Anxiety Disorders - General Flashcards
What are some common physical symptoms of anxiety?
Palpitations and raised HR, difficulty breathing/chest pain, ‘lump in the throat’, lightheadedness, numbness/tingling, shaking
One of the cognitive features of anxiety is derealisation - what is this?
The feeling that objects are unreal
One of the cognitive features of anxiety is depersonalisation - what is this?
Feeling like the self is distant or not really here
One of the cognitive features of anxiety is meta-worry - what is this?
Worrying about everything, and then worrying about worrying
In terms of everyday lifestyle, people suffering from anxiety have a preference for what?
Order and routine
What are some examples of behavioural symptoms of anxiety?
Avoiding certain situations, exaggerated responses, difficulty sleeping, excessive drug/alcohol use, restlessness, irritability
In the stress response, exposure to stress results in what?
Instantaneous and concurrent biological responses to assess the danger and organise an appropriate response
What structure of the brain acts as the emotional filter for assessing whether sensory material requires a stress or fear response?
The amygdala
What is the end goal of the stress response?
Stimulation of the adrenal glands to release cortisol
Why is it dangerous to always have a fight or flight response?
Cortisol levels will be chronically high which is to some extent neurotoxic
What does it mean if an anxiety disorder is in extent?
Anxiety is more extreme than normal
What does it mean if an anxiety disorder is in context?
There is anxiety in response to situations that are not normally anxiety provoking
What is generalised anxiety disorder?
Anxiety that is generalised and persistent, and not restricted to any particular environmental circumstances
When do people with GAD worry?
Most of the time, even when there is nothing to worry about
People with GAD often have fears of what?
Themselves or family members becoming ill soon or involved in an accident
GAD needs to be severe enough before it is properly diagnosed. What qualifies this?
Long lasting, most days for at least 6 months, not controllable and causing significant distress/impairment in function
What is the typical age of onset of GAD?
20-40
Describe the clinical course of GAD?
Chronic and fluctuating
Is GAD more common in men or women?
Twice as common in women
What are some features that GAD may be associated with?
Disability, medically unexplained physical symptoms, overuse of medical services
90% of cases of GAD are co-morbid with other psychiatric conditions such as what?
Depression, substance misuse and other anxiety disorders
What are the main treatment options for GAD?
CBT, SSRI/SNRI, pregablin, short term benzodiazepine
What is panic disorder?
Recurrent attacks of severe anxiety which are not restricted to any particular situation and are therefore unpredictable
In panic disorder, there will be a sudden onset of the physical symptoms of anxiety, and often a secondary fear of what?
Dying, losing control or going mad
50-67% of cases of panic disorder occur alongside what?
Agoraphobia
What are some things that can cause a similar presentation to panic disorder?
Hyperthyroidism, caffeine intoxication
What is important to be aware of when panic disorder is seen in an older person?
This is usually as a result of something else
When is the typical onset of panic disorder?
Adolescence to mid thirties
What is the usual clinical course of panic disorder?
Chronic, waxing and waning
What will be seen on 10 year follow up of patients with panic disorder?
1/3rd unchanged or worse, 1/3rd have a modest improvement, 1/3rd are well
Similarly to GAD, panic disorder can be associated with other psychiatric conditions such as?
Other anxiety disorders, depression and substance misuse
What are the treatment options for panic disorder?
CBT, anti-depressant (SSRI/SNRI/tricylic)
When may an anti-depressant be used for panic disorder?
Before giving CBT, to make the condition more manageable
Describe the onset of phobias?
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
In phobias, the fear is recognised as what? And is typified by what?
Recognised as irrational, and typified by avoidance and anticipatory anxiety
Agoraphobia describes a cluster of phobias embracing fears of what?
Leaving home, entering crowded placed or travelling alone on public transport
Some people with agoraphobia experience little anxiety why?
Because they simply avoid their phobic situation
Agoraphobia can be a primary condition but is more likely to be secondary to what?
Panic disorder or depression
What are some techniques that people with agoraphobia use to overcome their fear?
Getting others to do shopping for them, going to 24h shops when it is quiet, online shopping and drinking alcohol
What is a specific phobia?
A persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
If a person has a specific or social phobia, exposure to the phobic stimulus invariably provokes what?
An immediate anxiety response, similar to a panic attack
How does a person with a specific phobia get around this?
They either avoid the situation, or endure it with immense anxiety/distress
In specific phobias, normal functioning can be impaired by what?
Avoidance, anxious anticipation or distress in the feared situation
What are some treatment options for specific phobias?
Behavioural therapy i.e. graded exposure, adding CBT if necessary, SSRIs/SNRIs if required
What is social phobia?
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
In social phobia, the individuals fear that they will do what?
Act in a way that will be embarrassing and humiliating
Typically, in what type of social setting do social phobias occur in?
Relatively small social settings
What are some common symptoms of a social phobia?
Blushing, shaking, fear of vomiting, urgency or fear of micturition/defaecation
What are some treatment options for social phobia?
CBT, SSRIs/SNRIs, short term benzodiazepines
OCD is defined as what?
Recurrent obsessional thoughts and/or compulsive acts
What are obsessional thoughts?
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.
What are compulsive acts?
Repeated rituals or stereotyped behaviours which are not enjoyable or functional and are recognised as being pointless
What are some examples of the subjects of obsessional thoughts?
Contamination, fear of harm, order, physical symptoms, religion, sexual
What are some examples of compulsive acts?
Checking, cleaning, repeating acts or words, order/symmetry, hoarding, counting
To diagnose OCD, the obsessions and compulsions must be present when? What else must they be?
Present for most days for at least 2 weeks and be a source of distress/interference with activities
What is the mean age of onset of OCD? Is this earlier in men or women?
20, earlier onset in men
Most people with OCD will usually also experience what?
At least 1 major depressive episode
OCD has significant co-morbidity with what other conditions?
Schizophrenia, Tourette’s/tic disorders and eating disorders
How can OCD be treated?
CBT, SSRIs/clomipramine
