IC15 Anxiety & Sleep Disorders Flashcards
What is Anxiety Disorders?
Anxiety disorder is a condition where anxiety starts to impair function.
The irrational fear and anxiety that a pt faces is severe, excessive, and persistent to the point where it impairs function with daily living.
What are the 5 types of anxiety disorders that we learn in this IC?
- Generalized Anxiety Disorder (GAD)
- Panic Disorder (PD)
- Social Anxiety Disorder (SAD)
- Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
What is considered common in terms of percentages of a disease?
E.g. OCD has a prevalence of 3.6% in Singapore
Anything that is more than 1-2% is considered common.
What is the definition of the 5 types of anxiety disorders?
- Generalized Anxiety Disorder (GAD)
- Panic Disorder (PD)
- Social Anxiety Disorder (SAD)
- Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
GAD - excessive anxiety & worries ≥ 6 months
PD - anticipatory anxiety of recurrent panic attacks
SAD - fear of being scrutinized or humiliated by others in public
OCD - Obsessional thoughts/impulses that causes anxiety, followed by compulsive behaviours to relieve that anxiety
PTSD - Re-experiencing of trauma, Persistent Avoidance, Increased arousal
What are the neurotransmitters involved in anxiety?
- Noradrenaline
- Serotonin
- GABA
What are possible medical conditions that are associated with anxiety?
(1) Cardiovascular - ?
(2) Endocrine - ?
(3) Neurologic - ?
(4) Pulmonary - ?
(1) Cardiovascular - Heart failure
(2) Endocrine - Hyperthyroidism
(3) Neurologic - Dementia, Delirium
(4) Pulmonary - Asthma, COPD
What are some drug classes that can cause drug induced anxiety?
- Stimulants - a class of drug that can increase norepinephrine & dopamine levels
- Corticosteroids
- Antidepressants - e.g SSRI, SNRI
- Dopamine agonists
- Others - levothyroxine, caffeine and etc.
Other possible drug-related causes of anxiety are:
- Drug withdrawal, such as opioid or Benzodiazepine
- Drug intoxication
What is the definition of Generalized Anxiety Disorder (GAD)?
GAD is defined as excessive anxiety & worry occurring for ≥6 months about a number of events or activities.
What are the S&S that a pt must present for ≥6 months to be diagnosed w GAD?
Pt must present with ≥3 S&S of:
- Restlessness
- Easily fatigued
- Difficulty concentrating
- Sleep disturbances
- Irritability
- Muscle tension
REDSIM
for ≥ 6 months.
The symptoms cause significant functional impairment.
What is the criteria to diagnose a pt with panic disorder (PD)?
Patient must present with both (1) and (2):
(1) Recurrent unexpected panic attacks
(2) ≥1 panic attacks leading to ≥ 1 month of the following:
- Persistent anticipatory anxiety
- Worry about outcomes of the panic attack
- Significant change in behaviour related to the panic attacks
What is the criteria to diagnose a pt with social anxiety disorder (SAD)?
A pt must present w these fear for ≥6 months:
- Marked & persistent fear of ≥1 social situations, which the person is exposed to scrutiny by others.
- The person fears that they will act in a way that is humiliating or embarrassing.
This fear is so bad that it impairs function.
A pt w Obesessive-Compulsive Disorder (OCD) will present with either obsessions or compulsions.
What is considered as obsession and compulsion?
Obsession:
- Recurrent & persistent thoughts that are intrusive and inappropriate, causing anxiety.
- Person knows that the obsession is a product of his own mind
Compulsion:
- Repetitive behaviours or mental acts that a person feels driven to do in a response to an obsession.
- Behaviours are aimed to prevent and reduce distress, but are clearly excessive and not connected in a realistic way.
These obsessions and compulsions can be time consuming or significantly impairs function.
What is the difference between OCD and psychosis?
OCD patients are aware that their thoughts are irrational, whereas psychosis patients are unaware and they totally believe their thoughts.
What is the process of a pt developing PTSD?
- Person is exposed to a threat, death, serious injury, sexual violence and etc.
- Traumatic event is persistently re-experienced
- Pt puts in persistent effort to avoid any trauma stimuli
- Pt’s mood and cognition begins to worsen
- Trauma-related alterations can lead to arousal and reactivity - such as aggressive behaviour, sleep disturbances
What assessment tool can you use to assess the severity of a pt’s anxiety?
The Hamilton Anxiety Scale (HAM-A)
HAM-A is the GOLD standard to use, to assess a pt’s anxiety severity.
What are the possible treatments for GAD?
Non-pharmacological:
- Cognitive Behavioural Therapy (CBT)
- CBT to be used w medications
Pharmacotherapy:
- SSRIs
- Venlafaxine XR
- Pregabalin
What are the possible treatments for PD?
Non-pharmacological:
- Cognitive Behavioural Therapy (CBT)
- CBT to be used w medications
Pharmacotherapy:
- SSRIs
What are the possible treatments for Social Anxiety Disorder (SAD)?
SSRIs
What are the possible treatments for OCD?
Non-pharmacological:
- Cognitive Behavioural Therapy (CBT)
- CBT to be used w medication
Pharmacotherapy:
- SSRIs
- Clomipramine
What are the possible treatments for PTSD?
Non-pharmacological:
- Cognitive Behavioural Therapy (CBT)
- CBT to be used w medication
Pharmacotherapy:
- SSRIs
Recall from depression IC:
What are examples of serotonergic antidepressants?
- SSRIs (escitalopram, fluoxetine)
- SNRIs (venlafexine XR, duloxetine)
- Clomipramine (a TCA)
What is the approach to dosing when it comes to antidepressants?
Start low, go slow.
Starting dose must be low.
Maintenance dose may be high at the end of the range.
How does antidepressants help in anxiety patients?
Antidepressants are effective for excessive worrying type of symptoms.
Antidepressants take about 4-8 weeks for their onset.
Full response takes about 3 months.
How does benzodiazepines help in anxiety patients?
Benzodiazepines are effective for physical symptoms.
Benzodiazepines should be used for short term.
E.g of benzodiazepines: Clonazepam, lorazepam, alprazolam XR (most potent & for panic disorder)
