GAD Flashcards
for GAD, symptoms have to be impacting life and present most days for how long ?
6 months
what is the treatment of GAD
CBT
SSRI/SNRI
PREGABLIN
can benzos be given?
in the short term only
what is agoraphobia?
avoiding places or situations where you might feel panicked, trapped, embarrassed or hopeless
does panic disorder have to occur with agoraphobia?
no, can be separate
what can panic disorder be the direct result of ?
the physiological effects of a drug or general medical condition e.g. hyperthyroid, caffeine intoxication
Can generalised anxiety disorder be caused by substance misuse or another medical condition ?
no
typical onset of panic disorder?
adolescence and 30s
@ 10 year follow up - rule of 1/3ds?
with panic disorder, at 10 year follow up - 1/3 will be better, 1/3 the same and 1/3 worse
why can panic attacks be triggered by re breathing air/
increased CO2
panic atacks can be triggered in susceptible individuals by infusions of?
lactate
treatment of panic disorders?
Cognitive Behavioural Therapy
SSRIs / SNRIs / Tricyclics
The three types of phobia
agoraphobia
social phobia
specific phobia
when do phobias present?
usually early onset in life
A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes. Avoidance of the phobic situation is often prominent, and some people with agoraphobia experience little anxiety because they are able to avoid their phobic situations
agoraphobia
agoraphobia is usually 2y to another disorder such as ?
panic disorder or depression
someone who goes shopping to 24 hour store at night when quiet?
agoraphobia
a marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
specific phobia
phobia of spiders would be which type of phobia ?
specific
treatment of phobia ?
behavioural therapy -Graded exposure / systematic desensitisation
Add in CBT if necessary
SSRIs / SNRIs if required
the individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating?
social phobia/ social anxiety disorder
a persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
social phobia
tx of social phobia?
Cognitive Behavioural Therapy
SSRIs / SNRIs
Benzodiazepines (short term only)
what is OCD?
Recurrent obsessional thoughts and/or compulsive acts
what kind of obsessional thoughts?
Ideas, images or impulses entering the mind in a stereotyped way
Compulsive Acts examples?
Repeated rituals or stereotyped behaviours
Not enjoyable
Obsessional symptoms or compulsive acts must be present most days for at least?
2 weeks, and be a source of distress
treatment of OCD?
cognitive behaviour therapy and SSRI
what do benzos enhace the effect of
GABA
There is a benzodiazepine binding receptor on which receptor ?
GABA A receptor (a for anxiety)
what other substances act on the GABA - A receptor?
alcohol and barbiturates
agonists at the BZD site produce what effect? and antagonists produce what effect?
agoinsts produce relaxation and anti convulsant effects
antagonists cause anxiety and are pro-convulsant
Benzodiazepines - are they well tolerated?
yes
Problems with BZD if used over 2 weeks?
sedation and psychomotor impairment withdrawal problems dependancy and abuse alcohol interaction can worsen co morbid depression
treatment of anxiety conditions is generally ?
CBT or behavioural therapy and/or SSRIs.
important differentials for anxiety (medical)
hyperthyroid, cardiac disease and medication induced
medications that cause anxiety?
caffeine, salbutamol, theophylline, corticosteroids, antidepressants
first line SSRI?
sertraline (certainty)
what do you need to warn young patients about when starting them on sertraline?
increased risk of suicidal thinking and self harm
acts as an emotional filter for the brain for assessing whether sensory material via the thalamus requires a stress or fear response
amygdala
