Anxiety Disorders and Reaction to stress and trauma Flashcards by Hugh Janus

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

How well did you know this?

Not at all

Perfectly

What are the classifications of anxiety disorders

Generalised Anxiety Disorder 
Panic Disorder
PTSD
OCD
Phobias

How well did you know this?

Not at all

Perfectly

What is the most prevalent psychiatric disorder

Anxiety (11%)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

what may frequent panic disorder attacks lead to

agoraphobia

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is agoraphobia

fear of public/crowded/far from home places

How well did you know this?

Not at all

Perfectly

what is the common theme of agoraphobia

lack of exit

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is the definition of social phobia

marked fear of being the center of attention, embarrassment/humiliation

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are some common specific phobias

insects
birds
heights
flying
blood
dentists
needles
hospital

How well did you know this?

Not at all

Perfectly

what are some features of OCD

obsessive thoughts/impulses +/- compulsive acts/rituals on most days for at least 2 weeks

How well did you know this?

Not at all

Perfectly

when is OCD most common, and what is the mean onset of age

childhood, OCD

How well did you know this?

Not at all

Perfectly

what frequently coexist with OCD

Tourettes
Schizophrenia
Depression

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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"

How well did you know this?

Not at all

Perfectly

What are common comorbidities for anxiety disorders

depression
drug/alcohol misuse
personality disorders
anxiety symptoms secondary to organic pathology

How well did you know this?

Not at all

Perfectly

What drugs are typically used when treating anxiety

antidepressants (longer term)

benzodiazepines (shorter term)

beta blockers (symptom relief)

sometimes antipsychotics

How well did you know this?

Not at all

Perfectly

what is always the first-line treatment for anxiety

psychological intervention

How well did you know this?

Not at all

Perfectly

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)