Anxiety, OCD, Panic Flashcards
Risk factors + Aetiology for GAD?
1) Highest in 45-49yrs
2) More common in females
3) Genetic - shared heritability with panic, depression and OCD
4) Stressful life event (rape, early parental death)
5) Parenting - overprotective or lacking warmth
6) Dysfunctional marital/family relationships
Clinical presentation of GAD?
1) Poor concentration
2) Nervousness/restlessness
3) Irritability
4) Fatiguability
5) Muscle tension
6) Sleep disturbance
7) Sense of impending doom
Differential diagnosis for GAD?
Depression, mixed anxiety and depression, alcohol and drug induced, medication (antihypertensives and anti-arrhythmic, bronchodilators, beta agonists, anticonvulsants, antidepressants, antipsychotics, levothyroxine and NSAIDs)
Diagnosis of GAD?
Clinical - 3 symptoms present on most days for 6 months
Treatment of GAD?
Listening & education, exercise, meditation, CBT, behavioural therapy with graded exposure to anxiety-provoking stimuli, hypnosis.
Medication - 1st line - SSRI (Escitalopram), 2nd line SNRI (Venlafaxine), 3rd line TCA (Amitryptaline), Benzodiazepines (lorazepam/diazepam), GABA analogue (Pregabalin), Beta blocker (propanalol) for autonomic symptoms.
What is OCD? What is the epidemiology?
A common chronic disorder associated with marked anxiety and depression characterised by obsessions and compulsions. Mean age around 20 years and 70%onset before 25 years.
What are the risk factors for OCD?
1) Genetic
2) Abuse/neglect/social isolation/bullying
3) Stress/triggers - pregnancy or postnatal condition
4) Neurological conditions - tumour/frontotemporal dementia
5) Depression, GAD, Bipolar, eating disorder and alcohol misuse
What is the clinical presentation of OCD - with obsession?
Obsession: Idea, image, or impulse recognised by the patient as their own but is distressing, intrusive and repetitive. Can be resisted but results in mounting anxiety, anxiety can be relieved with an associated compulsion.
E.g.
1) Fear of harming oneself/others,
2) Fear of contamination,
3) Fear of disobeying religion, 4) Need for symmetry.
What is the clinical presentation of OCD - with compulsion?
Compulsion is an action recognised by the patient as unnecessary but still feel a subjective sense of need to perform the action repeatedly in order to avoid adverse events. Can be resisted but leads to mounting anxiety. 1) Checking doors, gas, taps 2) Hoarding 3) Washing + Cleaning 4) Repeating words silently Counting 5) Ordering and rearranging 6) Bodily fears
Differential diagnosis for OCD?
1) Anankastic personality disorder
2) Body dysmorphia
3) Schizophrenia
Diagnosis of OCD?
Clinical - obsessions and compulsions must cause distress or impair social/occupational function - should not be a result of another psychiatric disorder.
Treatment of OCD?
CBT - exposure and response therapy (ERT)
Antidepressants - SSRI (Fluoxetine)
TCA - Clomipramine
Antipsychotics - RIsperidone if psychotic features, or schizotypal traits
What is a panic attack?
Period of intense fear characterised by a constellation of symptoms reaching peak onset at 10 minutes and generally do not last longer than 30 mins. The attack can may be spontaneous or situational.
How do you define a panic disorder?
Recurrent panic attacks that are not secondary to alcohol/substance misuse, other psychiatric or health conditions. They may vary from occurring multiple times daily, or a few times a year.
There is usually a persistent worry between attacks about having another attack or consequences of the attack - leading to phobic avoidance of certain places and situations.
Who is at risk from a panic disorder?
1) Women are more likely to be affected with a highest peak incidence between 15-24yrs and 45-54 yrs.
2) Early parental loss, physical/sexual abuse
3) Divorced/widowed
