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Psychiatry > Anxiety Disorders - General > Flashcards

Anxiety Disorders - General Flashcards

1
Q

What are some common physical symptoms of anxiety?

A

Palpitations and raised HR, difficulty breathing/chest pain, ‘lump in the throat’, lightheadedness, numbness/tingling, shaking

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2
Q

One of the cognitive features of anxiety is derealisation - what is this?

A

The feeling that objects are unreal

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3
Q

One of the cognitive features of anxiety is depersonalisation - what is this?

A

Feeling like the self is distant or not really here

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4
Q

One of the cognitive features of anxiety is meta-worry - what is this?

A

Worrying about everything, and then worrying about worrying

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5
Q

In terms of everyday lifestyle, people suffering from anxiety have a preference for what?

A

Order and routine

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6
Q

What are some examples of behavioural symptoms of anxiety?

A

Avoiding certain situations, exaggerated responses, difficulty sleeping, excessive drug/alcohol use, restlessness, irritability

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7
Q

In the stress response, exposure to stress results in what?

A

Instantaneous and concurrent biological responses to assess the danger and organise an appropriate response

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8
Q

What structure of the brain acts as the emotional filter for assessing whether sensory material requires a stress or fear response?

A

The amygdala

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9
Q

What is the end goal of the stress response?

A

Stimulation of the adrenal glands to release cortisol

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10
Q

Why is it dangerous to always have a fight or flight response?

A

Cortisol levels will be chronically high which is to some extent neurotoxic

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11
Q

What does it mean if an anxiety disorder is in extent?

A

Anxiety is more extreme than normal

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12
Q

What does it mean if an anxiety disorder is in context?

A

There is anxiety in response to situations that are not normally anxiety provoking

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13
Q

What is generalised anxiety disorder?

A

Anxiety that is generalised and persistent, and not restricted to any particular environmental circumstances

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14
Q

When do people with GAD worry?

A

Most of the time, even when there is nothing to worry about

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15
Q

People with GAD often have fears of what?

A

Themselves or family members becoming ill soon or involved in an accident

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16
Q

GAD needs to be severe enough before it is properly diagnosed. What qualifies this?

A

Long lasting, most days for at least 6 months, not controllable and causing significant distress/impairment in function

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17
Q

What is the typical age of onset of GAD?

A

20-40

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18
Q

Describe the clinical course of GAD?

A

Chronic and fluctuating

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19
Q

Is GAD more common in men or women?

A

Twice as common in women

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20
Q

What are some features that GAD may be associated with?

A

Disability, medically unexplained physical symptoms, overuse of medical services

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21
Q

90% of cases of GAD are co-morbid with other psychiatric conditions such as what?

A

Depression, substance misuse and other anxiety disorders

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22
Q

What are the main treatment options for GAD?

A

CBT, SSRI/SNRI, pregablin, short term benzodiazepine

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23
Q

What is panic disorder?

A

Recurrent attacks of severe anxiety which are not restricted to any particular situation and are therefore unpredictable

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24
Q

In panic disorder, there will be a sudden onset of the physical symptoms of anxiety, and often a secondary fear of what?

A

Dying, losing control or going mad

25
Q

50-67% of cases of panic disorder occur alongside what?

A

Agoraphobia

26
Q

What are some things that can cause a similar presentation to panic disorder?

A

Hyperthyroidism, caffeine intoxication

27
Q

What is important to be aware of when panic disorder is seen in an older person?

A

This is usually as a result of something else

28
Q

When is the typical onset of panic disorder?

A

Adolescence to mid thirties

29
Q

What is the usual clinical course of panic disorder?

A

Chronic, waxing and waning

30
Q

What will be seen on 10 year follow up of patients with panic disorder?

A

1/3rd unchanged or worse, 1/3rd have a modest improvement, 1/3rd are well

31
Q

Similarly to GAD, panic disorder can be associated with other psychiatric conditions such as?

A

Other anxiety disorders, depression and substance misuse

32
Q

What are the treatment options for panic disorder?

A

CBT, anti-depressant (SSRI/SNRI/tricylic)

33
Q

When may an anti-depressant be used for panic disorder?

A

Before giving CBT, to make the condition more manageable

34
Q

Describe the onset of phobias?

A

These typically have an early onset, with 50% of cases of agoraphobia being present by age 20, and 80% of cases of social or specific phobias having presented by early adolesence

35
Q

In phobias, the fear is recognised as what? And is typified by what?

A

Recognised as irrational, and typified by avoidance and anticipatory anxiety

36
Q

Agoraphobia describes a cluster of phobias embracing fears of what?

A

Leaving home, entering crowded placed or travelling alone on public transport

37
Q

Some people with agoraphobia experience little anxiety why?

A

Because they simply avoid their phobic situation

38
Q

Agoraphobia can be a primary condition but is more likely to be secondary to what?

A

Panic disorder or depression

39
Q

What are some techniques that people with agoraphobia use to overcome their fear?

A

Getting others to do shopping for them, going to 24h shops when it is quiet, online shopping and drinking alcohol

40
Q

What is a specific phobia?

A

A persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation

41
Q

If a person has a specific or social phobia, exposure to the phobic stimulus invariably provokes what?

A

An immediate anxiety response, similar to a panic attack

42
Q

How does a person with a specific phobia get around this?

A

They either avoid the situation, or endure it with immense anxiety/distress

43
Q

In specific phobias, normal functioning can be impaired by what?

A

Avoidance, anxious anticipation or distress in the feared situation

44
Q

What are some treatment options for specific phobias?

A

Behavioural therapy i.e. graded exposure, adding CBT if necessary, SSRIs/SNRIs if required

45
Q

What is social phobia?

A

A persistent fear of one or more social or performance situations in which the individual is exposed to unfamiliar people or to possible scrutiny by others

46
Q

In social phobia, the individuals fear that they will do what?

A

Act in a way that will be embarrassing and humiliating

47
Q

Typically, in what type of social setting do social phobias occur in?

A

Relatively small social settings

48
Q

What are some common symptoms of a social phobia?

A

Blushing, shaking, fear of vomiting, urgency or fear of micturition/defaecation

49
Q

What are some treatment options for social phobia?

A

CBT, SSRIs/SNRIs, short term benzodiazepines

50
Q

OCD is defined as what?

A

Recurrent obsessional thoughts and/or compulsive acts

51
Q

What are obsessional thoughts?

A

Ideas, images or impulses entering the patient’s mind in a stereotyped way. These are recognised as the patient’s own thoughts and are unpleasant.

52
Q

What are compulsive acts?

A

Repeated rituals or stereotyped behaviours which are not enjoyable or functional and are recognised as being pointless

53
Q

What are some examples of the subjects of obsessional thoughts?

A

Contamination, fear of harm, order, physical symptoms, religion, sexual

54
Q

What are some examples of compulsive acts?

A

Checking, cleaning, repeating acts or words, order/symmetry, hoarding, counting

55
Q

To diagnose OCD, the obsessions and compulsions must be present when? What else must they be?

A

Present for most days for at least 2 weeks and be a source of distress/interference with activities

56
Q

What is the mean age of onset of OCD? Is this earlier in men or women?

A

20, earlier onset in men

57
Q

Most people with OCD will usually also experience what?

A

At least 1 major depressive episode

58
Q

OCD has significant co-morbidity with what other conditions?

A

Schizophrenia, Tourette’s/tic disorders and eating disorders

59
Q

How can OCD be treated?

A

CBT, SSRIs/clomipramine

Psychiatry (20 decks)

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