Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine year 1 semester 2 > Case 9- Treating anxiety and MUSD > Flashcards

Case 9- Treating anxiety and MUSD Flashcards

1
Q

Physical symptoms of anxiety disorders

A
  • Autonomic arousal symptoms- palpitations or pounding heart, accelerated heart rate. Sweating, trembling or shaking, dry mouth.
  • Chest and abdomen- difficulty breathing, feeling of chocking, chest pain or discomfort, nausea or abdominal stress
  • General symptoms- Numbness or tingling sensation, hot flushes or cold chills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Psychological symptoms of anxiety disorders

A
  • The brain and mind- feeling light headed, feeling that objects are unreal (derealization) or that you are not there (depersonalization), fear of dying
  • Symptoms of tension- muscle tension, aches and pains, restlessness, mental tension, feeling on the edge, difficulty swallowing, feeling a lump in your throat.
  • Non-specific symptoms- exaggerated response to minor surprises, difficulty concentrating, persistent irritability, difficult to sleep because of worrying.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The effect of anxiety on the patient

A
  • Distress
  • Can negatively effect relationships.
  • Premature mortality.
  • Missing school/work
  • Increased healthcare costs
  • Reduced productivity
  • Unemployment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain the under detection of anxiety disorders

A

Often patients do not present, patients and doctors may find it difficult to talk about emotional symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Psychological treatment for anxiety disorders

A

First line intervention for most anxiety disorders. Cognitive-behavioural therapy (CBT) is the most widely used type. It is a talking therapy that aims to understand how your problems began and what keeps them going. CBT works by helping you to link the way that you think (thoughts and assumptions) with how you feel (emotions) and your behaviour. Can be used in primary or secondary care.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Drug treatment for anxiety disorder

A

SSRI’s such as sertraline, paroxetine and escitalopram. Often takes weeks to be effective. Benzodiazapines can be used in severe cases for a short amount of time. Drugs which reduce anxiety are anxiolytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What to give for anxiety disorders when SSRI’s are not tolerates

A

Consider a serotonin-noradrenaline reuptake inhibitor (SNRI) such as duloxetine or venlafaxine. If both SSRI’s and SNRI’s are not tolerated/contraindicated consider using a pregabalin (anti-epilepsy drug). Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are Benzodiazepines not prescribed often

A

Have associated problems with dependence and tolerance with chronic use and difficulty getting off them after only a few weeks of use. Use should therefore be reserved for short courses of treatment between 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Examples of Benzodiazepines

A

Diazepam, alprazolam, chlordiazepoxide hydrochloride and chlobazam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What types of mental disorders are Benzodiazepines prescribed for

A

Should not be prescribed for stress-related symptoms or unhappiness but only for treating chronic stress. They are not appropriate for depression or chronic psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The criteria for prescribing benzodiazepines

A
  • You have severe, disabling, unacceptable distress
  • Associated with insomnia which is severe, disabling and causing extreme distress
  • Associated short-term psychosomatic, organ, or psychotic illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Contraindications for Benzodiazepines and Z-drugs

A

Benzodiazepines and the Z–drugs (Zolpidem, zopiclone) contraindicated in the elderly due to risk of ataxia, confusion and falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Beta blockers and anxiety

A

Beta blockers can reduce palpations and tremors but not anxiety associated muscle tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anxiolytic drugs- Buspirone (5-HT1A agonists)

A

Used to treat general anxiety disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Side effects of Buspirone

A

Dizziness, nausea and headache. There is no sedation or loss on coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contraindications of Buspirone

A

Epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treating insomnia

A

The cause of insomnia should be determined before prescribing drug treatment. Short acting hypnotics are an option for sleep onset insomnia and for elderly patients. Long-acting hypnotics may be considered for poor sleep maintenance with daytime effects. It is used when a daytime anxiolytic effect is required and when daytime sedation is acceptable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Transient insomnia

A

Caused by extraneous factors such as noise, shift work and jet lag. Use a rapidly eliminated hypnotic drug with 1-2 doses. Only prescribe drugs when needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Short term insomnia

A

Normally due to emotional problems or a serious medical illness. Hypnotics can be useful but shouldn’t be used for more than three weeks, a short acting drug is appropriate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Chronic insomnia

A

Rarely benefitted by hypnotics. Sleep disturbance is very common in depression (early wakening) and the underlying psychiatric condition should be treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is routine hypnotics undesirable

A

Tolerance can develop within 2 to 14 days. Subsequent withdrawal can cause rebound insomnia and withdrawal syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Benzodiazepine hypnotics

A

Nitrazepam and Flurazepam have prolonged actions with effects lasting into the next day. Loprazolam, Lormetazepam and Temazepan have shorter actions with little or no hangover effect but withdrawal is more common. Diazepam is sometimes used for insomnia associated with daytime anxiety but effects may be long lasting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Z-drugs (Z-hypnotics zolpidem and Zopiclone)

A

Non-benzodiazepine hypnotics which act on the benzodiazepine receptor alpha 1 subunit. It is not licensed for long term use. Both drugs have a short duration of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Side effects of Z-drugs

A

May cause dependence, daytime sedation and ataxia so are not appropriate for elderly patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Benzodiazepine mechanism of action

A

Benzodiazepine binds to GABA receptors -> increased GABA affinity towards its binding site -> increased frequency of Cl- channel opening -> increased Cl- influx -> Hyperpolarisation -> Increased CNS inhibition effect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Benzodiazepine pharmacokinetics

A

They are orally well absorbed and reach peak plasma concentration after 1 hour. They bind highly to plasma proteins and are very lipid soluble so accumulate in fat causing a high VD. They can be given as IV in acute seizures or anaesthesia or through IM which results in slow absorption

27
Q

Benzodiazepine excretion

A

Benzodiazepines undergo Hepatic P450 metabolism and are excreted as glucuronide conjugates in the urine (phase 2 metabolism). Metabolites may also be active causing cumulative effects and long hangovers. The duration of action can be divided into short, medium and long-acting drugs. This determines use of drug. The elderly may experience prolonged effects due to reduced metabolism

28
Q

Short acting Benzodiazepine’s

A

Temazepam, Lorazepam. Used as hypnotics, there is a reduced hangover effect. Lasts 12-18 hours

29
Q

Long acting Benzodiazepine’s

A

Chlordiazepoxide, Diazepam. 24-48 hours. Used as anticonvulsants, muscle relaxant and anxiolytics

30
Q

Ultra short Benzodiazepine’s

A

Midazolam. Less then 6 hours. Surgical sedative/hypnotic

31
Q

Acute toxic effects of Benzodiazepines

A

Overdose effects can be reversed by flumazenil which acts as an antagonist. Benzodiazepines are less dangerous then other drugs that cause prolonged sleep in overdose. If combined with a CNS depressant (i.e. alcohol) it may cause severe respiratory depression.

32
Q

Tolerance and Dependence of Benzodiazepines

A

Tolerance of the drug causes an increase in the dose required to produce the desired effect as there is long term change in the number of receptors. Dependence may become apparent after 4-6 weeks with cessation causing increased anxiety, tremors, dizziness and insomnia. Withdrawal should be gradual and symptoms may take 3 weeks to appear.

33
Q

Medically unexplained symptoms (MUS)

A

Physical symptoms persisting for more than several weeks and for which adequate medical examination has not revealed a condition that adequately explains the symptoms

34
Q

How many people experience MUS?

A

10-20% of people will have multiple episodes in their lifetime. About 50% of outpatient clinics fulfil the criteria for MUS

35
Q

Similarities between MUS and a functional disease

A

1) Lack of identifiable or visible pathology to cause symptoms
2) Persistence- lasts for weeks/months
3) Disorder of function

36
Q

Functional disease

A

1) Disease which affects a function or performance
2) Condition marked by signs or symptoms of an organic disease but examination fails to reveal any evidence of structural or physical abnormalities
3) Symptoms are real

37
Q

Impact of MUS

A

Annual NHS cost for MUS in adults is about £2.89 billion.
Sickness absence and decreased quality of life - cost the UK economy about £14 billion

Patients with MUS more likely to have more investigations:

  • due to no answers or reassurance
  • multiple tests, referrals, appointments
38
Q

Quality of life with someone with MUS

A

People with moderate or severe MUS have significant impairment in quality of life to the same extent as someone with explained symptoms:

  • similar rate of attendance and consultation
  • similar rate of referral and investigation
39
Q

Common MUS diagnosis

A 
Gastroenterology - IBS
Cardiology - non cardiac chest pain
Rheumatology - fibromyalgia
Neurology - chronic headache
ENT - dizziness/vertigo
Gynaecology - pelvic pain
Medicine - chronic fatigue
40
Q

Are MUS discrete conditions

A

No- there is a huge overlap between groups of symptoms and people vary with what they experience

41
Q

Risk factors for MUS

A 
Survivors of child abuse
Current physical illness
Severe illness or death of a close relative
People with long term conditions
Refugees
People with low health literacy
Women
42
Q

Prognosis of someone with MUS

A

50-75% of people diagnosed with MUS by their GP - symptoms decrease over 12 month
Good doctor patient relationship is associated with more positive outcome
10-30% of symptoms will worsen
Number of symptoms, duration and severity are associated with worth outcome

43
Q

Treatment for MUS

A

A good doctor patient relationship helps. Accepting suffering, managing symptoms and expectations and provide support for the patient.

44
Q

MUS symptoms

A
  • Gastrointestinal: abdominal pain, altered defecation, bloating/swelling, reflux, nausea and vomiting.
  • Cardiovascular: palpitations, chest pain, shortness of breath
  • Musculoskeletal: muscle or limb pain, joint pain, back pain, loss of strength, pain with movement.
  • Neurological: headaches and dizziness
  • ENT: dizziness, vertigo and tinnitus
  • Gynaecological: pelvic pain, painful intercourse
  • General: fatigue/tiredness, loss of memory, poor sleep
45
Q

Psychological association with MUS

A

Depression and anxiety are more common in MUS. That may be due to the stress of the symptoms and lack of diagnosis. Is it cause or effect

46
Q

Management of MUS

A
  • May need psychological support ie CBT
  • Exercise- discourage avoidant activity like not going out
  • Occupational medicine support to get patients back to work
  • Community activity groups
  • Patient support groups
  • Pain clinics
  • Talk to colleagues about when to stop investigating.
47
Q

MUS- Somatosensory amplification theory

A

Patients become hyper-aware of particular sensations and symptoms, the symptoms have an emotional quality like worry. The reception in the brain of the symptom becomes associated with the emotion. So by the time the person is aware of the symptom it is linked to the emotion. Example= ectopic heartbeats have been linked to fear.

48
Q

MUS- endocrine dysregulation theory

A

There is evidence of hypothalamic-endocrine dysfunction affecting the feedback loop that regulates stress responses. May be linked to over production of cortisol. This can result in chronic fatigue and pain.

49
Q

MUS- Immune system sensitisation theory

A

Chronic immune activation with production of cytokines that don’t switch off when the stressful stimulus is removed. Explains why illness is associated with symptoms like pain or fatigue.

50
Q

MUS- Autonomic nervous system dysfunction theory

A

As a result of parasympathetic nerve system dysfunction, a patients pulse rate may not return to normal after a stressful event

51
Q

MUS- Abnormal proprioception theory

A

Abnormal proprioception (feeling of where your body is and movement) can be a cause of physical symptoms in patients with MUS. Minimal changes in muscle tension could lead to an enhanced feeling of abnormality.

52
Q

MUS- the theory of central sensation

A

Heightened perception of and distress from sensory inputs (enhanced somatic response). This is because there is no inhibition of the touch signal to the pain signal so they combine and the person feels pain

53
Q

Hyperalgesia

A

Heightened perception of pain from painful stimuli (hurts more then it should)

54
Q

Allodynia

A

Perception of pain from non-painful stimuli (light touch)

55
Q

MUS- the signal filter model

A

This model uses the idea that we filter out signals from the body so that we don’t get over stimulation. When there are problems with the filter mechanism it increases our perception of pain.

56
Q

MUS- Illness behaviour model

A

Patient beliefs lead to avoidance. Example= chronic fatigue makes the patient believe they will get tired after activity so they avoid it, they then become deconditioned.

57
Q

MUS- sensitivity theory

A

Variant beliefs lead to avoidance. Example= chronic fatigue makes the patient believe they will get tired after activity so they avoid it, they then become deconditioned.

58
Q

MUS- CBT model

A

Combines many different theories, it shows how the symptom, awareness and emotional and autonomic response are all linked. Eg experience of chest pain/tightness – increased heart rate, increased blood pressure, fear over symptoms, panic, anxiety

59
Q

Diagnosing mood disorders

A

Diagnostics is largely based on history taking. Symptoms are subjective. Symptoms vary they can be situational (normal response to life event) or continual (continual unhelpful response to life events).

60
Q

Biological factors which can effect mood disorders

A

Anaemia, menopause and hyperthyroidism can make you feel tired and depressed

61
Q

Two core symptoms of depression?

A

During the last month have you felt depressed, down or helpless?
During the last month have you been bothered by little interest or pleasure in what you are doing?

62
Q

PHQ-9

A

A questionaire used to assess depression. However, it is only one tool. Severity and duration do not tell the whole story

63
Q

Characteristics of grief?

A

1) Biological symptoms of loss of sleep, appetite and concentration
2) Distress relates to a particular loss
3) The person retains their capacity for pleasure
4) Grief comes in waves
5) The person may express a passive wish for life to end
6) The person is able to look forward to the future
7) Most people cope without medical interventions

64
Q

Characteristics of depression

A

1) Biological symptoms plus psychological symptoms of hopelessness, worthlessness and guilt
2) Distress is usually generalised to all facets of life
3) The person enjoys nothing
4) Depression is constant and unremitting
5) The person may express suicidal ideation
6) The person has no sense of a positive future
7) Medical or psychological interventions are usually necessary

Medicine year 1 semester 2 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions