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Psychiatry > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

What are the types of anxiety disorders?

A

Specific phobias

Social phobia

Generalized anxiety disorder

Agoraphobia

Panic disorder

OCD

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2
Q

What are some common symptoms of neuroses?

A

Psychological = anticipatory fear of impending doom, restlessness, poor concentration

Cardiovascular = palpitations, chest pains

Respiratory = hyperventilation, cough, chest tightness

GI = abdo pain, loose stools, nausea and vomiting

Genitourinary = increased frequency of micturition

Neuromuscular = tremor, myalgia, headache

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3
Q

What is generalized anxiety disorder?

A
  • Present most of the time not associated with object / situations
  • Excessive or inappropriate worry about normal life events
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4
Q

What medical conditions are associated with anxiety?

A
  • Hyperthyroidism
  • Hypoglycaemia
  • Anaemia
  • Phaeochromocytoma
  • Cushing’s disease
  • COPD
  • Congestive cardiac failure
  • Malignancy
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5
Q

What substance-related conditions are associated with anxiety?

A
  • Intoxication e.g. cannabis, alcohol, caffeine
  • Withdrawal e.g. alcohol, benzos, caffeine
  • Side effects e.g. thyroxine, steroids, adrenaline
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6
Q

What psychiatric conditions are associated with anxiety?

A
  • Eating disorders
  • Depression
  • Schizophrenia
  • PTSD
  • Adjustment disorder
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7
Q

What is generalized anxiety disorder?

A

Ongoing, uncontrollable, widespread worry about events / thoughts that the patient recognizes as excessive and inappropriate (present on most days for at least 6 months)

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8
Q

What are the risk factors for GAD?

A
  • Family history
  • Divorce
  • Living alone / single parent
  • Low socioeconomic status
  • Domestic violence
  • Unemployment
  • Relationship problems
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9
Q

What are the features of GAD?

A
  • Worry (excessive, uncontrollable)
  • Autonomic hyperactivity (sweating, increased pupil size, increase HR)
  • Tension in muscles
  • Concentration difficulties
  • Headaches / hyperventilation
  • Energy loss
  • Restlessness
  • Startled easily
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10
Q

Name some symptoms of GAD?

A
  • Difficulty breating
  • Chest pain
  • Nausea
  • Abdo pain
  • Loose motions
  • Lightheadedness
  • Fear of dying
  • Hot flushes
  • Numbness / tingling
  • Headache
  • Muscle tension
  • Restlessness
  • Being startled
  • Concentration difficulties
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11
Q

What investigations for a patient presenting with anxiety?

A
  • Blood tests (FBC for infection / anaemia)
  • TFTs
  • Glucose (hypoglycaemia)
  • ECG for sinus tachycardia
  • Questionnaires GAD-7, Beck’s anxiety inventory
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12
Q

What are some differentials for patients presenting with anxiety?

A
  • GAD
  • Other neurotic disorders: panic disorder, specific phobias, OCT, PTSD
  • Depression
  • Schizophrenia
  • Personality disorder (e.g. dependent PD)
  • Excessive caffeine or alcohol consumption
  • Withdrawal from drugs
  • Organic: anaemia, hyperthyroidism, phaeochromocytoma, hypoglycaemia
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13
Q

What to screen for in anxiety?

A

Depression and substance misuse

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14
Q

What is the bio-psycho-social management of anxiety?

A

Biological = SSRI e.g. sertraline, SNRI e.g. venlafaxine or duloxetine, or pregablin. Benzos ONLY for short-term measures

Psychological = psychoeducational groups (low intensity) CBT (high intensity)

Social = self help methods (e.g. writing down thoughts and analysing them objectively) and support groups. Exercise should be encouraged and may benefit.

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15
Q

What is NICEs stepwise management of anxiety?

A
  • Identification and assessment. Psychoeducation and active monitoring
  • Low intensity psychological interventions (individual guided self-help)
  • High intentsity psychological intervention (CBT or applied relaxation) or drug treatment
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16
Q

What is a phobia?

A

Intense, irrational fear of an object, situation, place or person

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17
Q

What are the features of phobias?

A
  • Tachycardia
  • Vasovagal response (e.g. bradycardia)
  • Psychological e.g. anticipatory event, inability to relax, urge to avoid the feared situation, at extremes a fear of dying
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18
Q

What are the features of agoraphobia?

A
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19
Q

What are some differentials for anxiety?

A
  • GAD
  • Panic disorder
  • PTSD
  • Anxious personality disorder
  • Adjustment disorder
  • Depression
  • Schizophrenia
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20
Q

What forms the general management of anxiety disorders?

A
  • Establish good rapport
  • Advise avoidance of anxiety-inducing substances e.g. caffiene
  • Screen for substance misuse, personality disorders
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21
Q

What is the specific treatment of agrophobia?

A

CBT involving gradual exposure and desensitization

SSRIs are first line

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22
Q

What is the specific treatment of social phobias?

A

CBT with graduated exposure

SSRIs e.g. sertraline or SNRIs e.g. venlafaxine or MAOI e.g. moclobemide

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23
Q

What is the treatment of specific phobias?

A

Exposures using either self-help or more formally through CBT

Benzos can be used short term (e.g. if patient is claustophobic and needs a CT)

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24
Q

What is a panic disorder?

A

Recurrent, episodic, severe panic attacks which are unpredictable and not restricted to any particular situation

25
Q

What are the risk factors for panic disorders?

A
  • Family history
  • Recent trauma
  • White ethnicity
  • Major life events
  • Female
  • Asthma
  • Age (20-30)
  • Cigarette smoking
26
Q

What are the features of panic disorder?

A

Peak within 10 mins and rarely persist beyond an hour

Recurrent panic attacks which are not associated with a specific situation

Discrete episode of intense fear or discomfort, starting abruptlu, reaching a crescendo within a few mins with autonomic arousal: palpitatioms, sweating, shaking / tremor, dry mouth

27
Q

What are more of the features of panic disorder?

A

Palpitations

Abdo distress

Numbness

Intense fear of death

Choking

Chest pain

Sweating

Shaking

SoB

28
Q

What are the management steps of anxiety?

A
  • SSRIs are first-line (if no improvement after 12 weeks then TCA e.g. imipramine or clomipramine)
  • CBT
  • Self help e.g. support groups, encouraging exercise to promote health
29
Q

What is PTSD?

A

Intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event

30
Q

What is adjustment disorder?

A

Significant distress (greater than expected) accompanied by an impairment in social functioning

31
Q

Give examples of some traumatic events?

A

Severe assault

Major natural disaster (e.g. earthquakes, floods)

Serious RTA

Involvement in wars e.g. WWII

Freak occurences (e.g. near drowning)

32
Q

What are the features of PTSD?

A

Symptoms must occur within 6 months of event:

  • Reliving (flashbacks, nightmares)
  • Avoidance (associated people or locations)
  • Hyperarousal (irritability / outbursts)
  • Emotional numbing
33
Q

What are some differentials for PTSD?

A
  • Adjustment disorder
  • Acute stress reaction
  • Bereavement
  • Mood disorder
  • Organic: head injury, alcohol / substance misuse
34
Q

What is an acute stress reaction?

A

Exposure to an exceptional physical or mental stressor followed by immediate onset of symptoms (within 1 hour) with narrowing of attention, apparent disorientation, anger or verbal aggression. Must resolve within 48 hours

35
Q

What is the treatment of PTSD where symptoms are present within 3 months of trauma?

A
  • Watchful waiting
  • Trauma-focussed CBT
  • Zopiclone for sleep disturbance
  • Risk assessment for suicide
36
Q

What is the treatment for PTSD when symptoms have been present for more than 3 months after trauma?

A
  • CBT / eye movement desensitization and reprocessing
  • Drug treatment (if little benefit from therapy / patient refuses therapy)
  • Paroxetine, mirtazapine, amitriptyline, phenelzine
37
Q

What is OCD?

A

Recurrent obsessional thoughts or compulsive acts

38
Q

What are obsessions?

A

Unwanted intrusive thoughts, images or urges which repeatedly enter the mind, they are distressing and recognised as absurd

39
Q

What are compulsions?

A

Repetitive behaviours or mental acts that a person feels driven into performing - overt (observable) or covert (mental acts)

40
Q

What are the theories for the aetiology of OCD?

A

Biological: related to decreased serotonin and abnormalities of the frontal cortex and basal ganglia. Childhood group A beta-haemolytic strep infection may have a role in causing OCD

Psychoanalytic: filling the mind with obsessional thoughts to prevent undesirable ideas from entering consciousness

Behavioural: Operant conditioning - anxiety created the obsession is reduced by performing the compulsion

41
Q

How may OCD be diagnosed?

A
  • Obsessions / compulsions present on most days for a period of 2 weeks
  • Obsessions interfere with individual functioning
42
Q

What is the most common obession and compulsion?

A

Obsession = being contaminated

Compulsion = checking and cleaning

43
Q

What are some other obsessions and compulsions?

A

Obsession = fear of harm (e.g. locks not safe), excessive concern with symmetry

Compulsion = Checking gas taps, door locked, arranging objects

44
Q

What are some differentials for OCD?

A

Eating disorder

Anxiety disorder

Depressive disorder

Schizophrenia

Organic = epilepsy, dementia, head injury

45
Q

What is the management of OCD?

A

CBT (including exposure and response prevention)

Pharma (SSRIs e.g. fluoxetine, sertraline, paroxetine, citalopram, TCA e.g. clomipramine)

46
Q

What is helpful for OCD patients in general?

A

Psychoeducation, self-help books

Assess potential suicide risk

Co-morbid depression should be identified

47
Q

What is a somatoform disorder?

A

Group of disorders whose symptoms are suggestive of a physical disorder without physiological illness

48
Q

What are dissociative disorders?

A

Symptoms which cannot be explained by a medical disorder where there are convincing associations in time between symptoms and stressful events

  • Painful / stressful thoughts are subconsiously converted into more bearable physical symptoms by the patient
49
Q

What is the cause of somatoform disorders?

A

Patients adopt sick role which provides relief from stressful interpersonal expectations (primary gain) or care from others (secondary gain)

50
Q

What are some risk factors for somatoform and dissociative disorders?

A

Childhood abuse

Anxiety disorders

Mood disorders

Personality disorders

Social stressors

51
Q

How can somatization disorder be diagnosed?

A
  • 2 years duration of symptoms
  • Preoccupation with symptoms causes physical distress leading to repeated consultations
  • Refusal of reassurance from doctor
52
Q

What is hypochondiral disorder?

A

Patient misinterprets normal bodily sensations, leading them to the non-delusional preoccupation that they have a serious condition e.g. cancer

53
Q

What are the investigations for somatoform disorders?

A

- Diagnosis of exclusion

- Physical examination dependant on symptoms

- Bloods: FBC for anaemia, infection, U&Es for electrolyte disturbance, LFTs for liver or biliary pathology, CRP for infection or inflammation, TFTs for thyroid disorder

- GI symptoms: AXR, stool culture, OGD, colonoscopy, diagnostic laparoscopy

- Cardiac symptoms: ECG, 24 hr tape, ECHO, acngiogram

- GUM symptoms: urine dipstick, MSU, cytoscopy

54
Q

What is Munchausen’s syndrome (malingering and factitious disorder)?

A

Physical and psychological symptoms are intentionally produced

Malingering = advantageous consequences

Munchausen’s = individual wants to adopt the ‘sick role’ in order to receive the care of a patient

55
Q

Give examples of the difference between factitious, malingering, somatoform disorder and dissociative disorder?

A
56
Q

What is the biopsychosocial management of somatoform and dissociative disorders?

A

Bio = SSRIs, physical exercise

Psychological = CBT, coping strategies

Social = meditation, long walks, or involve family where appropriate

57
Q

How can somatisation be differentiated from hypochondria?

A

Somatisation = symptoms (2 years) - patient refuses negative test results

HypoChondria = cancer (belief in underlying disease)

58
Q

How is conversion disorder unique?

A
  • Loss of motor / sensory function
  • Factitious disorder = patient consciously feigns symptoms
  • Malingering = for material gain
  • Dissociative = normally psychiatric symptoms e.g. amnesia, stupor

Psychiatry (13 decks)

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