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3a psychiatry > Neuroses > Flashcards

Neuroses Flashcards

1
Q

What is the aetiology of generalised anxiety disorder?

A
  1. biological
    low levels of GABA
    heightened amygdala activation in response to stimulus
  2. Genetics
  3. childhood
    sexual and physical abuse
    demands for high achievement
    seperation and neglect
4. stress
financial problems
chronic disease
bereavement 
lack of relationship
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2
Q

outline the DSM5 criteria for GAD?

A
  1. > 6 months of excessive, difficult to control worry about everyday issues that is disproportionate to risk and that causes distress
  2. worry not confined to another mental health disorder
  3. > 3 of the following symptoms: restlessness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance
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3
Q

What symptoms are seen with generalised anxiety disorder?

A

increased sympathetic activity= sweating, palpitations, tachycardia, diarrhoea, drug mouth

hyper vigilance= difficulty getting to sleep, night terrors, irritability, poor concentration

motor tension= tremor, hyperactive deep reflexes, restlessness, headaches, muscle stiffness

physical symptoms= breathing difficulties, choking sensation, hyperventilation, faint/light headed , chest pain, butterflies in stomach

psychological symptoms= excessive worry, agitated, irritable, obsessions, fears

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4
Q

What is the difference between generalised anxiety disorder and panic attack disorder?

A

GAD attack comes on in relation to stressor whilst PAD in unprovoked and unpredictable

PAD is acute and short lived whilst GAD is chronic worrying

PAD is sudden onset of intense panic whilst GAD is gradual onset that intensifies over time

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5
Q

What are the differential diagnosis for generalised anxiety disorder?

A 
hyperthyroidism
pheochromocytoma
episodic hypoglycaemia 
depression
substance misuse
schizophrenia 
anxious personality disorder
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6
Q

What is the pathology behind generalised anxiety disorder?

A

increased sympathetic activity
overactivity of ascending noradrenergic neurones
increase arousal
excessive activity of serotonin causing enhanced responses to nerve stimuli

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7
Q

What is the management for generalised anxiety disorder?

A
  1. symptom control = exercise, self help, listening, education, active monitoring
  2. therapies = low intensity psychological interventions (IAPT individual guided self help , self help groups)
  3. SSRIs 1st line = sertraline (pregabalin and beta blockers next step) + high intensity psychological therapy e.g. CBT, relaxation therapy
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8
Q

What is used in acute generalised anxiety disorder crisis?

A

benzodiazepines - no longer than 2-4 weeks as high risk of dependence

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9
Q

Define phobia

A

reoccurring excessive and unreasonable psychological or autonomic symptoms of anxiety in the presence of specific feared object of situation, leading to avoidance

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10
Q

What are the clinical features of phobias?

A

the 3 A’s of phobias…
Anxiety symptoms
Anticipating anxiety
Avoidance behaviour

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11
Q

List some common phobias

A

animals
natural environment
blood/ infection/ injury
situational e.g. travel, closed spaces, heights

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12
Q

What is the management of phobias?

A

1st line = exposure therapy and response prevention
flooding
SSRI if not working

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13
Q

What is agoraphobia?

A

anxiety and panic symptoms associated with places or situations where escape may be difficult or embarrassing, leading to avoidance

for example in crowds, public places, travelling away from home, travelling alone

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14
Q

What is the treatment for agoraphobia?

A

CBT - involves graded exposire to avoided situation

SSRIs and short term benzodiazepines

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15
Q

What is social phobia?

A

symptoms of anxiety due to social situations leading to a desire of escape and avoidance

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16
Q

What are the clinical features of social phobia?

A 
fear of humiliation or embarrassment 
self critical and perfectionist 
difficulty in maintaining relationships 
thoughts of suicide
somatic symptoms when exposed to fear situation  - blushing, trembling, dry mouth
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17
Q

What is the management for social phobia?

A

Psychological (1st line) CBT, self help

Pharmacological (2nd line therapy)- SSRIs e.g. fluoxetine or short term benzodiazepines

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18
Q

Define panic disorder?

A

recurrent episodic severe panic attacks, which occur unpredictably and not restricted to any particular setting

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19
Q

Define panic attack?

A

period of intense fear characterised by a constellation of symptoms that develop rapidly, reaching a peak of intensity in about 10 mins and don’t last longer than 30 mins

20
Q

List the symptoms of a panic attack

A 
intense fear and impending doom with...
palpitations, tachycardia
sweating
breathlessness
chest pain/ discomfort 
nausea
dizziness
derealisation/ depersonalisation
fear of losing control going crazy or dying
21
Q

How is panic disorder diagnosed?

A

individual must have 4 episodes of pain attacks in 4 weeks
OR
1 severe attack followed by 4 weeks of worrying

22
Q

How is panic disorder managed?

A

1st line = SRRI (sertraline) start low dose and increase slowly , continue for 12-18 months
(in ineffective after 12 weeks, switch to imipramine or clomipramine)

+ CBT

23
Q

What is post traumatic stress disorder?

A

severe psychological disturbance following a traumatic event, characterised by involuntary re-experience of elements of the event, avoidance, emotional numbing and hyper arousal

24
Q

What are the clinical features of post traumatic stress disorder?

A

arise within 6 months of a traumatic event
symptoms last for over 1 month:

FLASHBACK, AVOIDANCE, HYPERAROUSAL

FLASHBACK **— re experiencing symptoms, occur in the daytime(flashbacks, or intrusive images or thoughts) or as nightmares when asleep
AVOIDANCE - of people or places that remind the person of the event
HYPERAROUSAL- on guard, watchful of danger, irritable, jumpy, anxious

+ EMOTIONAL NUMBING - person expresses a lack of ability to experience feelings or feels detached from other people, or has negative thoughts about themselves.

25
Q

What are some of the signs of PTSD?

A 
isolated avoidant modes of living
alcohol abuse
numb to emotions
depression
altered world views
26
Q

What are the management options for PTSD?

A

1st line = Eye movement desensitisation and processing (EMDR) (if >4 weeks of symptoms)

+ narrative exposure therapy + SSRI (paroxetine)

27
Q

What is eye movement desensitisation and processing?

A

used to treat PTSD
patient moves eyes in certain patterns whilst attempting to recall memory
helps to re process memory and restore it

28
Q

Define obsessions

A

unwelcome, persistent, recurrent and purposeless words, ideas or phrases that come into the mind

29
Q

What type of obsessions can there be?

A
  1. thoughts - blasphemy, sex, violence, numbers
  2. images - vivid, morbid, violent scenes
  3. impulses
  4. ruminations
  5. doubts
30
Q

What is a compulsion?

A

repetitive, purposeful physical or mental behaviours performed with reluctance in response to an obsession

excessive activity
not connected to obsession in a realistic way
designed to prevent discomfort

31
Q

List types of compulsions

A 
hand washing
cleaning/ excessive tidiness 
counting
checking
touching and rearranging objects 
hoarding
32
Q

Define Obsessive Compulsive Disorder(OCD)

A

common chronic condition associated with marked anxiety and depression, characterised by obsessions and compulsions, causing distress and interfere with persons social functioning

33
Q

What is the ICD-10 criteria for diagnosis of OCD?

A

OBSESSIONAL THOUGHTS

  • ideas, images, thoughts that enter the persons mind again and again
  • distressing and person tries to resist them
  • recognised as persons own thoughts

COMPULSIONS

  • stereotyped behaviour repeated again and again
  • not enjoyable
  • performed to prevent unlikely event, often involving harm to person
  • recognised by person as pointless and repeated attempts to report them
34
Q

What is OCD associated with?

A

avoidant, dependent and histrionic trains
schizophrenia
tourettes

35
Q

How is OCD managed?

A

1st: CBT - including exposure and response prevention
2nd: SSRI or clomipramine

36
Q

What is somatoform pain disorder?

A

complaint of persistent severe and distressing pain which is not explained or not adequately explained by organic pathology

37
Q

How is somatoform pain disorder managed?

A

treat comorbid depression
pain clinic: offer anti depressions, Transcutaneous electrical nerve stimulation
Psychological: relaxation training, hypnosis, CBT

DO NOT PRESCRIBE OPIATES AS NOT EFFECTIVE

38
Q

What is somatisation disorder?

A

where there is repeated presentation with medically unexplained symptoms affecting multiple organ systems

main symptoms vary each time- often non specific and atypical, GI and skin complaints most common
life revolves around illness
very emotional
affects daily life
ICD-10 => 2 years of multiple physical symptoms with no explanation

39
Q

What is hypochondriacal disorder?

A

where people fear that minor symptoms may be due to a serious disease

have lots of fears
spend a lot of time thinking about symptoms
linked to OCD and dysmorphophobia

40
Q

What is dissociative disorders/ conversion disorders?

A

physical symptoms occur in absence of pathology and have clear relationship with psychological stress

painful memories or thoughts and distress associated

41
Q

What is the ICD-10 criteria for dissociative disorder?

A

> 1 symptoms can’t control that affect body movements or sense that can’t be explained
related to stressful event or trauma
cause significant stress/ difficulty in social life
symptoms not accounted for by any other mental health problem

42
Q

What is adjustment disorder?

A

range of abnormal psychological response to life adversity

caused by stressful event

43
Q

What are the clinical features of adjustment disorder?

A 
weeks after stressful event
<6 months duration 
mix of depressive/ anxiety symptoms
demoralisation
physical symptoms- aches, fatigue, indigestion
impairment to normal functioning
marked distress
44
Q

Which score is used to assess GAD?

A

GAD 7 questionnaire

45
Q

which medication can induce anxiety symptoms?

A 
salbutamol
theophylline 
beta blockers
herbal medicines
anti depressants
corticosteroids

3a psychiatry (9 decks)

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