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Medicine, Year 3, Mental Health > Clinical Topic 1: Anxiety > Flashcards

Clinical Topic 1: Anxiety Flashcards

1
Q

Generalised Anxiety Disorder:

  • What is the age of onset?
  • What gender(s) does it affect?
A

Age of onset: 20s

Affects women 2x as much as men

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2
Q

Panic Disorder:

  • What is the age of onset?
  • What gender(s) does it affect?
A

Age of onset: mid-20s and 50s (bimodal)

Affects women 2-3x as much as men

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3
Q

Why does Generalised Anxiety Disorder affect women more than men?

A

Protective effects of testosterone, and cultural expectations of women

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4
Q

Specific Phobias:

  • What is the age of onset?
  • What gender(s) does it affect?
A

Age of onset: First exposure in adolescence, but develops in adulthood
Affects women 2-3x as much as men

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5
Q

What hormones are released during anxiety?

A

Cortisol, Catecholamines

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6
Q

What are the clinical features of Generalised Anxiety Disorder, and what criteria must be met for a diagnosis to be made?

A

Psycho-social symptoms: “Free-floating” worry about normal, everyday things i.e. showering, cooking. Having catastrophic thoughts.

Biological symptoms: Palpitations, sweating, nausea, weight loss, insomnia

Social symptoms: Isolation, functional impairment

Diagnosis: 4 or more symptoms, for >6 months

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7
Q

What are the treatment options for Generalised Anxiety Disorder?

A
  • Psychoeducation: Self-help, CBT books, mindfulness apps
  • Psychological Intervention: CBT, Motivational Interviewing, Problem-solving therapy
  • Medication: Sertaline, Escitalopram (SSRI), Pregabalin (Ca channel blocker), Buspirone (5-HT1A agonist), Benzodiazepines (short-time relief)
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8
Q

Give examples of two conditions which can cause Anxiety?

A

Hyperthyroidism

Pheochromocytoma

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9
Q

How can you determine if a patient’s anxiety may be caused by Pheochromocytoma?

A

24-hour urine Catecholamine test

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10
Q

Give examples of seven Anxiety-related disorders

A
  1. Generalised Anxiety
  2. Panic disorder
  3. Specific phobia
  4. Social phobia
  5. Agoraphobia
  6. Obsessive Compulsive Disorder
  7. Post-traumatic Stress Disorder
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11
Q

What are commonalities and differences between Generalised Anxiety Disorder and Panic Disorder

A

Both do not have a specific trigger, however GAD describes constant anxiety, whereas Panic Disorder describes periodical anxiety

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12
Q

What are the clinical features of Panic Disorder

A

Same criteria as Generalised Anxiety Disorder, however the patient’s recurrent attacks should be unpredictable in nature

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13
Q

What are the treatments options for Panic Disorder

A
  • Cognitive Behavioural Therapy

- Selective Serotonin Reuptake Inhibitors

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14
Q

Which phobias impact on Quality of Life more than others?

A

Specific phobias - little impact on QoL (avoidance)
Social phobias - large impact on QoL
Agoraphobias - large impact on QoL

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15
Q

What is Attentional Bias as seen in patients with Specific Phobias?

A

Patients with Specific Phobias may see a trigger earlier than others who do not perceive it to be a phobia, or misinterpret objects which may resemble their phobia but is not (i.e. a Tomato stalk for a spider)

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16
Q

What are the treatment options for Specific Phobias?

A
  • Exposure therapy

- Cognitive Behavioural Therapy

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17
Q

How might parents prevent Phobia formation in their children?

A

Through positive association techniques i.e. small rewards like a sticker when visiting the dentist

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18
Q

Social Phobias:

  • What is the age of onset?
  • What gender(s) does it affect?
A
  • Age of onset is early adolescence

- Affects women 2-3x as much as men

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19
Q

State 3 safety behaviours associated with Social Phobias

A
  • Drinking alcohol
  • Avoiding eye-contact
  • Not asking questions
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20
Q

What are the treatment options for Social Phobias?

A
  • Cognitive Behavioural Therapy
  • Guided self-help
  • SSRIs i.e. Sertraline, Escitalopram
  • BB i.e. Propanolol / Atenolol (to treat performance anxiety in musicians)
21
Q

Agoraphobia:

  • What is the age of onset?
  • What gender(s) does it affect?
A

Age of onset: Early 20s, 30s

More common in women

22
Q

What is the first-line SSRI for a children with anxiety / depression?

A

Fluoxetine

23
Q

Define “agoraphobia”

A

Anxiety disorder with fear and avoidance of places or situations that might one panic, feel trapped, helpless or embarrassed

24
Q

What are the clinical features to diagnose Agoraphobia? What sort of safety behaviours do such patients exhibit?

A

Any two of the following:

  • Anxiety in a public place
  • Anxiety in crowds
  • Anxiety when travelling away from home
  • Anxiety when travelling alone

Safety behaviours: Won’t leave without a trusted individual, do online shopping, travelling to specific destinations

25
Q

What are the treatment options for Agoraphobia?

A
  • Cognitive Behavioural Therapy
  • SSRIs
  • Benzodiazepines (short-term)
26
Q

Obsessive Compulsive Disorder:

  • What is the age of onset?
  • What gender(s) does it affect?
A

Develops BEFORE age 12

Equal presentation in males & females

27
Q

State 4 risk factors for Obsessive Compulsive Disorder

A
  • Overprotective parenting style
  • Learned OCD from parents
  • Stressful life events
  • Streptococcal infection
28
Q

What is the criteria for an Obsessive Compulsive Disorder diagnosis?

A

Criteria for GAD and:

Obsessions or compulsions present for most days for at least 2 weeks and be a source of distress. Individual must have resistance and find the ritual unpleasant

29
Q

What are the treatment options for Obsessive Compulsive Disorder?

A
  • CBT: Exposure and Responce Prevention

- SSRIs: As effective as CBT in >18 year olds

30
Q

State some behaviours exhibited by OCD patients

A 
Checking
Cleaning / Contamination
Hoarding
Repetitive Thinking
Orderliness
Avoidance
31
Q

Describe when an Acute Stress Reaction may start and when it may resolve

A
  • Starts within an hour of exposure to stressor
  • Symptoms resolve within 8 hours of removing stressor
  • NO residual symptoms after a few days
32
Q

What is the name given to very severe Acute Stress Reaction? How are patients described?

A

Dissociative stupor, whereby patients are unresponsive but not unconscious

33
Q

What are the treatment options for Acute Stress Reaction?

A

Supportive Management

  • Remove patient from stressor, care for in safety
  • Admit patient to psychiatric / medical ward
  • Monitor patient for suicide depending on symptoms
  • Short term benzodiazepines
34
Q

Describe when PTSD symptoms may begin from the point of exposure to stressor

A

In most cases, symptoms start as soon as exposed to stressor

35
Q

What are the treatment options for PTSD?

A
  • Trauma focused CBT
  • Eye-movement desensitisation and reprogramming
  • SSRI PAROXETINE
36
Q

Which part of the brain processes emotions and determines whether a stress response is required?

A

Amygala

37
Q

Which serotonin receptor is thought to be most significant in anxiety? Give an example of a medication which can agonise this?

A

5-HT1A, Buspirone

38
Q

Mechanism of action of benzodiazepines?

A

Positive allosteric modulators of GABAa receptors

39
Q

When withdrawing benzodiazepine treatment, you should reduce the dose how often?

A

Every 2-3 weeks, in steps of 2-2.5mg

40
Q

During withdrawal of benzodiazepines, when should they be taken?

A

At night

41
Q

Which area of the brain is responsible for re-experiencing traumatic memories?

A

Hippocampus

42
Q

Benzodiazepines should be used in anxiety for how long?

A

Less than 2 weeks

43
Q

To be diagnosed with OCD, obsessional thoughts or compulsive acts must be present for most days for at least how long?

A

2 weeks

44
Q

If a beta blocker is to be prescribed for anxiety, which one is most likely to be used?

A

Propanolol

45
Q

What is the antidote to Benzodiazepines?

A

Flumazenil

46
Q

What are the two types of drug classes which act on GABAa? How do they act on Cl ions?

A

Benzodiazepines: Increase frequency of Cl- flux
Barbituates: Increase duration of Cl- flux

47
Q

What duration should symptoms typically be present, before the diagnosis of PTSD can be made?

A

1 month

48
Q

What is GAD7?

A

Used as a screening tool and severity measure for generalised anxiety disorder

Medicine, Year 3, Mental Health (10 decks)

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