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neurotic disorders Flashcards

1
Q

what parts of brain involved in normal anxiety?

A

hippocampus
amygdala
thalamus
frontal and temporal regions

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2
Q

NTs involved in normal anxiety

A

NA
serotonin
GABA-A

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3
Q

core symptoms of a disorder of anxiety?

A
  1. psychological and physical symptoms + avoidance
  2. symptoms consistent with DSM V/ICD 10
  3. not caused by organic disease or other psych disorder
  4. pervasive, distressing, disabling
  5. affecting function
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4
Q

prevalence?

A

women 30%

men 18%

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5
Q

place of living and anxiety?

A

urban>rural

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6
Q

physical symptoms to ask about in history?

A
  1. restless
  2. muscular tension
  3. fatigue
  4. SOB
  5. palpitations
  6. abdominal pain
  7. diarrhoea
  8. urinary frequency
  9. tingling of extremities
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7
Q

important adjuncts to ask in history?

A
  1. affective symptoms
  2. alcohol/substance use/withdrawal
  3. caffeine/meds
  4. premorbid
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8
Q

ICD 10 classification

A
  1. neurotic, stress related and somatoform disorders
  2. phobic - agoraphobia, social, specific
  3. other anxiety disorders - panic, GAD
  4. OCD
  5. reaction to severe stress and adjustment disorders - PTSD
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9
Q

important features of phobic anxiety disorders?

A
  1. evoked by certain well defined situations or objects which are not actually dangerous
  2. avoided or endured with dread
  3. anticipatory anxiety
  4. often co-exists with depression
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10
Q

important features of agoraphobia?

A
  1. lack of immediately available escape
  2. leaving home
  3. entering shops
  4. crowds
  5. public places
  6. public transport
  7. occurs with or without panic disorder
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11
Q

6 month prevalence of agoraphobia?

A

3-6%

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12
Q

gender in agoraphobia?

A

women - 75%

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13
Q

age of onset agoraphobia?

A

24yrs

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14
Q

course of agoraphobia/

A

chronic fluctuating

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15
Q

aetiology of agoraphobia?

A

life events, preceded by neurotic or dependent personality traits

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16
Q

what thoughts in agoraphobia?

A
  1. fear of death
  2. collapse
  3. no one would help if something happened
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17
Q

behaviour in agoraphobia?

A

avoid

may be subtle eg companion/trolley/pram

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18
Q

what to rule out in agoraphobia?

A

depression
substance abuse
psychosis

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19
Q

tx for agoraphobia?

A
  1. psychological - CBT

2. meds: SSRI

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20
Q

social phobia prevalence

A

6 month 1.7%

10-13% lifetime

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21
Q

gender in social phobia

A

equal

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22
Q

onset of social phobia?

A

teens/ early childhood

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23
Q

comorbidities in social phobia?

A

depression

substance misuse

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24
Q

cause of social phobia?

A

can be specific eg public speaking or generalised

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25
Q

thoughts in social phobia?

A
  1. negative perception by others
  2. people will notice blushing, tremor
  3. fear of vomiting, fainting, humiliation
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26
Q

behaviours in social phobia?

A

avoid

use safety behaviours

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27
Q

tx of social phobia?

A
  1. tx comorbidity
  2. ddx schizoid personality disorder
  3. psych: CBT
  4. meds: SSRI
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28
Q

age of onset simple phobias

A

any but common in kids

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29
Q

lifetime prevalence simple phobia

A

5-10%

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30
Q

female male ratio simple phobias

A

2.1

except blood-injection type where same

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31
Q

tx of simple phobia

A

graded exposure therapy

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32
Q

what is panic disorder

A
  1. recurrent discrete attacks of severe anxiety
  2. last mins
  3. anticipatory anxiety
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33
Q

features of panic attacks

A
  1. ANS anxiety and fear of death/heart attack/suffocation
  2. need several within one month
    minutes
  3. not predictable
  4. anticipatory
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34
Q

prevalence panic disorder

A

1.5%

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35
Q

gender panic disorder

A

women more slightly

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36
Q

genetics panic disorder

A

probs

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37
Q

somatic sx of panic attack

A
  1. palpitations
  2. chest pain
    3 . SOB
  3. choking
  4. dizzy
38
Q

thoughts in PD?

A

fear of dying
fear of going mad
fear of losing control

39
Q

behaviours in panic disorder

A

escape

avoid

40
Q

tx panic disorder

A
  1. rule out physical cause
  2. psychoeducate
  3. CBT
    SSRI
  4. benzos - very last resort
41
Q

classic description of GAD?

A

free floating anxiety

42
Q

prevalence GAD

A

lifetime 4-6%

43
Q

course of GAD

44
Q

gender GAD

45
Q

cause of GAD?

A
  1. related to stressors in predisposed personality

2. genetics - prob linked to that of depressive illness

46
Q

comorbid in GAD?

A

depressive

other anxiety disorders

47
Q

thoughts in GAD

A
  1. worry about random things for long time
  2. can’t control worry
  3. feel as though worry is useful - if I think about it enough I’ll be prepared
48
Q

somatic features GAD?

A
  1. muscle tension
  2. fatigue
  3. trembling
  4. epigastric discomfort
49
Q

tx GAD

A
  1. difficult
  2. treat any comorbidity
  3. modify environmental factors.
  4. relaxation techniques
  5. avoid caffeine
  6. CBT
  7. meds: SSRI
50
Q

benzos in GAD

51
Q

prevalence of OCD?

52
Q

gender OCD

A

pretty equal

53
Q

pathology of OCD?

A

caudate nucleus and cingulate gyrus

serotonin

54
Q

what is an obsession?

A
  1. ideas, images or impulses with are intrusive and pervasive
  2. cause distress and are resisted
  3. OWN thoughts
55
Q

common themes in OCD?

A 
cleanliness
contamination
doubt
violence
sex
56
Q

what is a compulsion?

A

stereotyped repetitive act
recognise as pointless
reduce tension

57
Q

features of OCD?

A
  1. obsessions are ego dystonic
  2. obsessions are indicative of personal defect, immorality or badness
  3. thoughts resisted
  4. compulsions are not pleasurable but relieve anxiety
58
Q

violent obsessions worry in OCD?

A

nope acting on them is really rare, less than general population

59
Q

comorbidity in OCD?

A
  1. depression

2. obsessional personality: ego-syntonic -

60
Q

tx OCD

A
  1. psych: psychoeducation, behavioural therapy eg exposure, response prevention; CBT
  2. meds: SSRI high dose. 2nd line = clomipramine

NB combo therapy optimal

61
Q

what is PTSD?

A
  1. delayed/protracted response to a stressful event or situation
  2. event = exceptionally threatening/catastrophic
  3. event = would cause distress in anyone
62
Q

cause of PTSD?

A
  1. personality traits
  2. 80% previous psych prob
  3. possible biological basis
63
Q

course of PTSD?

A

fluctuating, most recover

64
Q

brain regions in PTSD?

A
  1. memory processing problems: hippocampus, amygdala, frontal cortex
  2. heightened stress: thalamus, hypothalamus, locus coeruleus
65
Q

onset of PTSD?

A

within 6 months of event

66
Q

acute stress reaction?

A

onset and subsides in days after event

67
Q

what groups of symptoms are seen in PTSD?

A
  1. reliving- intrusive memories or dreams
  2. arousal - ANS + hypervigilance, startle response and insomnia
  3. avoidance and fear of cues which will remind of the event
68
Q

outside the group of PTSD symptoms what else is seen?

A
  1. numbness
  2. detachment
  3. dramatic outbursts of fear/violence
  4. substance misuse
69
Q

effects of PTSD on person

A
  1. depression
  2. suicidal ideation
  3. ongoing effects of the event itself eg refugee
  4. emotionally enduring personality change - chronic over many years
70
Q

tx of PTSD?

A
  1. MDT
  2. CBT
  3. behaviour therapy
  4. refer to specialist agency eg rape crisis or refugee agency
  5. SSRI
71
Q

what two things have no evidence in PTSD?

A
  1. critical incident debriefing

2. eye movement desensitisation and recall

72
Q

what is an acute stress reaction?

A
  1. lasts hours or days
  2. can be within 1hr after exceptional stress
  3. stress usually severe / threat to security or physical integrity
73
Q

things that may cause an acute stress reaction?

A
  1. natural disaster
  2. major accident
  3. serious assauly
  4. warfare
  5. rape
  6. multiple bereavement
  7. fire
74
Q

signs and symptoms ASR?

A
  1. vary
  2. initial daze
  3. subsequent depression, anxious, angry
  4. social withdrawal
  5. disoriented, aggression, hopeless
  6. overactivity
  7. excessive grief
75
Q

classification of ASR?

A

mild - no symptoms
moderate- 2 symptoms
severe - 4 of above or stupor

76
Q

epidemiology ASR?

A

15-25% after stress

77
Q

cause of ASR?

78
Q

RFs for ASR?

A
  1. exhaustion
  2. medical illness
  3. elderly
79
Q

tx ASR?

80
Q

px ASR?

81
Q

what are adjustment disorders?

A
  1. state of subjective stress
  2. interferes with functioning
  3. adapting to life change or consequences of a stressful event
82
Q

what might an adjustment disorder be a sign of?

A

subthreshold

mood/anxiety/somatoform/conduct disorder

83
Q

important features of an adjustment disorder

A
  1. must be 1 month after stressor
  2. don’t go on longer than 6 months after stressor removed
  3. must be a stressor!
84
Q

comorbidity adjustment disorder

A
  1. more alcohol abuse

2. individual predisposition

85
Q

prevalence of adjustment disorder

A

5%

can be up to 20% in general hosp setting

86
Q

tx adjustment disorders?

A
  1. supportive psychotherapy
  2. coping mechanisms
  3. practical support eg carers, child care, financial, OT, support groups
  4. antidepressant/anxiolytic if symptoms persistent or if psych intervention is unsuccessful
87
Q

px adjustment disorder?

A

70% recovery at 5yrs
adolescents 40%

major psych prob development in 20% - usually depression or alcohol related

88
Q

what is a common adjustment disorder?

A

grief reaction

89
Q

grief vs depression

A

controversial whether normal/abnormal grief is distinct from depression

bereaved have depressive sx

90
Q

what is normal grief

A

variable

basically the feelings, thoughts and behaviours associated with bereavement

91
Q

what is abnormal gruef

A
  1. intense, prolonged, delayed, or absent
  2. thoughts of worthlessness or death
  3. slowed thoughts, movements
  4. guilt
  5. poor function
  6. hallucinations that aren’t the image or voice of the deceased

Psych (23 decks)

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