Anxiety Disorders and Reaction to stress and trauma Flashcards
what are the features of pathological anxiety
1) Autonomy - no environmental trigger
2) Intensity - beyond capacity to bear discomfort
3) Duration - persistence is bad
4) Behaviour - impairs function
What are the classifications of anxiety disorders
Generalised Anxiety Disorder Panic Disorder PTSD OCD Phobias
What is the most prevalent psychiatric disorder
Anxiety (11%)
How does anxiety present - Physically and psychologically
Physical: dry mouth Diarrhoea Difficulty breathing palpitations chest tightness frequent/urgent micturition
Psychological: night terrors worrying thoughts irritability noise sensitivity
what are some features of generalised anxiety disorders
free-floating anxiety not tied down to individual situations
leads to risk-averse behaviour
could be paralyzed by fear
What is the ICD-10 diagnostic criteria for Generalised Anxiety Disorder
Persistent and generalised somatic and psychological symptoms of anxiety for several weeks/months present most days for most of the time
symptoms include:
apprehension
motor tension
autonomic overactivity
what are some features of panic disorder
Unpredicatable attacks of severe anxiety
Palpitations, choking, chest pain, dizziness common
Often lose touch with reality temporarily and have catastrophic cognitions (i.e think they’re gonna die)
<10 min duration
what may frequent panic disorder attacks lead to
agoraphobia
what is the ICD-10 criteria for panic disorder
several attacks in 1 month
must be in circumstances of no objective danger
not confined to predictable situations
freedom from anxiety symptoms between attacks
What is agoraphobia
fear of public/crowded/far from home places
what is the common theme of agoraphobia
lack of exit
what is the ICD-10 criteria for agoraphobia diagnosis
psychological and autonomic symptoms, primarily manifestations of anxiety m not secondary to other symptoms
anxiety must be restricted to 2 of the following - crowds, public places, travelling alone, travelling away from home
avoidance must be prominent
What is the definition of social phobia
marked fear of being the center of attention, embarrassment/humiliation
What is the ICD-10 diagnostic criteria for social phobia
Psychological, behavioural or autonomic symptoms primarily manifested through anxiety and not secondary to other disorders
Anxiety must be restricted to particular social situations
Phobic situations to be avoided when possible
What are some common specific phobias
insects birds heights flying blood dentists needles hospital
what are some features of OCD
obsessive thoughts/impulses +/- compulsive acts/rituals on most days for at least 2 weeks
when is OCD most common, and what is the mean onset of age
childhood, OCD
what frequently coexist with OCD
Tourettes
Schizophrenia
Depression
what are OCD obsessions defined as
thoughts/images that are:
excessive repetitive intrusive/resisted by pt unpleasant original in own mind (no thought insertion) interfere with functioning
What are OCD compulsions defined as
a physical act that is:
excessive/unreasonable repetitive Anxiety Inducing from Patients mind Interferes with functioning intrusive and resisted Pt magical thinking may occur - "if i can touch door frame 5x nothing bad can happen to my family"
What are common comorbidities for anxiety disorders
depression
drug/alcohol misuse
personality disorders
anxiety symptoms secondary to organic pathology
What drugs are typically used when treating anxiety
antidepressants (longer term)
benzodiazepines (shorter term)
beta blockers (symptom relief)
sometimes antipsychotics
what is always the first-line treatment for anxiety
psychological intervention
whats an important point to tell patients starting antidepressants for anxiety
it may increase anxiety initially
what benzodiazepines have shorter and longer half lives
lorazepam = short half life
diazepam = long half life
what time period should benzos be used for and why
<4 weeks as they are very addicitive, and sometimes reduce the efficacy of psychological intervention
what is EMDR
eye movement densitisation reprocessing - used for PTSD
a patient must recount experiences in as much detail as possible whilst being fixed on a finger being waved in front of them
alongside a psychologist will explore the feelings around the event and promote some rationalisation and cognitive awarenes
what should EMDR be used for
NON-COMBAT PTSD
what should be used for combat reated PTSD
trauma-focused CBT
What is the NICE stepped care guidelines for anxiety disorders
STEP 1 - all known/suspected presentations
psychoeducation
active monitoring
STEP 2 - step 1 fails
guided self help
low intensity psychological interventions
STEP 3 - step 2 fails/functional impairment
CBT
primary care drug treatment
STEP 4 - complex/treatment refractory
secondary care referral
MDT
what normal fears exist in 0-6 month olds
loud noses
rapid position change
loss of physical support
rapidly approaching objects
what normal fears exist in 7-12 month olds
strangers
looming objects
surprise people/objects
what normal fears exist in 1-5 year olds
strangers storms animals dark separation from parents objects machines loud noises toilet
what normal fears exist in 6-12 year olds
supernatural bodily injury burglars disease failure critisism punishment
what normal fears exist in 13-18 year olds
school performance
peer scrutiny
what is an acute stress reaction
disorder on the spectrum of PTSD but not as severe
brief response to severely stressful events, roughly 3 days to 1 month after the event
most people experience at least one in their life
what indicates a worse prognosis for acute stress reactions
seeking mental professional help (indicates worse social support)
what are some symptoms of acute stress reactions
anxiety/depression numbness/detachment decreased concentration insomnia restlessness anger autonomic symptoms
how do you manage an acute stress reaction
encourage talking to family/friends/professionals
encourage recall (dont repress/forget it)
learn effective coping skills
anxiolytic (AD benzo, BB antipsych) IF SEVERE
hypnotics if sleep disturbed
how many people that are formally diagnosed progress to PTSD
78% (however the majority aren’t formally diagnosed)
what is an adjustment disorder
psychological adaptation to a new set of social circumstances occurring <3 months from the new event
what are some symptoms of an adjustment order
anxiety/depression
occasional outbursts
substance abuse
impaired social functioning
what is the management of an adjustment disorder
resolve circumstances if possible
encourage to talk about feelings to prevent avoidance/denial
prevent medication whenever possible
consider talking therapy
prognosis of adjustment disorders
few months - few years duration
adults do well
adolescents have an increased risk of developing a psychiatric illness later in life
when are bereavement reactions considered abnormal
> 6 months and severely affecting patients ability to fuction
what are some usual symptoms of bereavement
anergy decreased mood anhedonia disturbed sleep/appetite anxiety
what are some abnormal grief symptoms - that still can present normally
guild
survivor guilt (feel as if they should have died too)
morbid worthlessness
psychomotor retardation
prolonged/serious functional impairment
hallucinatory experiences - quite common and completely normal
what is the definition of PTSD
delayed protracted response to a stressful event that would cause pervasive distress to almost anyone
when do symptoms typically present themselves with PTSD
normally a few weeks to a few months after the event
how do you differ an acute stress reaction to PTSD
symptoms must be present >6 months from the event for PTSD
apart from symptoms occuring a few weeks after a primary trauma, what is another method that PTSD may come from
a secondary trauma may ‘awaken’ memories of the primary trauma
what is the lifetime prevalence of PTSD
5-10%
what is the prevalence of PTSD in domestic abuse victims
45%
symptoms of PTSD
core triad of:
1) hyperarousal
2) re-experiencing
3) avoidance
Other symptoms:
depression/guilt
substance abuse
management of PTSD
BIO
SSRI or Venlafaxine (SNRI)
PSYCHO
CBT (trauma focused)
EMDR
Psychoeducation
SOCIAL Educate family avoid alcohol reintegration support
Prognosis of PTSD
50% recover within 1 year
poor prognosistic indicators for PTSD
Family History of mental illness comorbid mental illness long duration poor social support poor pre-morbid function
what % of soldiers return to active sevice ater PTSD
80%
differentials for anxiety symptoms
Endocrine (thyroid, phaecytochroma)
metabolic (acidosis, hyper/hypothermia)
hypoxia (CCF, asthma, angina, anaemia. COPD)
eurological (seizures, vestibular dysfunction, cardiac arrythmia, drug withdrawal, drug intoxication)
