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CP2 Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Why is some anxiety normal

A

Normal adaptive response to stressful situations i.e fight or flight

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2
Q

What are the 4 domains used to differentiate normal and pathological anxiety?

A

Autonomy
Intensity
Duration
Behaviour

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3
Q

Normal developmental fears: birth - 6months (4)

A

Loud noises
Loss of physical support
Rapid position changes
Rapidly approaching other objects

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4
Q

Normal developmental fears: 7-12 months (4)

A

Strangers
Looming objects
Unexpected objects
Unfamiliar people

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5
Q

Normal developmental fears: 1-5 years

A 
Strangers 
Storms 
Animals 
Dark 
Parent separation 
Objects 
Machines/loud noises 
Toilet
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6
Q

Normal developmental fears: 6-12 years

A 
Supernatural
Body injury
Disease 
Burglars 
Failure 
Criticism 
Punishment
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7
Q

Normal developmental fears: 12-18 years

A

School performance
Peer scrutiny
Appearance

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8
Q

Prevelance panic disorder

A

around 2%

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9
Q

Prevelance OCD

A

2.5%

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10
Q

Prevenlance PTSD

A

3.5%

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11
Q

Prevelance GAD

A

3%

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12
Q

What is PTSD

A

Delayed response to a stressful event of an exceptionally threatening or catastrophic nature

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13
Q

How long does Sx of PTSD take to come on after trauma?

A

Few w to few m

Can arise much later in life

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14
Q

What % of females who have suffered from domestic violence have PTSD

A

45%

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15
Q

What % PTSD recover in 1 year

A

50%

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16
Q

Factors suggesting poor prognosis PTSD (5)

A 
Mental illness 
Long duration 
FHx mental illness 
poor social support 
Pre-morbid fct
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17
Q

Sx of anxiety - psychological arousal (6)

A 
worrying thoughts 
irritability 
sensitivity to noise 
restlessness 
fearful anticipation 
poor [  ]
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18
Q

Sx anxiety - autonomic arousal (6)

A 
Dry mouth
Diarrhoea 
Difficulty breathing 
Palps 
Chest discomfort 
Freq + urgent micturition
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19
Q

Def GAD

A

Free floating anxiety that may fluctuate but neither situational nor episodic

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20
Q

What 3 elements are present in GAD

A

Apprehension
Motor tension
Autonomic overactivity

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21
Q

Def Panic disorder

A

Recurrent attacks of severe anxiety, not restricted to any particular situation, therefore unpredictable

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22
Q

Sx Panic disorder(6)

A 
Palps
Choking 
Chest pain 
Dizziness 
Loss of touch w/ reality 
Generally anxiety Sx free between attacks
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23
Q

How long do panic attacks last

A

<10mins

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24
Q

Def Agoraphobia

A

Fear of avoidance of crowds, public places, travelling alone, travelling away from home

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25
Q

What is always present in agoraphobia

A

Avoidance

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26
Q

Def Social phobia

A

Fear of being focus of attention, of embarrassment or humiliation

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27
Q

Sx social phobia (4)

A

Blushing/shaking
Fear of vomiting
Urgency/fear of micturition
AVOIDANCE

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28
Q

Most common isolated specific phobias

A 
Animals 
Birds
Insects
Heights
Thunder
Flying 
Small enclosed spaces
Sight of blood/injury/injections/dentists/hospitals
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29
Q

Def OCD

A

Disorder characterised by obsessive Sx +/or compulsive acts rituals
Present on most days for at least 2 weeks
–> distress + interfering w/ activities

30
Q

M:F OCD

A

M=F

31
Q

Mean onset of Sx to diagnosis OCD

A

9 years

32
Q

Which other MH conditions does OCD frequently co-exist with? (3)

A

Schizophrenia
Tourettes
Depression

33
Q

Ego-syntonic Sx

A

Sx to not usually distress the patient

34
Q

Ego-dystonic Sx

A

Sx cause distress to pt

Hence in OCD

35
Q

What is a rumination

A

Repeatedly thinking about the causes and experience of previous distress + difficulties
Voluntary, not resisted

36
Q

What are obsessions

A 
Thoughts, ideas which are acknowledged as excessive or unreasonable
Repetitive 
Intrusive + resisted by pt 
Unpleasant 
Originate in mind of pt 
Cause distress
37
Q

What are compulsions

A

Physical act which = acknowledged as excessive/ unreasonable
Repetitive
Intrusive + resisted by pt
Unpleasant
Desire to carry out act is from mind of pt

38
Q

What is magical thinking?

A

If i touch this door 5 times , no harm will come to my family

39
Q

DDx anxiety disorder (7)

A

Endocrine - thyroid/PCC
Metabolic - DKA/hypothermia/hyperthermia
Hypoxia - CHF/angina/COPD/Anaemia
Neurological - seizures/vestib dysfunction
Cardiac - arrhythmias
Dx withdrawal - alcohol/opiates
Dx - caffiene/amphetamine/cocaine/legal highs

40
Q

How do pt manage their own anxiety?

A

Avoidance + safety behaviours

41
Q

Anxiety Mx - step care approach - Step 1:

A

All known + suspected PS anxiety

Psychoeducation + active monitoring

42
Q

Anxiety Mx - step care approach - Step 2:

A

No improvement after step 1
Guided self-help + low intensity psycho interventions
IAPT

43
Q

Anxiety Mx - step care approach - Step 3

A

Inadequate response to step 2/marked functional impairment
High intensity psycho intervention (CBT)
Or Dx Tx in 1’ care

44
Q

Anxiety Mx - step care approach - Step 4:

A

Complex Tx refractory

Rx to 2’ care

45
Q

What is done in psychoeducation

A

Pts knowledge + awareness of illness is improved

Improves understanding + support pt haves + receives

46
Q

What is systematic desensitisation or graded exposure

A 
For phobia 
Involves ID'd fear 
Setting Tx aims in steps 
Starting w/ situations causing milder anxiety 
Req repeated exposure to stimuli
47
Q

What is flood exoopsure

A

Pt instantly exposed to highest level of anxiety heirarchy until anxiety diminishes

48
Q

Exposure + response prevention therapy

A

For OCD
Pt encouraged to ressit carrying out compulsions until urge diminishes
THen exposed to> severe compulsion evoking situations

49
Q

What is EMDR

A

Eye movement desnsitisation reprocessing
For PTSD
OG trauma re-experienced in as much detail as possible
Fix eyes on therapists fingers as it passes from side to side

50
Q

3 types of medication which can be used in the treatment of anxiety disorders

A

Anti-D’s, namely SSRIs
B-blockers
Bentos

51
Q

What must clinicians warn pt of when starting them on SSRIs for anxiety

A

Possible brief increase in anxiety in initiation period of mess

52
Q

Mode of action benzos

A

Potentiate GABA - bind to GABAa receptor complex —> increased affinitity of the complex for GABA

53
Q

E.g. of benzo with a shorter t1/2

A

Lorazepam

54
Q

E.g. of benzo with a long t1/2

A

Diazepam

55
Q

Due to addiction, what is the max amount of time benzo’s should be prescribed for

A

4 weeks

56
Q

Indications - benzodiazepines (5)

A 
Insomnia 
Anxiety disorder 
Alcohol withdrawal 
Akathisia
Acute mania/psychosis
57
Q

What is an acute stress reaction

A

Brief response to severely stressful events

58
Q

How long after an event can an acute stress reaction occur?

A

Up to 1 month after

59
Q

Sx acute stress reaction

A

Sx anxiety/depression
Numbness, detachment, poor concentration, insomnia, restlessness, anger, autonomic Sx
Unhelpful coping strategies common

60
Q

Mx acute stress reaction

A 
Reduce emotional response - talk to others 
Encourage but not force, recall 
Learning effective coping skills 
Anxiolytics only if severe 
Hypnotics - severe sleep disturbance
61
Q

What % of those w/ acute stress reaction go on to develop PTSD

A

78%

62
Q

What is Adjustment disorder

A

Psychological reaction to adapting to a new set of circumstances

63
Q

Sx adjustment disorder (5)

A

Sx anxiety, worry, depression, irritability
Physical Sx e.g. palps + tremor
Occasional outbursts dramatic/aggressive behaviour
Abuse alcohol/Dx
Social function impaired

64
Q

Mx adjustment disorder (4)

A

Help resolve change circumstances
Help natural process of adjustment
Relieve anxiety by encouraging to talk
Consider Rx to talking therapy

65
Q

When is bereavement a medical issue?

A

If over 6 months + significantly affecting persons relationships and ability to function

66
Q

Sx bereavement (5)

A 
Poor energy 
Low mood 
Lack of enjoyment 
Disturbed sleep + appetite 
Sx anxiety
67
Q

Sx of abnormal grief (5)

A

Guilt about things other than actions
Thoughts of death other than survivor feeling
Significant psychomotor retardation
Prolonged and serious functional impairment
Hallucinatory experiences (beyond voice or transient images of dead person)

68
Q

What is the core triad for Sx of PTSD

A

Hyperarousal
Re-experiencing
Avoidance

69
Q

Common coping strategy PTSD

A

Substance use

70
Q

Psychological Tx PTSD (3)

A

Psycho education
EMDR
Trauma focused CBT

71
Q

Biological Mx PTSD

A

Anti-D

72
Q

Social Mx PTSD

A

Education for family
SUpport in reintegration into environment
AVOID alcohol

CP2 Psychiatry (15 decks)

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