Anxiety DO Flashcards
___________ comprises excessive anxiety and
worry about various life circumstances and is not
related to a specific activity, time or event such as
trauma, obsessions or phobias.
Generalised anxiety
Gen features of GAD
• persistent unrealistic and excessive anxiety
• worry about a number of life circumstances for
6 months or longer
Diagnostic criteria for generalised
anxiety disorder
Three or more of: • restless, ‘keyed up’ or ‘on edge’ • easily fatigued • difficulty concentrating or ‘mind going blank’ • irritability • muscle tension • sleep disturbance
Ddx for GAD
- depression
- drug and alcohol dependence/withdrawal
- benzodiazepine dependence/withdrawal
- hyperthyroidism
- angina and cardiac arrhythmias
- iatrogenic drugs
- caffeine intoxication
Mx of GAD
maladaptive thinking, feelings, perceptions and related behaviours are identified, assessed, challenged and modified, can be of considerable benefit.
CBT
____ and_______- have shown to
benefit some anxiety disorders
SSRIs and other antidepressants
assess efficacy of antidepressants after at least
_______(in contrast to 6–8 weeks when treating
major depression) and treat for at least 6 months
12 weeks
_________ is of benefit in social anxiety disorder,
particularly with anticipated stressful events
propranolol
___________ have a limited role in anxiety
disorders. If used, they should be reserved
for people who have not responded to at least
2 therapies
benzodiazepines
A________ is defined as a discrete period of
intense fear or discomfort in which four (or more) of
symptoms develop abruptly and reach a
peak within 10 minutes
panic attack
Organic disorders that simulate a panic attack
are ____, ______, ______
hyperthyroidism, phaeochromocytoma and
hypoglycaemia
T or F
A single panic attack is synonymous with
panic disorder
F
not same
________
is when there are recurrent attacks that are followed
by at least a month of worrying about future attacks
and/or the consequences of them.
Panic disorder
Panic disorder can occur with or without associated _________though >90% of people with agoraphobia develop it as a result of recurrent panic attacks.
agoraphobia,
Mx of panic Do if non-pharma work (pyschotherapy)
If simple
psychotherapy and stress management fail then
patients should be referred for CBT
In panic DO
________can be
useful in reducing panic attacks and agoraphobia
Antidepressants
response rate for anti-dep in panic DO
with the response rate being 60–90%.
Continual use of__________has previously been
utilised in panic and other anxiety disorders but is
now no longer recommended
benzodiazepines (BDZs, e.g.
alprazolam or clonazepam)
BZD use
avoid using _________as they are the
most highly addictive
short-acting drugs
A benzodiazepine withdrawal syndrome, which can include 1 2 3 4
rebound anxiety, depression, confusion, insomnia and seizures, may occur
Avoidance includes staying away from many
situations where there are issues of distance from
home, crowding or confinement
Agoraphobia
________ is experienced in anxietyprovoking
social situations in which the person
feels subject to critical public scrutiny (e.g. canteens,
restaurants, staff meetings, speaking engagements).
Social anxiety disorder
Types of social anxiety DO
It can either be generalised (fear of numerous
social situations, including both performance and
interactional situations) or non-generalised (fear of
one or just a few situations of performance type).
Meds for specific situations
Generalised anxiety disorder
SSRI, duloxetine (30–120 mg), venlafaxine controlled release (75–225 mg)
Meds for specific situations
Panic disorder
SSRI, venlafaxine controlled release (75–225 mg)
Meds for specific situations
Obsessive-compulsive disorder
SSRI
Meds for specific situations
Social anxiety disorder (generalised)
SSRI, venlafaxine controlled
release (75–225 mg)
Meds for specific situations
Social anxiety disorder (non-generalised)
propranolol 10–40 mg
orally, 30–60 minutes
before the social event or
performance
Anxiety is associated with obsessive thoughts and
compulsive rituals.
Obsessive–compulsive disorder (OCD)
_______ are recurrent and persistent
intrusive ideas, thoughts, impulses or images that
are usually resisted by the patient
The obsessions
_________ are
repetitive, purposeful and intentional behaviours
conducted in response to an obsession to prevent a
bad outcome for the person (e.g. excessive washing of
the genitals).
Compulsions
Mx of OCD
Optimal management is a combination of psychotherapeutic— particularly CBT—and pharmacological
treatment,
The person with this disorder has an exaggerated
preoccupation with an imagined defect in appearance
Body dysmorphic disorder
This is defined as a constellation of abnormal
anxiety-related symptoms lasting at least 3 days
and occurring within 4 weeks of a traumatic
event
Acute stress disorder
• acute PTSD: duration of symptoms_______
• chronic PTSD: duration of symptoms_______
• delayed onset PTSD: onset of symptoms at least
______
<3 months
≥ 3 months
6 months after the stressor
Features of PTSD
• \_\_\_\_\_\_\_\_\_\_—recollections, nightmares, flashbacks • \_\_\_\_\_\_\_\_\_\_\_ • \_\_\_\_\_ • hyperarousal phenomena
intrusive features
avoidance of events that symbolise or resemble the trauma
persistent negative alterations in cognitions and
mood
What phenomenon: exaggerated startle
response, irritability, anger, difficulty with
sleeping and concentrating, hypervigilance,
reckless or self-destructive behaviour
hyperarousal phenomena
Duration of Tx for PTSD pts
they should be used for at
least 12 months
Sx of HVS
- lightheadedness, faintness or dizziness
- breathlessness
- palpitations
- sweating
- dry mouth with aerophagy
- agitation
- fatigue and malaise
This term is reserved for patients who present with
anxiety symptoms within 3 months of response to
an identifiable psychosocial stressor
Adjustment disorder with anxious mood
___________ is defined as
the tendency to experience, conceptualise and
communicate mental states and distress as physical
symptoms or altered bodily function
Somatic symptom disorder (SSD)
SSD is persistent with a history of
numerous unsubstantiated physical complaints
over several years beginning before the age of _____
30.
Types of SSD
those with predominantly somatic complaints and those with predominantly pain issues (previously known as pain disorder).
Mx of SSD
Management involves skilful counselling,
explanation for symptoms, searching for and treating
comorbid conditions (e.g. depression, anxiety)
and CBT.
