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Psychiatry > Anxiety Disorders and Reaction to stress and trauma > Flashcards

Anxiety Disorders and Reaction to stress and trauma Flashcards

1
Q

what are the features of pathological anxiety

A

1) Autonomy - no environmental trigger
2) Intensity - beyond capacity to bear discomfort
3) Duration - persistence is bad
4) Behaviour - impairs function

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2
Q

What are the classifications of anxiety disorders

A 
Generalised Anxiety Disorder 
Panic Disorder
PTSD
OCD
Phobias
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3
Q

What is the most prevalent psychiatric disorder

A

Anxiety (11%)

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4
Q

How does anxiety present - Physically and psychologically

A 
Physical:
dry mouth
Diarrhoea
Difficulty breathing
palpitations
chest tightness
frequent/urgent micturition
Psychological:
night terrors
worrying thoughts
irritability 
noise sensitivity
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5
Q

what are some features of generalised anxiety disorders

A

free-floating anxiety not tied down to individual situations

leads to risk-averse behaviour

could be paralyzed by fear

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6
Q

What is the ICD-10 diagnostic criteria for Generalised Anxiety Disorder

A

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

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7
Q

what are some features of panic disorder

A

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

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8
Q

what may frequent panic disorder attacks lead to

A

agoraphobia

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9
Q

what is the ICD-10 criteria for panic disorder

A

several attacks in 1 month

must be in circumstances of no objective danger

not confined to predictable situations

freedom from anxiety symptoms between attacks

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10
Q

What is agoraphobia

A

fear of public/crowded/far from home places

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11
Q

what is the common theme of agoraphobia

A

lack of exit

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12
Q

what is the ICD-10 criteria for agoraphobia diagnosis

A

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

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13
Q

What is the definition of social phobia

A

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

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14
Q

What is the ICD-10 diagnostic criteria for social phobia

A

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

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15
Q

What are some common specific phobias

A 
insects
birds
heights
flying
blood
dentists
needles
hospital
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16
Q

what are some features of OCD

A

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

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17
Q

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

A

childhood, OCD

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18
Q

what frequently coexist with OCD

A

Tourettes
Schizophrenia
Depression

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19
Q

what are OCD obsessions defined as

A

thoughts/images that are:

excessive 
repetitive
intrusive/resisted by pt
unpleasant
original in own mind (no thought insertion) 
interfere with functioning
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20
Q

What are OCD compulsions defined as

A

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"
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21
Q

What are common comorbidities for anxiety disorders

A

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

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22
Q

What drugs are typically used when treating anxiety

A

antidepressants (longer term)

benzodiazepines (shorter term)

beta blockers (symptom relief)

sometimes antipsychotics

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23
Q

what is always the first-line treatment for anxiety

A

psychological intervention

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24
Q

whats an important point to tell patients starting antidepressants for anxiety

A

it may increase anxiety initially

25
Q

what benzodiazepines have shorter and longer half lives

A

lorazepam = short half life

diazepam = long half life

26
Q

what time period should benzos be used for and why

A

<4 weeks as they are very addicitive, and sometimes reduce the efficacy of psychological intervention

27
Q

what is EMDR

A

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

28
Q

what should EMDR be used for

A

NON-COMBAT PTSD

29
Q

what should be used for combat reated PTSD

A

trauma-focused CBT

30
Q

What is the NICE stepped care guidelines for anxiety disorders

A

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

31
Q

what normal fears exist in 0-6 month olds

A

loud noses
rapid position change
loss of physical support
rapidly approaching objects

32
Q

what normal fears exist in 7-12 month olds

A

strangers
looming objects
surprise people/objects

33
Q

what normal fears exist in 1-5 year olds

A 
strangers
storms
animals
dark
separation from parents
objects
machines
loud noises
toilet
34
Q

what normal fears exist in 6-12 year olds

A 
supernatural
bodily injury 
burglars
disease
failure
critisism
punishment
35
Q

what normal fears exist in 13-18 year olds

A

school performance

peer scrutiny

36
Q

what is an acute stress reaction

A

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

37
Q

what indicates a worse prognosis for acute stress reactions

A

seeking mental professional help (indicates worse social support)

38
Q

what are some symptoms of acute stress reactions

A 
anxiety/depression 
numbness/detachment 
decreased concentration
insomnia
restlessness
anger
autonomic symptoms
39
Q

how do you manage an acute stress reaction

A

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

40
Q

how many people that are formally diagnosed progress to PTSD

A

78% (however the majority aren’t formally diagnosed)

41
Q

what is an adjustment disorder

A

psychological adaptation to a new set of social circumstances occurring <3 months from the new event

42
Q

what are some symptoms of an adjustment order

A

anxiety/depression
occasional outbursts
substance abuse
impaired social functioning

43
Q

what is the management of an adjustment disorder

A

resolve circumstances if possible
encourage to talk about feelings to prevent avoidance/denial
prevent medication whenever possible
consider talking therapy

44
Q

prognosis of adjustment disorders

A

few months - few years duration
adults do well
adolescents have an increased risk of developing a psychiatric illness later in life

45
Q

when are bereavement reactions considered abnormal

A

> 6 months and severely affecting patients ability to fuction

46
Q

what are some usual symptoms of bereavement

A 
anergy
decreased mood
anhedonia 
disturbed sleep/appetite
anxiety
47
Q

what are some abnormal grief symptoms - that still can present normally

A

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

48
Q

what is the definition of PTSD

A

delayed protracted response to a stressful event that would cause pervasive distress to almost anyone

49
Q

when do symptoms typically present themselves with PTSD

A

normally a few weeks to a few months after the event

50
Q

how do you differ an acute stress reaction to PTSD

A

symptoms must be present >6 months from the event for PTSD

51
Q

apart from symptoms occuring a few weeks after a primary trauma, what is another method that PTSD may come from

A

a secondary trauma may ‘awaken’ memories of the primary trauma

52
Q

what is the lifetime prevalence of PTSD

A

5-10%

53
Q

what is the prevalence of PTSD in domestic abuse victims

A

45%

54
Q

symptoms of PTSD

A

core triad of:

1) hyperarousal
2) re-experiencing
3) avoidance

Other symptoms:
depression/guilt
substance abuse

55
Q

management of PTSD

A

BIO
SSRI or Venlafaxine (SNRI)

PSYCHO
CBT (trauma focused)
EMDR
Psychoeducation

SOCIAL 
Educate family
avoid alcohol
reintegration 
support
56
Q

Prognosis of PTSD

A

50% recover within 1 year

57
Q

poor prognosistic indicators for PTSD

A 
Family History of mental illness
comorbid mental illness
long duration 
poor social  support
poor pre-morbid  function
58
Q

what % of soldiers return to active sevice ater PTSD

A

80%

59
Q

differentials for anxiety symptoms

A

Endocrine (thyroid, phaecytochroma)

metabolic (acidosis, hyper/hypothermia)

hypoxia (CCF, asthma, angina, anaemia. COPD)

eurological (seizures, vestibular dysfunction, cardiac arrythmia, drug withdrawal, drug intoxication)

Psychiatry (13 decks)

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