disease

85
Q

Define Dysmorphophobia

A

Excess preoccupation with barely noticeable/imagined defects

86
Q

Define Somatoform Autonomic Dysfunction

A

Symptoms are related to autonomic nervous system

Resp - Psychogenic Ventilation
GI - IBS
CVS - Da Costa’s Syndrome

87
Q

Any Somatoform disorder is likely a diagnosis of exclusion, however give three factors that may point towards this diagnosis

A

Previous Mental Health Issues
Symptoms in Multiple Body Systems
Vague Symptoms

88
Q

Give two differential diagnoses for Somatoform Disorders

A

Malingering (Patient seeks advantageous consequences of being diagnosed with medical condition)

Munchausen’s (Individual wishes to adopt sick role for emotional gain

89
Q

Describe the management of Somatoform Disorder

A

Antidepressants and Physical Exercise
CBT
Coping Strategies

Year 4 Psychiatry (12 decks)

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