Anxiety Disorders Flashcards
1
Q
Why is some anxiety normal
A
Normal adaptive response to stressful situations i.e fight or flight
2
Q
What are the 4 domains used to differentiate normal and pathological anxiety?
A
Autonomy
Intensity
Duration
Behaviour
3
Q
Normal developmental fears: birth - 6months (4)
A
Loud noises
Loss of physical support
Rapid position changes
Rapidly approaching other objects
4
Q
Normal developmental fears: 7-12 months (4)
A
Strangers
Looming objects
Unexpected objects
Unfamiliar people
5
Q
Normal developmental fears: 1-5 years
A
Strangers Storms Animals Dark Parent separation Objects Machines/loud noises Toilet
6
Q
Normal developmental fears: 6-12 years
A
Supernatural Body injury Disease Burglars Failure Criticism Punishment
7
Q
Normal developmental fears: 12-18 years
A
School performance
Peer scrutiny
Appearance
8
Q
Prevelance panic disorder
A
around 2%
9
Q
Prevelance OCD
A
2.5%
10
Q
Prevenlance PTSD
A
3.5%
11
Q
Prevelance GAD
A
3%
12
Q
What is PTSD
A
Delayed response to a stressful event of an exceptionally threatening or catastrophic nature
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
14
Q
What % of females who have suffered from domestic violence have PTSD
A
45%
15
Q
What % PTSD recover in 1 year
A
50%
16
Q
Factors suggesting poor prognosis PTSD (5)
A
Mental illness Long duration FHx mental illness poor social support Pre-morbid fct
17
Q
Sx of anxiety - psychological arousal (6)
A
worrying thoughts irritability sensitivity to noise restlessness fearful anticipation poor [ ]
18
Q
Sx anxiety - autonomic arousal (6)
A
Dry mouth Diarrhoea Difficulty breathing Palps Chest discomfort Freq + urgent micturition
19
Q
Def GAD
A
Free floating anxiety that may fluctuate but neither situational nor episodic
20
Q
What 3 elements are present in GAD
A
Apprehension
Motor tension
Autonomic overactivity
21
Q
Def Panic disorder
A
Recurrent attacks of severe anxiety, not restricted to any particular situation, therefore unpredictable
22
Q
Sx Panic disorder(6)
A
Palps Choking Chest pain Dizziness Loss of touch w/ reality Generally anxiety Sx free between attacks
23
Q
How long do panic attacks last
A
<10mins
24
Q
Def Agoraphobia
A
Fear of avoidance of crowds, public places, travelling alone, travelling away from home
25
What is always present in agoraphobia
Avoidance
26
Def Social phobia
Fear of being focus of attention, of embarrassment or humiliation
27
Sx social phobia (4)
Blushing/shaking
Fear of vomiting
Urgency/fear of micturition
AVOIDANCE
28
Most common isolated specific phobias
```
Animals
Birds
Insects
Heights
Thunder
Flying
Small enclosed spaces
Sight of blood/injury/injections/dentists/hospitals
```
29
Def OCD
Disorder characterised by obsessive Sx +/or compulsive acts rituals
Present on most days for at least 2 weeks
--> distress + interfering w/ activities
30
M:F OCD
M=F
31
Mean onset of Sx to diagnosis OCD
9 years
32
Which other MH conditions does OCD frequently co-exist with? (3)
Schizophrenia
Tourettes
Depression
33
Ego-syntonic Sx
Sx to not usually distress the patient
34
Ego-dystonic Sx
Sx cause distress to pt
| Hence in OCD
35
What is a rumination
Repeatedly thinking about the causes and experience of previous distress + difficulties
Voluntary, not resisted
36
What are obsessions
```
Thoughts, ideas which are acknowledged as excessive or unreasonable
Repetitive
Intrusive + resisted by pt
Unpleasant
Originate in mind of pt
Cause distress
```
37
What are compulsions
Physical act which = acknowledged as excessive/ unreasonable
Repetitive
Intrusive + resisted by pt
Unpleasant
Desire to carry out act is from mind of pt
38
What is magical thinking?
If i touch this door 5 times , no harm will come to my family
39
DDx anxiety disorder (7)
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
How do pt manage their own anxiety?
Avoidance + safety behaviours
41
Anxiety Mx - step care approach - Step 1:
All known + suspected PS anxiety
| Psychoeducation + active monitoring
42
Anxiety Mx - step care approach - Step 2:
No improvement after step 1
Guided self-help + low intensity psycho interventions
IAPT
43
Anxiety Mx - step care approach - Step 3
Inadequate response to step 2/marked functional impairment
High intensity psycho intervention (CBT)
Or Dx Tx in 1' care
44
Anxiety Mx - step care approach - Step 4:
Complex Tx refractory
| Rx to 2' care
45
What is done in psychoeducation
Pts knowledge + awareness of illness is improved
| Improves understanding + support pt haves + receives
46
What is systematic desensitisation or graded exposure
```
For phobia
Involves ID'd fear
Setting Tx aims in steps
Starting w/ situations causing milder anxiety
Req repeated exposure to stimuli
```
47
What is flood exoopsure
Pt instantly exposed to highest level of anxiety heirarchy until anxiety diminishes
48
Exposure + response prevention therapy
For OCD
Pt encouraged to ressit carrying out compulsions until urge diminishes
THen exposed to> severe compulsion evoking situations
49
What is EMDR
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
3 types of medication which can be used in the treatment of anxiety disorders
Anti-D’s, namely SSRIs
B-blockers
Bentos
51
What must clinicians warn pt of when starting them on SSRIs for anxiety
Possible brief increase in anxiety in initiation period of mess
52
Mode of action benzos
Potentiate GABA - bind to GABAa receptor complex —> increased affinitity of the complex for GABA
53
E.g. of benzo with a shorter t1/2
Lorazepam
54
E.g. of benzo with a long t1/2
Diazepam
55
Due to addiction, what is the max amount of time benzo’s should be prescribed for
4 weeks
56
Indications - benzodiazepines (5)
```
Insomnia
Anxiety disorder
Alcohol withdrawal
Akathisia
Acute mania/psychosis
```
57
What is an acute stress reaction
Brief response to severely stressful events
58
How long after an event can an acute stress reaction occur?
Up to 1 month after
59
Sx acute stress reaction
Sx anxiety/depression
Numbness, detachment, poor concentration, insomnia, restlessness, anger, autonomic Sx
Unhelpful coping strategies common
60
Mx acute stress reaction
```
Reduce emotional response - talk to others
Encourage but not force, recall
Learning effective coping skills
Anxiolytics only if severe
Hypnotics - severe sleep disturbance
```
61
What % of those w/ acute stress reaction go on to develop PTSD
78%
62
What is Adjustment disorder
Psychological reaction to adapting to a new set of circumstances
63
Sx adjustment disorder (5)
Sx anxiety, worry, depression, irritability
Physical Sx e.g. palps + tremor
Occasional outbursts dramatic/aggressive behaviour
Abuse alcohol/Dx
Social function impaired
64
Mx adjustment disorder (4)
Help resolve change circumstances
Help natural process of adjustment
Relieve anxiety by encouraging to talk
Consider Rx to talking therapy
65
When is bereavement a medical issue?
If over 6 months + significantly affecting persons relationships and ability to function
66
Sx bereavement (5)
```
Poor energy
Low mood
Lack of enjoyment
Disturbed sleep + appetite
Sx anxiety
```
67
Sx of abnormal grief (5)
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
What is the core triad for Sx of PTSD
Hyperarousal
Re-experiencing
Avoidance
69
Common coping strategy PTSD
Substance use
70
Psychological Tx PTSD (3)
Psycho education
EMDR
Trauma focused CBT
71
Biological Mx PTSD
Anti-D
72
Social Mx PTSD
Education for family
SUpport in reintegration into environment
AVOID alcohol
