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Psychiatry > Anxiety - GAD, Panics, Phobias, OCD > Flashcards

Anxiety - GAD, Panics, Phobias, OCD Flashcards

1
Q

what acts as an emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response?

A

amygdala

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2
Q

what is generalised anxiety disorder?

A

anxiety that is generalised and persistent but not restricted to any particular environmental circumstances (ie free floating)

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3
Q

the dominant symptoms of GAD are variable but what do they include?

A 
persistent nervousness
trembling 
muscular tensions 
sweating 
lightheadedness
palpitations 
dizziness 
epigastric discomfort
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4
Q

what 3 things make anxiety severe enough to be diagnosed with GAD?

A 
long lasting (most days for at least 6 months)
not controllable 
causing significant distress / impairment in function
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5
Q

what are the features of GAD?

A 
restlessness
easily fatigued 
difficulty concentrating 
irritability 
muscle tension 
sleep disturbance
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6
Q

what is the typical age of onset of GAD?

A

20-40

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7
Q

what % of GAD patients are co-morbid with other psychiatric disorders (eg depression, substance abuse, other anxiety disorders)?

A

90%

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8
Q

how is GAD treated?

A

CBT
SSRIs / SNRIs
pregabalin

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9
Q

what can be used as short term treatment for GAD?

A

benzodiazepines (short term only)

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10
Q

how does CBT work?

A

help individual identify thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety

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11
Q

what is panic disorder?

A

recurrent attacks of severe anxiety (panic) which are not restricted to any particular situation or set or circumstances so are unpredictable

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12
Q

panic disorder involves sudden onset of what symptoms?

A 
palpitations 
chest pain 
choking sensations 
dizziness 
feelings of unreality (depersonalisation or derealisation)

also secondary fear of dying, losing control or going mad

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13
Q

panic disorder only occurs with agoraphobia - true or false?

A

false, can occur with or without

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14
Q

what is the typical onset of panic disorder?

A

adolescence to mid-30s

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15
Q

is panic disorder usually chronic?

A

yes

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16
Q

what other disorders is panic disorder usually co-morbid with?

A

anxiety disorders
depression
drug and alcohol misuse

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17
Q

panic attacks can be triggered in susceptible individuals by what biological process?

A

infusions of lactate (by-product of muscular activity)

or by re-breathing air (increased CO2)

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18
Q

what does a PET scan show during a panic attack?

A

increased metabolism at anterior pole of temporal lobe - parahippocampal gyrus

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19
Q

how can panic disorder be treated?

A

CBT

SSRIs / SNRIs / tricyclics

20
Q

what can be given short term for panic disorder?

A

benzodiazepines

21
Q

what are the three types of phobia?

A

agoraphobia
social phobia
specific phobia

22
Q

what is agoraphobia?

A

a fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes

23
Q

agoraphobia is mostly a primary disorder - true or false?

A

false - may be a primary disorder but more often secondary to other pathology (eg panic disorder or depression)

24
Q

what is a specific phobia?

A

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

25
Q

how can specific phobias be treated?

A

behavioural therapy - exposure
add in CBT if necessary

SSRIs/SNRIs if required

26
Q

what is a social phobia / social anxiety disorder?

A

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

27
Q

what are the common anxiety symptoms in social phobia?

A

blushing or shaking
fear of vomiting
urgency or fear of micturition or defaecation

28
Q

what behavioural symptoms can social phobias be linked to?

A

poor school performance, school refusal, poor employment history

react to novel situations by avoidance and withdrawal to safety

29
Q

can social phobia be identified in toddlers?

A

yes

30
Q

what processes go on within brain in social phobia?

A

increased bilateral activation of amygdala and increased rCBF to the amygdala

this normalises on successful treatment

31
Q

how can social phobias be treated?

A

CBT
SSRIs / SNRIs

benzodiazepines (short term only)

32
Q

what is obsessive compulsive disorder?

A

recurrent obsessional thoughts and / or compulsive acts

33
Q

what are obsessive thoughts that occur in OCD?

A

ideas, images or impulses entering mind in stereotyped way

recognised as patients own thoughts but unpleasant, resisted and ego-dystonic

34
Q

what are examples of compulsive acts in OCD?

A 
repeated rituals or stereotyped behaviours 
not enjoyable 
not functional 
recognised as pointless
resistance may diminish over time
35
Q

what is diagnostic criteria for OCD?

A

obsessional symptoms or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and interference with activities

36
Q

what are common obsessions in OCD?

A

contamination from dirt, germs and viruses
fear of harm (eg doors locked)
excessive concern with order / symmetry
obsessions with body or physical symptoms
religious or blasphemous thoughts
sexual thoughts
urge to hoard possessions
thoughts of violence or aggression (stabbing ones baby (lol)

37
Q

what are common compulsions in OCD?

A 
checking (eg gas taps)
cleaning, washing 
repeating acts 
mental compulsions (eg special words)
ordering, symmetry or exactness
hoarding / collecting 
counting
38
Q

what is the peak incidence age for males?

A

13-15

39
Q

what is the peak incidence age for females?

A

24-25

40
Q

what conditions do OCD have a significant co-morbidity with?

A 
schizophrenia 
tourettes 
other tic disorders 
body dysmorphic disorder
eating disorders
trichtillomania
41
Q

how can OCD be treated?

A

CBT (including response prevention)

SSRs / clomipramine

42
Q

what is the mechanism of benzodiazepines?

A

enhance effect of GABA (allosteric modulation)

43
Q

what is the role of GABA receptor?

A

GABA-A receptor is an inhibitory ionotropic receptor
in presence of GABA the ion channel allows chloride ion influx
membrane hyperpolarisation
results in inhibitory postsynaptic potential

44
Q

what other two substances act on GABA-A receptor?

A

alcohol

barbiutrates

45
Q

name 5 problems encountered with benzodiazepines (particularly if used over 2 weeks)?

A 
sedation and psychomotor impairment 
discontinuation / withdrawal problems 
dependency and abuse 
alcohol interaction 
can worsen co-morbid depression

Psychiatry (27 decks)

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