Anxiety/Somatisation Flashcards
What are the criteria for a hypochondriacal disorder?
≥6m persistent belief of 2 serious conditions (1 named)
OR
Persistent preoccupation (distress/interferes w. func) with presumed deformity (body dysmorphic disorder)
Pt will seek medical Ix / Tx
Pt refuses to accept medical reassurance no physical cause
List some predisposing / precipitating / perpetuating factors of health anxiety (3/2/2)
Predispo:
FH health anxiety
FH OCD
Early life trauma
Precipitating:
Previous illness
Signif illness of loved
Perpetuating:
Somatosensory amplification (too much attention on it)
Localised brain sensitivity (ant. cingulate / prefrontal cortex)
List some DDx for health anxiety (4)
Depression/Anxiety disorders
Personality disorder
Organic conditions (MS, SLE, porphyrias) - initial vague Sx
Dissociative/conversion disorders
What are the subtypes of health anxiety? (3)
Cognitive - high cognitive awareness/ pronounced fear of disease
Somatising - high symptom awareness/ pronounced bodily preoccupation
Behavioural - belief of having disease w. certain behavs
What is dissociative disorder?
How may it present? (6)
Pt denying traumatic event + converting anxiety into physical symptoms (for medical attention)
Amnesia Fugue state Possession/trance Convulsions Limb paralysis Sensory loss
What rapport/approach should be taken with health anxiety / somatisation? (5)
Understand/appreciate that pt’s Sx are real
Focus more on Sx management (> Tx cure)
Do minimal/only necessary Ix/Tx
Ideally reg appts with same hcare professional
Give psych explanation for physical Sx
Outline a bio-psycho-social management for health anxiety/ somatisation?
Bio: limited use, poss SSRIs/antipsychotic (hypochondriacal delusion), avoid BZDs
Psycho: CBT (C: modifying dysfunctional thoughts in response to Sx; B: reduce problematic behaves e.g. avoidance, seeking reassurance)
Social: encourage normal function (pt may have avoided normal activities as think exac Sx), involve social network
List some Sx of anxiety (5 psych + 6 physical)
Psychological: Worrying thoughts Irritability Fearful anticipation Poor concentration Sleep disturbance
Autonomic: Dry mouth Diarrhoea Freq/urgent micturition Palpitations / chest discomfort
Muscle tension (aches/tremors)
Dizziness (hyperventilation consequences)
List the ICD-10 criteria for GAD
Generalised/persistent psych+somatic - on most days for wks/months
Psychological Sx
Autonomic Sx
Muscle tension
List the ICD-10 criteria for panic disorder (4)
Several attacks within 1m
Can be unpredictable situations
Circumstances with no objective danger
Relief from anxiety Sx b/wn attacks
List the ICD-10 criteria for agoraphobia
Psych + Autonomic Sx of anxiety (not secondary to..)
Avoidance of phobic situations prominent
Situations include: Crowds Public places Travelling alone Travelling away from home
List the ICD-10 criteria for social phobia
Psych + Autonomic Sx of anxiety (not secondary to…)
Trigger is certain social situations
Avoidance of phobic situations where poss
Describe the NICE step-care approach for anxiety
Step 1 (all known anxiety presentations) → Psychoeducation + active monitoring
Step 2 (no improvement after education/monitoring) → Self-help + IAPT
Step 3 (inadequate response to step 2 / func impaired) → High-intensity psychological intervention (CBT) /drugs
Step 4 (complex/ refractory/ v marked func impairment) → Secondary care/MDT + complex psych/drug regimes
What pharmacological Tx can be given for anxiety disorders? (4)
Antidepressants: NB poss brief increase anxiety
B-Blocker: reduce HR/autonomic Sx
BZDs: short-term use only (<4wks) + can reduce efficacy of psych Tx
Antipsychotics: not routine but poss in severe
What are some Sx/features of an Acute Stress Reaction? (8)
Sx of Anxiety/Depression Numbness/detachment/derealisation Poor concentration Insomnia Anger Autonomic Sx
Poor coping strategies (avoid thinking/talking / Denial)
Unhelpful coping strategies (e.g. alcohol)
What are the RFs for developing PTSD after stress/trauma? (3)
Pre-existing poor support network
Pre-existing MH probs
More serious trauma e.g. shooting/RTA
How may an Acute Stress Reaction be managed? (5)
BIO
Anxiolytic (for severe anxiety)
Hypnotics (for severe sleep disturbance)
PSYCHO
Encouraging recall
Learning effective coping skills
SOCIAL
Talking to fam/friends/professionals
What are the Sx/features of adjustment disorder (7)
Within 3m of event
Sx of anxiety/depression
Sx autonomic
Sx dramatic/aggressive outbursts
Poss drug/alc abuse
Social functioning impaired
More gradual/prolonged than acute stress reaction
Describe the management of adjustment disorder (4)
PSYCHO:
Encourage talking/expressing feelings
Consider primary care talking therapy
SOCIAL
Help resolve change if poss (work support/ support grp)
Help natural adjustment (prevent avoidance/denial, encourage to seek solutions)
What factors may indicate an abnormal grief reaction? (6)
Guilt (not the usual seen i.e. their non/actions when died)
Thoughts of death (not the usual of shoulda died instead)
Hallucinations (not the usual)
Morbid preoccupation with worthlessness Psychomotor retardation (signif) Prolonged/serious functional impairment
When may Sx of PTSD appear?
Latency period wks/months (rarely >6m)
May arise much later (from minor secondary trauma)
Sx persist 6m after event
What is the prevalence of PTSD
5-10% lifetime prevalence
45% female domestic violence victims
What are the core triad of Sx seen in PTSD (AARH)
+ other commonly seen Sx (3)
Avoidance of reminders
Anhedonia (or numb/detached)
Re-experiencing: flashbacks / nightmares
Hyperarousal: anxiety / insomnia / poor conc
Also seen: Depression / Guilt / Substance use
Describe the biopsychosocial management around PTSD (1:3:3)
Bio: SSRIs
Psycho: Psychoeducation / Trauma-focused CBT / EMDR
Social: Educate family / Support social reintegration / avoid alc
What are some poor prognostic factors in PTSD (5)
Co-morbid/PMH/FH mental illness Poor support network Long duration Poor pre-morbid functioning Outstanding compensation claims
