Anxiety & stress Flashcards
What are the physical symptoms of anxiety?
Constitutional: fatigue, sweating, shiver, mydriasis, cold skin
GI: N/V/D, constipation, butterflies, choking, dry mouth
CV: chest pain, palpitations, tachycardia, HT
Respi: SOB, hyperventilation
Neuro: dizzy, tremor, paresthesia
MSK: muscle tension
What is a panic attack?
An abrupt surge of intense fear or discomfort that peaks within minutes
4 symptoms: sweating, trembling, unsteady (dizzy), depersonalization/derealization, elevated HR, N/V, tingling (paresthesia), SOB, Fear of losing control/dying, choking, chest pain, chills
What is panic disorder?
Recurrent panic attacks
1 attack followed by 1 months of anticipatory anxiety & maladaptive coping
How to mx panic disorder?
SSRI & CBT
What is GAD?
Long standing, free floating anxiety
Duration: 6m
Symptoms: worry (difficult to control), wound up (fatigue), absentminded (poor conc), restlessness, tension (muscle), sleepless
How to manage GAD?
SSRI + CBT
Others: short term BZD (bridging, prn)
What is agoraphobia?
Duration: 6m
Out of proportion anxiety about being in public spaces
2 causes of anxiety: open spaces, enclosed spaces, public transportation, leaving home alone, standing in line/crowd
Coping: avoidance, endurance of intense anxiety, req companion
How to manage agoraphobia?
SSRI + CBT (systematic desensitization, flooding or modelling)
What are the poor prognostic factors of GAD & agoraphobia?
Severe initial symptoms Marked agoraphobia Low SES, low education Poor social Long duration untreated
What is acute stress reaction?
Symptoms appear within 1m of stressor
What is PTSD?
Onset: within 6m of traumatic event
Duration: 1m
1) Intrusion symptoms: repetitive re-experiencing as flashback/dreams/memories/int or ext cues
2) Avoidance of stimuli
3) Negative mood & cognition: dissociative amnesia, negative beliefs/expectations, negative emotional state, self blame, anhedonia, detachment from others, avolition
4) Arousal symptoms: irritable/angry, reckless, hypervigilance, exaggerated startle response, x conc, poor sleep
How to manage PTSD?
Pharm: SSRI/SNRI/mirtazapine, prazosin (nightmares & hypervigilance), SGA (augment for severe)
Non-pharm: CBT (trauma-focused therapy, EMDR)
What is adjustment disorder?
Onset: within 3m of non-traumatic life event
Duration: within 6m of event
What are the prognostic factors of PTSD?
Pre-traumatic: personality & coping, psychiatric comobidity
Peri-traumatic: nature/duration/severity of event, physical harm & disfigurement
Post-traumatic: social support, financial & litigation worries, impairment on relationships, maladaptive coping, help seeking behavior, further trauma, severity of PTSD
How to assess functional impairment for PTSD?
Occupational
Social, family
ADL
Childcare
