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Psychiatry > Anxiety/Somatisation > Flashcards

Anxiety/Somatisation Flashcards

1
Q

What are the criteria for a hypochondriacal disorder?

A

≥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

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2
Q

List some predisposing / precipitating / perpetuating factors of health anxiety (3/2/2)

A

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)

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3
Q

List some DDx for health anxiety (4)

A

Depression/Anxiety disorders
Personality disorder
Organic conditions (MS, SLE, porphyrias) - initial vague Sx
Dissociative/conversion disorders

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4
Q

What are the subtypes of health anxiety? (3)

A

Cognitive - high cognitive awareness/ pronounced fear of disease

Somatising - high symptom awareness/ pronounced bodily preoccupation

Behavioural - belief of having disease w. certain behavs

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5
Q

What is dissociative disorder?

How may it present? (6)

A

Pt denying traumatic event + converting anxiety into physical symptoms (for medical attention)

Amnesia
Fugue state
Possession/trance
Convulsions
Limb paralysis
Sensory loss
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6
Q

What rapport/approach should be taken with health anxiety / somatisation? (5)

A

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

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7
Q

Outline a bio-psycho-social management for health anxiety/ somatisation?

A

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

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8
Q

List some Sx of anxiety (5 psych + 6 physical)

A 
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)

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9
Q

List the ICD-10 criteria for GAD

A

Generalised/persistent psych+somatic - on most days for wks/months

Psychological Sx
Autonomic Sx
Muscle tension

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10
Q

List the ICD-10 criteria for panic disorder (4)

A

Several attacks within 1m
Can be unpredictable situations
Circumstances with no objective danger
Relief from anxiety Sx b/wn attacks

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11
Q

List the ICD-10 criteria for agoraphobia

A

Psych + Autonomic Sx of anxiety (not secondary to..)
Avoidance of phobic situations prominent

Situations include:
Crowds
Public places
Travelling alone
Travelling away from home
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12
Q

List the ICD-10 criteria for social phobia

A

Psych + Autonomic Sx of anxiety (not secondary to…)
Trigger is certain social situations
Avoidance of phobic situations where poss

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13
Q

Describe the NICE step-care approach for anxiety

A 
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
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14
Q

What pharmacological Tx can be given for anxiety disorders? (4)

A

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

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15
Q

What are some Sx/features of an Acute Stress Reaction? (8)

A 
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)

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16
Q

What are the RFs for developing PTSD after stress/trauma? (3)

A

Pre-existing poor support network
Pre-existing MH probs
More serious trauma e.g. shooting/RTA

17
Q

How may an Acute Stress Reaction be managed? (5)

A

BIO
Anxiolytic (for severe anxiety)
Hypnotics (for severe sleep disturbance)

PSYCHO
Encouraging recall
Learning effective coping skills

SOCIAL
Talking to fam/friends/professionals

18
Q

What are the Sx/features of adjustment disorder (7)

A

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

19
Q

Describe the management of adjustment disorder (4)

A

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)

20
Q

What factors may indicate an abnormal grief reaction? (6)

A

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
21
Q

When may Sx of PTSD appear?

A

Latency period wks/months (rarely >6m)
May arise much later (from minor secondary trauma)
Sx persist 6m after event

22
Q

What is the prevalence of PTSD

A

5-10% lifetime prevalence

45% female domestic violence victims

23
Q

What are the core triad of Sx seen in PTSD (AARH)

+ other commonly seen Sx (3)

A

Avoidance of reminders
Anhedonia (or numb/detached)
Re-experiencing: flashbacks / nightmares
Hyperarousal: anxiety / insomnia / poor conc

Also seen: Depression / Guilt / Substance use

24
Q

Describe the biopsychosocial management around PTSD (1:3:3)

A

Bio: SSRIs
Psycho: Psychoeducation / Trauma-focused CBT / EMDR
Social: Educate family / Support social reintegration / avoid alc

25
Q

What are some poor prognostic factors in PTSD (5)

A 
Co-morbid/PMH/FH mental illness
Poor support network
Long duration
Poor pre-morbid functioning
Outstanding compensation claims

Psychiatry (11 decks)

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