Clinical Topic 1: Anxiety Flashcards
Generalised Anxiety Disorder:
- What is the age of onset?
- What gender(s) does it affect?
Age of onset: 20s
Affects women 2x as much as men
Panic Disorder:
- What is the age of onset?
- What gender(s) does it affect?
Age of onset: mid-20s and 50s (bimodal)
Affects women 2-3x as much as men
Why does Generalised Anxiety Disorder affect women more than men?
Protective effects of testosterone, and cultural expectations of women
Specific Phobias:
- What is the age of onset?
- What gender(s) does it affect?
Age of onset: First exposure in adolescence, but develops in adulthood
Affects women 2-3x as much as men
What hormones are released during anxiety?
Cortisol, Catecholamines
What are the clinical features of Generalised Anxiety Disorder, and what criteria must be met for a diagnosis to be made?
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
What are the treatment options for Generalised Anxiety Disorder?
- 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)
Give examples of two conditions which can cause Anxiety?
Hyperthyroidism
Pheochromocytoma
How can you determine if a patient’s anxiety may be caused by Pheochromocytoma?
24-hour urine Catecholamine test
Give examples of seven Anxiety-related disorders
- Generalised Anxiety
- Panic disorder
- Specific phobia
- Social phobia
- Agoraphobia
- Obsessive Compulsive Disorder
- Post-traumatic Stress Disorder
What are commonalities and differences between Generalised Anxiety Disorder and Panic Disorder
Both do not have a specific trigger, however GAD describes constant anxiety, whereas Panic Disorder describes periodical anxiety
What are the clinical features of Panic Disorder
Same criteria as Generalised Anxiety Disorder, however the patient’s recurrent attacks should be unpredictable in nature
What are the treatments options for Panic Disorder
- Cognitive Behavioural Therapy
- Selective Serotonin Reuptake Inhibitors
Which phobias impact on Quality of Life more than others?
Specific phobias - little impact on QoL (avoidance)
Social phobias - large impact on QoL
Agoraphobias - large impact on QoL
What is Attentional Bias as seen in patients with Specific Phobias?
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)
What are the treatment options for Specific Phobias?
- Exposure therapy
- Cognitive Behavioural Therapy
How might parents prevent Phobia formation in their children?
Through positive association techniques i.e. small rewards like a sticker when visiting the dentist
Social Phobias:
- What is the age of onset?
- What gender(s) does it affect?
- Age of onset is early adolescence
- Affects women 2-3x as much as men
State 3 safety behaviours associated with Social Phobias
- Drinking alcohol
- Avoiding eye-contact
- Not asking questions
What are the treatment options for Social Phobias?
- Cognitive Behavioural Therapy
- Guided self-help
- SSRIs i.e. Sertraline, Escitalopram
- BB i.e. Propanolol / Atenolol (to treat performance anxiety in musicians)
Agoraphobia:
- What is the age of onset?
- What gender(s) does it affect?
Age of onset: Early 20s, 30s
More common in women
What is the first-line SSRI for a children with anxiety / depression?
Fluoxetine
Define “agoraphobia”
Anxiety disorder with fear and avoidance of places or situations that might one panic, feel trapped, helpless or embarrassed
What are the clinical features to diagnose Agoraphobia? What sort of safety behaviours do such patients exhibit?
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
What are the treatment options for Agoraphobia?
- Cognitive Behavioural Therapy
- SSRIs
- Benzodiazepines (short-term)
Obsessive Compulsive Disorder:
- What is the age of onset?
- What gender(s) does it affect?
Develops BEFORE age 12
Equal presentation in males & females
State 4 risk factors for Obsessive Compulsive Disorder
- Overprotective parenting style
- Learned OCD from parents
- Stressful life events
- Streptococcal infection
What is the criteria for an Obsessive Compulsive Disorder diagnosis?
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
What are the treatment options for Obsessive Compulsive Disorder?
- CBT: Exposure and Responce Prevention
- SSRIs: As effective as CBT in >18 year olds
State some behaviours exhibited by OCD patients
Checking Cleaning / Contamination Hoarding Repetitive Thinking Orderliness Avoidance
Describe when an Acute Stress Reaction may start and when it may resolve
- Starts within an hour of exposure to stressor
- Symptoms resolve within 8 hours of removing stressor
- NO residual symptoms after a few days
What is the name given to very severe Acute Stress Reaction? How are patients described?
Dissociative stupor, whereby patients are unresponsive but not unconscious
What are the treatment options for Acute Stress Reaction?
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
Describe when PTSD symptoms may begin from the point of exposure to stressor
In most cases, symptoms start as soon as exposed to stressor
What are the treatment options for PTSD?
- Trauma focused CBT
- Eye-movement desensitisation and reprogramming
- SSRI PAROXETINE
Which part of the brain processes emotions and determines whether a stress response is required?
Amygala
Which serotonin receptor is thought to be most significant in anxiety? Give an example of a medication which can agonise this?
5-HT1A, Buspirone
Mechanism of action of benzodiazepines?
Positive allosteric modulators of GABAa receptors
When withdrawing benzodiazepine treatment, you should reduce the dose how often?
Every 2-3 weeks, in steps of 2-2.5mg
During withdrawal of benzodiazepines, when should they be taken?
At night
Which area of the brain is responsible for re-experiencing traumatic memories?
Hippocampus
Benzodiazepines should be used in anxiety for how long?
Less than 2 weeks
To be diagnosed with OCD, obsessional thoughts or compulsive acts must be present for most days for at least how long?
2 weeks
If a beta blocker is to be prescribed for anxiety, which one is most likely to be used?
Propanolol
What is the antidote to Benzodiazepines?
Flumazenil
What are the two types of drug classes which act on GABAa? How do they act on Cl ions?
Benzodiazepines: Increase frequency of Cl- flux
Barbituates: Increase duration of Cl- flux
What duration should symptoms typically be present, before the diagnosis of PTSD can be made?
1 month
What is GAD7?
Used as a screening tool and severity measure for generalised anxiety disorder
