Anxiety - GAD, Panics, Phobias, OCD Flashcards
what acts as an emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response?
amygdala
what is generalised anxiety disorder?
anxiety that is generalised and persistent but not restricted to any particular environmental circumstances (ie free floating)
the dominant symptoms of GAD are variable but what do they include?
persistent nervousness trembling muscular tensions sweating lightheadedness palpitations dizziness epigastric discomfort
what 3 things make anxiety severe enough to be diagnosed with GAD?
long lasting (most days for at least 6 months) not controllable causing significant distress / impairment in function
what are the features of GAD?
restlessness easily fatigued difficulty concentrating irritability muscle tension sleep disturbance
what is the typical age of onset of GAD?
20-40
what % of GAD patients are co-morbid with other psychiatric disorders (eg depression, substance abuse, other anxiety disorders)?
90%
how is GAD treated?
CBT
SSRIs / SNRIs
pregabalin
what can be used as short term treatment for GAD?
benzodiazepines (short term only)
how does CBT work?
help individual identify thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety
what is panic disorder?
recurrent attacks of severe anxiety (panic) which are not restricted to any particular situation or set or circumstances so are unpredictable
panic disorder involves sudden onset of what symptoms?
palpitations chest pain choking sensations dizziness feelings of unreality (depersonalisation or derealisation)
also secondary fear of dying, losing control or going mad
panic disorder only occurs with agoraphobia - true or false?
false, can occur with or without
what is the typical onset of panic disorder?
adolescence to mid-30s
is panic disorder usually chronic?
yes
what other disorders is panic disorder usually co-morbid with?
anxiety disorders
depression
drug and alcohol misuse
panic attacks can be triggered in susceptible individuals by what biological process?
infusions of lactate (by-product of muscular activity)
or by re-breathing air (increased CO2)
what does a PET scan show during a panic attack?
increased metabolism at anterior pole of temporal lobe - parahippocampal gyrus
how can panic disorder be treated?
CBT
SSRIs / SNRIs / tricyclics
what can be given short term for panic disorder?
benzodiazepines
what are the three types of phobia?
agoraphobia
social phobia
specific phobia
what is agoraphobia?
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
agoraphobia is mostly a primary disorder - true or false?
false - may be a primary disorder but more often secondary to other pathology (eg panic disorder or depression)
what is a specific phobia?
a marked and persistent fear that is excessive or unreasonable, cued by presence or anticipation of a specific object or situation
how can specific phobias be treated?
behavioural therapy - exposure
add in CBT if necessary
SSRIs/SNRIs if required
what is a social phobia / social anxiety disorder?
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
what are the common anxiety symptoms in social phobia?
blushing or shaking
fear of vomiting
urgency or fear of micturition or defaecation
what behavioural symptoms can social phobias be linked to?
poor school performance, school refusal, poor employment history
react to novel situations by avoidance and withdrawal to safety
can social phobia be identified in toddlers?
yes
what processes go on within brain in social phobia?
increased bilateral activation of amygdala and increased rCBF to the amygdala
this normalises on successful treatment
how can social phobias be treated?
CBT
SSRIs / SNRIs
benzodiazepines (short term only)
what is obsessive compulsive disorder?
recurrent obsessional thoughts and / or compulsive acts
what are obsessive thoughts that occur in OCD?
ideas, images or impulses entering mind in stereotyped way
recognised as patients own thoughts but unpleasant, resisted and ego-dystonic
what are examples of compulsive acts in OCD?
repeated rituals or stereotyped behaviours not enjoyable not functional recognised as pointless resistance may diminish over time
what is diagnostic criteria for OCD?
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
what are common obsessions in OCD?
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)
what are common compulsions in OCD?
checking (eg gas taps) cleaning, washing repeating acts mental compulsions (eg special words) ordering, symmetry or exactness hoarding / collecting counting
what is the peak incidence age for males?
13-15
what is the peak incidence age for females?
24-25
what conditions do OCD have a significant co-morbidity with?
schizophrenia tourettes other tic disorders body dysmorphic disorder eating disorders trichtillomania
how can OCD be treated?
CBT (including response prevention)
SSRs / clomipramine
what is the mechanism of benzodiazepines?
enhance effect of GABA (allosteric modulation)
what is the role of GABA receptor?
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
what other two substances act on GABA-A receptor?
alcohol
barbiutrates
name 5 problems encountered with benzodiazepines (particularly if used over 2 weeks)?
sedation and psychomotor impairment discontinuation / withdrawal problems dependency and abuse alcohol interaction can worsen co-morbid depression
