Anxiety Disorders Flashcards
What are the anxiety disorders?
• Panic Disorder (with or without agoraphobia) • Social Anxiety Disorder (social phobia) • Specific Phobias • Health Anxiety (hypochondriasis) • Obsessive Compulsive Disorder (OCD)/Body Dysmorphic Disorder (BDD) • Post-Traumatic Stress Disorder (PTSD) • Generalised Anxiety Disorder (GAD)
What is a specific phobia?
• Phobias describe a group of disorders in which anxiety is experienced only or predominantly in certain well defined situations which are not dangerous • They can cause marked distress and impair a persons ability to function • A marked fear of specific object or situation (e.g. dogs, spiders, thunder, balloons, snakes, flying, blood, etc) o Inability to be rational o When put in contact with stimulus they are put in their fight or flight response within seconds • Marked avoidance of such object or situations – they will keep avoiding the stimulus • Different types of phobias: o Agoraphobia: fear or crowds travel or events away from home o Social phobia: fear of scrutiny by other people. Sx: blushing, shaking hands, nausea, urgency to go to the toilet o Simple phobia: numerous phobias restricted to specific situations
What is a panic disorder?
- A fear of your own physiological & psychological reactions
- Physiological reaction feeds that sense of being out of control
- Bodily changes viewed as signs of impending collapse, insanity or death – an imminent catastrophe – something awful is going to happen
What is generalised anxiety disorder?
• Essentially a WORRY problem • Specific content of (type 1) worries changes/varies • Includes “worries about worries” (type ll worries) – metaworries – worries about worries • Usually accompanied by low level physical symptoms (e.g. insomnia, muscle tension, GI problems, headache) - • Often maintained by the belief that worry is useful (positive worry beliefs) – e.g. it motivates, shows responsibility, prepares for problems, or stops bad things happening. – They think the worry is helpful • RFs: Aged 35- 54, being divorced or separated, living alone, being a lone parent • Protective factors: being ages 16 to 24, being married of cohabiting
How is anxiety managed?
- CBT, relaxation, behavioural therapy, meditation,
- Pharmacological: SSRI (sertraline), venlafaxine, duloxetine, MAOI (phenelzine) as 2nd or 3rd treatments
- Benzodiazepines can be used as 1st line: issues: tolerance and dependence. Beware when prescribing them to people with drug and alcohol use. Not a long term solution
- Pregabalin can be used as monotherapy or with an anti depressant. Antipsychotics: quetiapine – generally reserved for acute distress.
- Beta blockers can be used for somatic symptoms
What is social anxiety?
- At its core lies a fear of negative evaluation by others – people think other people think bad things of them
- Can lead to avoidance of feared situations, (counterproductive) use of safety behaviours (ie sitting in the kitchen out of peoples way), anticipatory anxiety, and unhelpful ‘post mortems’ following social encounters.
What are OCDs
- Unwanted recurring distressing intrusive thoughts or images (=obsessions) • e.g. being contaminated, causing harm, behaving inappropriately, etc.
- Ego dystonic thought (not syntonic)– these morals do not fit with the persons ethical or moral ideals •
- To manage the distress (primarily anxiety) caused by intrusions the patient conducts neutralising behaviours (=compulsions) e.g. cleaning obsessively
- Obsessions: contamination, doubting, aggression or horrific impulses, sexual images – stereotypes, purposeless words ideas or phrases which enter the mind perceived by the patient as nonsense
-
Compulsions (aka neutralizing behaviours) – senseless, repeated rituals
- Overt: washing, checking, ordering, aligning
- Covert: praying, counting, repeating words
How is OCD managed?
- Mild:1st: Low intensity CBT including exposure and response prevention (ERP)
- 2nd: course of SSRI or more intensive CBT
- Moderate: Either course of SSRI (fluoxetine) or more intensive CBT (ERP)
- Severe: combined treatment with SSRI and CBT
What are the symptoms of PTSD?
- Re experiencing: flashbacks to trauma, nightmares, repetitive and distressing intrusive images
- Avoidance: avoiding people, situations or circumstances resembling or associated with the event
- Hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating 4.
- Emotional numbing - lack of ability to experience feelings, feeling detached
How is PTSD managed?
- • Following a traumatic event single-session interventions (often referred to as debriefing) are not recommended
- Watchful waiting may be used for mild symptoms lasting less than 4 weeks
- 1ST: Trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases
- Pharmacological: drug treatments for PTSD should not be used as a routine first-line treatment for adults.
- If so, Venlafaxine or a SSRI e.g. sertraline should be tried.
- Severe: risperidone may be used
What are some of the associations with repeated self harm?
- Previous self-harm/ psychiatric contact
- Alcohol / Drug misuse
- Unemployment/ Social class V
- H/o trauma, sexual or physical abuse
- Criminal record/ history of violence
- Single / divorced / separated
- Family history- 4 fold increase risk, twin and adoption studies
