Common Psychiatric Histories - Anxiety Flashcards
Anxiety
-key questions
Background to attacks
- new or ongoing?
- frequency
Attack detail
- triggers - place, time, person
- onset - rate
- duration
Somatic
-palpitations, SOB, tight chest, sweating, dizzy
Impacts on life
- coping mechanisms - support network, substances, compulsions
- relationships, work, hobbies, sleep
- depression screen
GAD
- core features
- risk factors
- management
Long term out of proportion anxiety most days about everything
Core features
- fatigue
- restless, on edge
- irritable
- poor focus
- sleep disrupted
- muscle tension
- CV or abdo complaints
Risk factors
- FHx
- childhood, recent life stresses
- chronic physical health cond
- substance use
Management
- CBT
- SSRIs
- mindfullness/sleep hygiene/relaxation techniques
PTSD
- 4 core features
- management
Exposure to traumatic event
SYMPTOMS FOR 1MONTH+
Intrusive symptoms
- visual, sensory flashbacks
- unpredictable onset in day and night
- insomnia, nightmares
Avoidance of anything related to event
-people, situations, circumstances
Negative alterations in cognition and mood
- amnesia for significant parts
- detachment from positive feelings, anhedonia
- guilt, blame, fear
Alterations in arousal and reactivity
Mx
- trauma focused CBT
- SSRIs
- EMDR
OCD
- core features
- risk factors
- management
Core features
Obsessions
-intrusive thoughts leading to distress
-recognition that they are irrational
Compulsions
- physical or mental acts that provide short term relief
- anxiety worsens if compulsions resisted
Risk factors
-FHx
Management
- CBT
- SSRIs
Phobias
- core features
- risk factors
- management
Anxiety over specific trigger
Core features
Anticipatory anxiety
-catastrophic thoughts, fears of being unable to cope
-‘how would you react if you were exposed to the situation now?’
Behavioural avoidance
Risk factors
- FHx
- other anxiety, mood disorders
Management
-CBT + exposure therapy
Social anxiety
- core features
- risk factors
- management
Risk factors
- anxiety, mood disorders
- FHx
- past life stressors
Anticipatory anxiety
-fear of being judged, criticised, embarrassement, symptoms of anxiety visible to others
SNS response
- high HR, RR, sweating
- muscle tension
Management
- CBT
- SSRIs
Panic disorder
- core features
- risk factors
- management
Risk factors
- FHx
- life stressors
Unexpected onset
-brief intense physical/psychological symptoms
Worry
- fears of losing control or dying
- fears of attacks
Behavioural avoidance
- to avoid provoking attacks
- agoraphobia, impacts on daily functioning
Management
Acute - reassurance (you will not die, the symptoms are not harmful, focus on your breathing and ground yourself)
Ongoing - CBT, SSRI
Important systems reviews
Depression screen
Core - low mood, anhedonia, low energy
Biological - early waking, difficulty sleeping,
Future - hopeless, self harm, suicidal ideation
Risk to self
-self care (eating, hygiene)
Risk to others
-dependents (unintentional neglect)
Systemic
- weight loss - related to appetite?
- fever, night sweats, backpain
Cardiopulmonary
- Hx of heart, lung conditions
- palpitations, chest pain, coughs
Endocrine
- Hx of diabetes
- polyuria, polydipsia
Possible organic differentials
Endocrine
- Hyperthyroidism
- Phaeochromocytoma
- Hypoglycemia
Cardiopulmonary
- Arrythmias
- ACS
- Lung conditions
Drug related
- caffeine, alcohol, recdrugs
- asthma meds, CS, herbal
Past medical history
Drug history
Family history
Under the care of mental health services before?
Physical health conditions?
-drug management
Drug history
- prescribed, herbal, OTC, inhaled
- caffeine, alcohol, recdrugs
Family history
-physical/mental health
Social history
-impacts of PC on life
Living
- accommodation
- social network, dependents, carers
Occupation
- work and impacts
- hobbies and impacts
Substances
-alcohol, smoking, recdrugs
Travel?
SSRI counselling key points
- condition used to treat
- ATHLETICSS
Understanding of condition
Action
- we have a variety of brain chemicals, each with many functions
- if we have a good balance of these brain chemicals, we feel good
- an imbalance of these brain chemicals can contribute to anxiety and depression
- SSRIs can help restore this balance
Timeline - OD How to take - PO tablet Length of treatment - stop 3-6months after feeling better => taper Effects - 4-6wks to take effect Tests - N/A
Important side effects -
-GI upset (D+N+V), appetite, weight changes
-headaches, drowsy
-2wks initial anxiety
-withdrawal symptoms (VITAL THAT WE DO NOT ABRUPTLY STOP SSRIs)
Complications, contraindications
-V rare, may trigger suicidality and self harm in young
Supplementary advice
-Mind
