Neuroses Flashcards
What is the aetiology of generalised anxiety disorder?
- biological
low levels of GABA
heightened amygdala activation in response to stimulus - Genetics
- childhood
sexual and physical abuse
demands for high achievement
seperation and neglect
4. stress financial problems chronic disease bereavement lack of relationship
outline the DSM5 criteria for GAD?
- > 6 months of excessive, difficult to control worry about everyday issues that is disproportionate to risk and that causes distress
- worry not confined to another mental health disorder
- > 3 of the following symptoms: restlessness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance
What symptoms are seen with generalised anxiety disorder?
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
What is the difference between generalised anxiety disorder and panic attack disorder?
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
What are the differential diagnosis for generalised anxiety disorder?
hyperthyroidism pheochromocytoma episodic hypoglycaemia depression substance misuse schizophrenia anxious personality disorder
What is the pathology behind generalised anxiety disorder?
increased sympathetic activity
overactivity of ascending noradrenergic neurones
increase arousal
excessive activity of serotonin causing enhanced responses to nerve stimuli
What is the management for generalised anxiety disorder?
- symptom control = exercise, self help, listening, education, active monitoring
- therapies = low intensity psychological interventions (IAPT individual guided self help , self help groups)
- SSRIs 1st line = sertraline (pregabalin and beta blockers next step) + high intensity psychological therapy e.g. CBT, relaxation therapy
What is used in acute generalised anxiety disorder crisis?
benzodiazepines - no longer than 2-4 weeks as high risk of dependence
Define phobia
reoccurring excessive and unreasonable psychological or autonomic symptoms of anxiety in the presence of specific feared object of situation, leading to avoidance
What are the clinical features of phobias?
the 3 A’s of phobias…
Anxiety symptoms
Anticipating anxiety
Avoidance behaviour
List some common phobias
animals
natural environment
blood/ infection/ injury
situational e.g. travel, closed spaces, heights
What is the management of phobias?
1st line = exposure therapy and response prevention
flooding
SSRI if not working
What is agoraphobia?
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
What is the treatment for agoraphobia?
CBT - involves graded exposire to avoided situation
SSRIs and short term benzodiazepines
What is social phobia?
symptoms of anxiety due to social situations leading to a desire of escape and avoidance
What are the clinical features of social phobia?
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
What is the management for social phobia?
Psychological (1st line) CBT, self help
Pharmacological (2nd line therapy)- SSRIs e.g. fluoxetine or short term benzodiazepines
Define panic disorder?
recurrent episodic severe panic attacks, which occur unpredictably and not restricted to any particular setting
Define panic attack?
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
List the symptoms of a panic attack
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
How is panic disorder diagnosed?
individual must have 4 episodes of pain attacks in 4 weeks
OR
1 severe attack followed by 4 weeks of worrying
How is panic disorder managed?
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
What is post traumatic stress disorder?
severe psychological disturbance following a traumatic event, characterised by involuntary re-experience of elements of the event, avoidance, emotional numbing and hyper arousal
What are the clinical features of post traumatic stress disorder?
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.
