ANXIETY RELATED DISORDERS Flashcards
What are the most heritable anxiety related disorders?
Panic disorder
Obsessive Compulsive Disorder
More than a third of patients with these disorders will have a first degree relative with the same diagnosis.
What are the neurotransmitter systems implicated in anxiety disorders?
GABA
Serotonin
Noradrenaline
What are the main anxiety related disorders?
Generalised anxiety disorder Panic disorder (with or without agoraphobia) Social phobia Specific phobia Post-traumatic stress disorder Obsessive-compulsive disorder
What is the difference between fear and anxiety?
Anxiety is a response to an unknown threat, whereas fear is a response to a threat from a known, external or definite object.
What are the two patterns of pathological anxiety?
- Generalised - does not occur in discrete episodes and lasts for hours or days and is of mild to moderate severity. Not associated with specific external situation or stimulus, but rather is excessive worry about many normal life events.
- Paroxysmal - abrupt onset, occurs in discrete episodes and tends to be severe, in its severest form being panic attacks. Can be further subdivided into episodes that occur spontaneously and those that are triggered by a particular perceived threat.
What are the physical signs and symptoms of anxiety?
Tachycardia Palpitations Hypertension Shortness of breath/rapid breathing Chest pain Choking sensation Tremor Muscle tension Dry mouth Sweating Cold skin Nausea or vomiting Diarrhoea Abdominal discomfort (Butterflies) Dizziness, light-headed, syncope Mydriasis (pupil dilation) Paraesthesia (tingling)
What is agoraphobia?
Fear of public places. Now used more widely to mean a fear of somewhere where immediate escape is not possible.
What is a social phobia?
Fear of social situations where the patient might be exposed to scrutiny by others that might lead to humiliation or embarrassment. This can be limited to doing a specific thing in front of others (eg public speaking) or may involve almost all social activities.
What is the most common type of specific phobias?
Situational phobias - eg public transport, flying, driving, tunnels, bridges, lifts.
What are the three elements of generalised anxiety disorder as set out by the ICD-10?
Apprehension
Motor tension (restlessness, fidgeting, tension headache, inability to relax)
Autonomic overactivity
What is anticipatory anxiety?
Fear of having further panic attacks.
What medical conditions are associated with anxiety?
Causing dyspnoea: CCF PE COPD Asthma
Causing increased sympathetic outflow:
Hypoglycaemia
Phaeochromocytoma
Pain Cerebral trauma Cushing's disease Hyperthyroidism Temporal lobe epilepsy Vitamin deficiencies
What is a compulsion in the context of OCD?
They are repetitive mental operations or physical acts which the patient feels compelled to perform in response to their own obsessions. They are performed to reduce anxiety through the belief that they will prevent the dreaded event from occurring. Eg excessive washing of hands.
What are the 4 most commonly seen types of obsession in patients with OCD?
Fear of contamination
Pathological doubt (eg have I turned off the stove)
Reprehensible violent, blasphemous or sexual thoughts, images or impulses
Need for symmetry and precision
What are the ICD-10 guidelines for diagnosing OCD?
- Obsessions and compulsions must be present for at least two successive weeks and are a source of distress or interfere with the patient’s functioning
- They are acknowledged as coming from the patients mind (rather than thought insertion)
- The obsessions are unpleasantly repetitive.
- At least one thought or act is resisted unsuccessfully.
- A compulsive act is not in itself pleasurable (apart from the relief of anxiety)
