Anxiety disorders - BB Flashcards
Three system model - conceptualisation of panic disorder
- Thoughts
- Feelings
- Behaviour
PTSD diagnosis features
- Re-experiencing - flashbacks, nightmares, reptitive distressing images
- Avoidance - avoiding people or situations, or circumstances resembling event
- Hyperarousal - hypervigilence to threat, exaggerated startle response, sleep problems, irritability, difficulty concentrating
- Emotional numbing - lack ability to experience feelings, feeling detached
Secondary psychological disorders that are at increased risk of developing after PTSD
- Depression
- Drugs and alcohol misuse
- Panic disorder
- Somatisation
- Other anxiety disorder
Management of PTSD
- Watchful waiting if lasted less than 4 weeks
- Military personal have access to treatment via armed forces
Psychological:
* Trauma focused CBT
* Eye movement desensitisation and reprocessing
Pharmacological:
* Not routine
* Venlafaxine or SSRI
* Risperidone if necessary
Classic generic model of panic - Clark model
- Trigger stimulus (internal or external) causes perceived threat
- Cycles into apprehension
- Body sensations
- Interpretation of sensations as catastrphic
- And cycles round
Key thing that characterises panic disorder
- Catastrophic cognition - eg I am going to die, lose control and go crazy etc
Key features clinical depression
- Anhedonia
- Low mood
- Lack energy - one most days, for 2 weeks
Depression differentials
Differentials:
* Hypothyroidism - weight gain, dry hair/skin, nails breaking
* Bipolar affective disorder - any periods of euphoric mood? Feeling like can get lots done? Lots of energy?
* Depression with psychosis - ever see or hear things that other people can’t? delusions eg poverty, nihilism, guilt
* Anxiety - worry, preoccupation and checking
* Substance misuse disorder
* Organic disorder
Other symptoms of depression to cover
- Appetite - including weight changes
- Sleep
- Diurnal mood variation
- Libido change
- Focus and concentration
- Guilt
- Self harm
- Unusual or concerning ideas
- Unusual behaviour or experiences - delusions, hallucinations
What else to ensure cover in low mood history?
- Timescale
- Functional impairment
- RISK - self harm/suicide
- Collateral history
- Previous psychiatric history
- PMH
- DH
- FH - psychiatric disorders
- SH
- Personal history
- DONT FORGET ICE
Common side effects fluoxetine
- GI disturbance
- Headaches
- Dry mouth
- Dizziness
- Sexual dysfunction - diffiuclty achieveing orgasm and arousal
- Bleeding
- Suicidal ideation
Time required for fluoxetine benefit
2-3 weeks, often give it 4
Differentials for ?OCD
- Anxiety
- Normal reaction - any real life stressors that could cause this response?
- Psychotic dimension to depression
Core features OCD
- Obsessions - persistent ideas, images or impulses that enters mind that is distressing for patient. enters mind over and over again
- Compulsion - repetitive actions that ease the distress that the obsession cause by to prevent the unlikely event involved in obsession
Can people develop compulsions without obsessions and vice versa?
Yes - predominantly obsessional thoughts or ruminations
* Ideas, images or impulses which are nearly always distressing to subject
* Can cause inability to make trivial decisions in day to day
Predominatly compulsive acts (obessional rituals)
* Often cleaning related
* Underlying cause is fear - try to avert danger
Management options for OCD
Watchful waiting if not severe
Psychological:
* Referral for exposure and response prevention
* Allocation of CPN
* Psychoeducation - inc online resouces eg OCD-UK
Biological:
* SSRI - high dose
* Clomipramine
Class of Clomipramine
Tricyclic antidepressant
Side effects Clomipramine
- Similar to SSRI
- Can cause sedation - caution with driving and machinery use
Can you offer clomipramine if risk of suicide?
- No - much more toxic than SSRI in overdose (cardiotoxic)
- If indication for use is trong, consider offering short repeat prescriptions and ensure safety plans robust
Type of psychotherapy for OCD
- CBT
- Exposure and reponse prevention
NICE guidelines OCD
Low intensity treatments to begin with:
* Brief individual CBT + structured self help - including ERP
* Brief individual CBT via telephone - including ERP
* Group CBT - including ERP
If mild functional impairement unable to engage in low intensity CBT/inadequate response:
* SSRI or more intensive CBT (inc ERP)
Moderate functional impairemnt:
* SSRI or more instensive CBT
Severe functional impairement
* SSRI and CBT (inc ERP) combined
Ever need for patients with OCD to be hospitalised?
- Depends on nature and degree of illness, treatment available in hospital, degree of impairement and risk
- Sometimes need setting for focused OCD treatment
- Sometimes impairement of self care
- Risk to self high
- Risk to others - rare
What do patients typically do with repeitive thoughts in OCD?
- Try and resist them
- Then they give in and act to relieve tension and anxiety
- When resisted, anxiety gets worse
What forms can obsessions come as?
- Thoughts
- Images
