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Psychiatry > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

What are anxiety disorder?

A

Disorders where anxiety is the main symptom
Feelings of tension, worried thoughts, and physical changes
Recurring intrusive thoughts or concerns

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2
Q

What are the different types of anxiety disorders?

A

Generalised anxiety disorder - persistent anxiety
Mixed anxiety and depressive disorder - equal elements of anxiety and depression
Panic disorder - diagnosed when patient has repeated, sudden attacks of overwhelming anxiety, accompanied by severe physical symptoms
Phobic disorders - fear triggered by a stimulus that are predictable and are normally no concern to others

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3
Q

What are the risk factors for anxiety disorders?

A 
Trauma
Stress
Personality type
Other mental health disorders
Having blood relative with anxiety
Drugs or alcohol
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4
Q

What might the behaviour and appearance of a patient with anxiety be like?

A

Looking apprehensive or fearful, difficulty concentrating, restlessness
Unkempt
Lose fitting clothes if lost weight

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5
Q

What might the speech of someone with anxiety disorder be like?

A

Fast and anxious

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6
Q

What might the emotion of someone with anxiety disorder be like?

A

Mood - apprehension/fear or irritable

Affect - may vary

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7
Q

What might the perception of someone with anxiety disorder be like?

A

Derealisation

Depersonalisation

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8
Q

What might the thoughts of someone with anxiety disorder be like?

A

Worried
Apprehension
Fear
Fast thoughts

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9
Q

How common are anxiety disorders?

A

GAD - 4-6% of population, more common in women
Mixed - 7% prevalence
8% prevalence of phobias

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10
Q

What are the psychiatric differentials of anxiety disorder?

A 
Depressive illness
OCD
Pre-senile dementia
Alcohol dependence
Drug dependence
Benzodiazepine withdrawal
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11
Q

What are the organic differentials of anxiety disorder?

A

Hyperthyroidism
Hypoglycaemia
Phaeochromocytoma
Arrhythmias

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12
Q

What are the physical symptoms of anxiety?

A 
GI
Resp
CVS
GU
Nervous system
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13
Q

What are the GI symptoms of anxiety?

A 
Dry mouth
Difficulty swallowing
Epigastric discomfort
Aeophagy
Diarrhoea
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14
Q

What are the resp symptoms of anxiety?

A

Feeling of chest constriction
Difficulty inhaling
Over-breathing
Choking

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15
Q

What are the CVS symptoms of anxiety?

A

Palpitations
Awareness of missed beats
Chest pain

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16
Q

What are the GU symptoms of anxiety?

A

Increased frequency
Failure of erection
Lack of libido

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17
Q

What are the nervous symptoms of anxiety?

A 
Fatigue
Blurred vision
Dizziness
Sensitivity to noise and/or light 
Headache
Sleep disturbance
Trembling
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18
Q

What are the psychological symptoms of anxiety?

A 
Apprehension and fear
Irritability
Difficulty concentrating
Distractibility
Restlessness
Depersonalisation
Derealisation
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19
Q

What investigations are done for someone with anxiety?

A 
Physical examination
History
FBC, U&E, serum creatinine, eGFR
ESR/CRP
TSH
Serum cortisol
Kidney USS
Afrenaline in blood and urine tests
Glucose levels, HbA1c
CXR
ECG
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20
Q

What is the biological management of anxiety?

A

Benzodiazepines
SSRIs
Anti-psychotics
Beta-blockers

21
Q

What is the psychological management of anxiety?

A 
Relaxation techniques
Anxiety management
CBT
Biofeedback
Behavioural therapies - graded exposure
22
Q

What is the social management of anxiety?

A

Financial - eligible benefits, debt counselling
Employment - acquiring or changing a job or career
Housing - adequate, secure tenancy, safe social neighbours
Young children - childcare support

23
Q

What is OCD?

A

Frequent obsessive thoughts and compulsive behaviours

24
Q

What are the different types of OCD?

A

Contamination - obsession over contracting illness/spreading germs, causes serious anxiety and distress, excessive washing/avoiding crowded spaces
Perfection - overwhelming fear of making mistakes, intense need for things to be perfect or done right, may or may not be accompanied by fear that harm will come to oneself or others if things aren’t done perfectly
Doubt/harm - aggressive, intrusive thoughts of violence to someone and the responses the person uses to cope with these thoughts
Forbidden thoughts - intrusive thoughts about the possibility of harming yourself or others, disturbing thoughts involving sex/religion

25
Q

What questions is it important to ask in the history?

A

Are there thoughts that you have a need to act on?
Thought content?
Frequent unwanted thoughts that seem uncontrollable?
Do you try and get rid of these thoughts and if so what do you do?
Do you wash or clean a lot?
Do you keep checking things repeatedly?
Are you concerned with symmetry and putting things in order?
Do your daily activities take a long time to complete?
Do these problems trouble you?
Does this behaviour make sense to you?
Rituals/repetitive behaviour?

26
Q

What are the risk factors for OCD?

A 
Older teens/young adult
Family history
Presence of another mental illness
Paediatric autoimmune neuropsychiatric disorders
Stress
Pregnancy and postpartum period
27
Q

How common is OCD?

A

Affects over 2% of population
50% of all cases are severe
Less than a quarter are mild cases
Gradual onset

28
Q

What could be the differential diagnoses of OCD?

A

Depression
Anxiety
Hypochondriasis

29
Q

How does OCD present?

A

Obsessions
Emotions
Compulsions

30
Q

How do obsessions present in OCD?

A

Unwanted, intrusive and often distressing thoughts, images, or urges repeatedly entering your mind

  • Fear of deliberately harming yourself or others
  • Fear of harming yourself or others by mistake
  • Fear of contamination by disease, infection, or unpleasant substance
31
Q

How do emotions present in OCD?

A

Feeling of intense anxiety/distress

32
Q

How do compulsions present in OCD?

A

Repetitive behaviours/mental acts a person with OCD feels driven to perform as a result of anxiety and distress

  • Cleaning and hand washing
  • Checking
  • Counting
  • Ordering and arranging
  • Hoarding
  • Asking for reassurance
  • Repeating words in their head
  • Thinking neutralising thoughts to counter obsessive thoughts
  • Avoiding places and situations that could trigger obsessive thoughts
33
Q

What is the pathology of OCD?

A

Dopamine-serotonin imbalance

Disturbed basal ganglia regulation

34
Q

What are the NICE diagnostic questions for OCD?

A

Do you wash or clean a lot?
Do you check things a lot?
Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
Do your activities take a long time to finish?
Are you concerned about putting things in a special order or are you very upset by mess?
Do these problems trouble you?

35
Q

What is the management of OCD?

A

Psychological therapy - CBT with exposure and response prevention
Antidepressants - SSRIs/clomipramine
Support groups
Psychoeducation

36
Q

What is the prognosis of OCD?

A

15% show progressive worsening of symptoms or deterioration in functioning over time
5% have complete remission of symptoms between episodes of exacerbation

37
Q

What is PTSD?

A

Type of anxiety disorder occurring in people who have experiences or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape of who have been threatened with death, sexual violence, or serious injury

38
Q

What are the different types of PTSD?

A 
Normal stress response
Acute stress disorder
Uncomplicated PTSD
Complex PTSD
Co-morbid PTSD
39
Q

What are the risk factors for PTSD?

A

Living through dangerous events and traumas
Getting hurt
Seeing another person hurt, or seeing a dead body
Childhood trauma
Feeling horror, helplessness, or extreme fear
Having little or no social support after the event
Dealing with extra stress after the event such as a loss of a loved one, pain, injury, or loss of a job or home
Having a history or mental illness or substance abuse

40
Q

How common is PTSD?

A

Can occur in all people of any ethnicity, nationality, or culture and at any age
Affects approximately 3.5% of adults every year
1 in 11 diagnosed with PTSD in lifetime
Women x2 likely to have it as men

41
Q

Name 3 differential diagnoses of PTSD

A 
Acute stress disorder
Dissociation disorders
Depression
GAD
Panic disorder
Phobias
Substance abuse
Psychiatric manifestation of medical conditions
42
Q

How does PTSD present?

A

Re-experiencing symptoms
Avoidance symptoms
Arousal or reactivity symptoms
Cognition and mood symptoms

43
Q

Give an example of re-experiencing symptoms

A

Flashbacks
Reoccurring memories or nightmares related to the event
Distressing and intrusive thoughts or images
Physical sensations like sweating, trembling, pain, or feeling sick

44
Q

Give examples of avoidance symptoms

A

Staying away from places, events, or objects that are reminders of experience
Feeling that you need to keep yourself busy all the time
Using alcohol or drugs to avoid memories
Feeling emotionally numb or cut off from your feelings
Feeling numb or emotionally detached from you body
Being unable to remember details of the trauma

45
Q

Give examples of arousal and reactivity symptoms

A

Being jumpy and easily startled
Feeling tense, on guard, or on edge
Having difficulty concentrating on even simple and everyday tasks
Having difficulty falling asleep or staying asleep
Feeling irritable and having angry and aggressive outbursts
Self-destructive or reckless behaviour

46
Q

Give examples of cognition and mood symptoms

A

Trouble remembering key features of the traumatic event
Feeling like you can’t trust anyone
Distorted thoughts about the trauma that causes feelings of blame and guilt
Overwhelming negative emotions, such as fear, sadness, anger, guilt, or shame
Loss of interest in previous acitivites
Feeling like no-where is safe
Difficulty feeling positive emotions such as happiness or satisfaction

47
Q

What is the pathology of PTSD?

A

Hyperactivity of sympathetic branch of the autonomic nervous system as evidenced by changes in HR, BP, skin conductance level, and other psychophysiological measures
Elevated noradrenergic reactivity to pharmacological challenges

48
Q

What investigations should you do with someone who has PTSD?

A

Bloods

49
Q

What is the management of PTSD?

A 
Trauma focussed CBT
EMDR
Psychoeducation
Prolonged exposure therapy
Medication
- Venlafaxine or SSRIs - peroxitine or sertraline
- Anti-psychotics - risperidone

Psychiatry (15 decks)

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