Anxiety (general, OCD, phobic, panic) Flashcards
What are the types of anxiety?
Generalised anxiety OCD Phobic PTSD Panic disorder
What is generalised anxiety disorder?
A long term condition which is associated with excessive, persistent and unreasonable anxiety about lots of things.
When the anxiety about one issue is resolves, the person becomes anxious about something else.
What test should be done when diagnosing GAD?
Blood test - to rule out hyperthyroidism.
What is the DSM5 criteria for GAD?
- Excessive anxiety and worry for more days than not, for >6 months.
- Person finds it hard to control their anxiety
- Anxiety causes impairment on everyday life
- It isn’t better explained by another medical disorder
- Must have 3 or more of the 6 key symptoms (children only need 1 symptom)
What are the 6 key symptoms of GAD in the DSM5 criteria?
- Restlessness
- Lack of concentration
- Easily fatigued
- Irritability
- Muscle tension
- Disturbed sleep
Which gender is more at risk of developing GAD?
Female
What are the somatic symptoms of GAD?
Muscle tension Trembling Sweating Hyperventilation Nausea Globius hystericus
What are the GI symptoms of GAD?
Nausea Vomiting Wind Frequent loose stools Dyspepsia Dry mouth Swallowing difficulties
What are the cardiovascular symptoms of GAD?
Palpitations
Chest pain
What are the respiratory symptoms of GAD?
Tight chest
Hyperventilation
Difficulty inhaling
What are the genitourinary symptoms of GAD?
Erectile dysfunction
Amenorrhea
Dysmenorrhea
Frequency and urgency
What causes numbness and tingling in anxiety?
Hyperventilation - hypocapnoea - low calcium levels - carpopedal spasm
What are the behavioural signs of GAD?
Reassurance seeking
Avoidance
Dependence
What is a cognitive symptom of GAD?
Repetitive thoughts
What is the main difference between GAD and phobic anxiety?
Same symptoms - GAD is present all of the time, phobic symptoms are caused by something specific.
What age does anxiety rarely begin after?
Rarely occurs after 35yrs - if patient presents with anxiety, theres more likely to be an underlying cause.
What is the 1st line treatment for GAD?
CBT (+SSRI)
What is the 2nd line treatment for GAD?
Buspirone
Beta blocker
low dose antipsychotic
How long can benzodiazepines be used for in GAD?
No more than 10 days.
When should benzodiazepines be used in GAD?
Only used to overcome initial symptoms so patient can move on to proper treatment.
What is panic disorder?
Recurrent attacks of severe anxiety.
They are not restricted to a particular situation or set of circumstances.
Unpredictable.
When are symptoms present in panic disorder?
During the panic attack.
They feel relief outwith the attacks, unlike in GAD.
What is it called when someone fears their next panic attack?
Anticipatory anxiety.
What are the symptoms of panic disorder?
Palpitations sweating shaking dyspnoea numbness feeling of impending doom chest discomfort Presyncope
(Can have any symptom like in GAD).
How long does a panic attack last?
Usually 5-20 mins.
Can last up to 1hr.
Which 2 age groups are panic disorders most common in?
20s
50s
Bimodal distribution.
Which gender is at a higher risk of developing panic disorder?
A female is 2-3x more likely than male.
What is the 1st line treatment for panic disorder?
CBT
80-100% effective.
What is the 2nd line treatment of panic disorder?
SSRI
can add on a TCA - clomipramine
What is a phobic disorder?
An overwhelming fear of something.
What is the most common phobia?
Social phobia
What is the most common anxiety disorder?
Social phobia
What is agoraphobia?
Fear of open spaces and crowds
Associated with panic attacks
Which age groups commonly develops agoraphobics?
20s
30s
What is a social phobia?
A fear of scrutiny from other people
Associated with panic attacks
What are the most common symptoms in social phobia?
Tremor
Blushing
What is the 1st line treatment for most phobias?
CBT
What is another psychological treatment which can be used to treat phobias?
Flooding - exposure therapy.
What is a 2nd line treatment for phobic disorder?
SSRI
What is PTSD?
A delayed reaction to a stressor of exceptional severity (that would distress anyone).
What are common causes of PTSD?
Rape Combat Natural or human disaster Assault Torture Witnessing any of these things
What are symptoms of PTSD?
Hyperarousal
Re-experiencing phenomena
Avoidance of reminders
What is hyperarousal?
persistent anxiety
irritability
Insomnia
Poor concentration
What are re-experiencing phenomena symptoms?
Intense intrusive images
Flashbacks when awake
Nightmares during sleep
What are avoidance of reminder symptoms?
Emotional numbness
Recall difficulty
Diminished interests
Cue avoidance
Which gender is at a higher risk of developing PTSD?
Females
What are risk factors for developing PTSD?
Previous mood disorder
Previous trauma
Lack of social support
Female
What are protective factors regarding PTSD?
Good paternal relationship
Higher education and social status
What is the treatment for mild PTSD?
Watchful waiting - review in 1 month.
What is the treatment for more severe PTSD?
Eye movement desensitisation and reprocessing.
SSRI or TCA.
What are core features of OCD?
Compulsive acts or rituals
Repeated thoughts
Anxiety which gets worse if the acts are not carried out
Fear that something bad will happen if patient doesn’t carry out the act
What is the 1st line treatment for OCD?
Exposure response prevention therapy
OR
CBT
What is the 2nd line treatment for OCD?
More severe CBT
SSRI medication - Fluoxetine
TCA - clomipramine
Which is a very rare treatment for OCD?
Psychosurgery
What are the 3 A’s of anxiety?
Anxious thoughts
Autonomic symptoms
Avoidant behaviour
