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Psychiatry > Neurotic disorders > Flashcards

Neurotic disorders Flashcards

1
Q

What is the prevalence of GAD?

A

1 in 20

mixed anxiety and depression has a 14.2% point prevalence

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2
Q

Name the types of neurotic disorder.

A

Phobic anxiety disorder
Generalised anxiety disorder
Panic disorder
Obsessive compulsive disorder

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3
Q

What is the presentation of anxiety?

A 
Altered physical sensations (eg palpitations, shaking, sweating)
Altered thoughts (worrying, panic attack)
Altered behaviours (uneasy, jumpy, irritable, avoidance, self-medicating with alcohol)
Altered emotions (fear in panic disorder, desperation, low mood)
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4
Q

What is the cause of anxiety?

A

No single cause.

Conscious or definable trigger, or unconscious/unknown triggers.
FHx
Secondary to physical or mental illness (thyroid, depression)
SFx of prescribed medication eg some ADx

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5
Q

Describe the characteristics of agoraphobia.

A

Fear of space (open or closed).
Difficulty travelling (distance away from home).
Worst in queue.
Fear of being trapped.
Better if way out, accompanied (eg pets, companion).
Increased risk of panic attacks.
F>M, onset 20-35 y/o

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6
Q

Describe the characteristics of social phobia.

A

Fear of interaction in social situations, fear of being scrutinised.
Low self esteem, fear of criticism.
Complaints of: blushing, hand tremor, palpitations, nausea, urgency of micturition.
Worst if few people, eating with people…
Patients sometimes believe the phobia is secondary manifestation of anxiety (anxiety is the problem)
F>M, onset adolescence

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7
Q

Describe the characteristics of phobic anxiety disorders.

A
  • Anxiety symptoms restricted to specific situation/object.
  • Fear is out of proportion to the situation.
  • Fear cannot be reasoned or explained why.
  • Anticipatory anxiety.
  • Avoidance behaviour (positive feedback, can perpetuate).
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8
Q

Describe the characteristics of GAD (generalised anxiety disorder).

A

≥6/12, free floating anxiety that may fluctuate, but is neither situational (phobic) or episodic (panic).
Worry and apprehension about everyday problems/events.
Physiological symptoms.

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9
Q

What is the best management for GAD?

A

Psychosocial - counselling, CBT.
Rx - SSRIs/SNRIs (Venlafaxine),
Benzodiazapines (not long term!!),
Beta blockers eg propanolol for symptoms like tremor and tachycardia

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10
Q

What is the best management for phobias?

A

CBT (graded exposure, anxiety management, sometimes flooding or modelling)
ADx

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11
Q

What is a panic disorder?

A 
Panic attacks (rapid onset of severe anxiety, 20-30 minutes) repeatedly and unexpectedly.
Fear of implications and consequences of panic attacks trigger further attacks, cycle continues.
Dx = 4 panic attacks in 4 weeks.
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12
Q

What is the best management for panic disorder/panic attacks?

A

CBT

SSRIs/TCAs/Benzodiazapines

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13
Q

What disorders do panic attacks occur in?

A 
Panic disorder
Phobic anxiety disorders
GAD
OCD
Organic disorders (hyperthyroidism, phaeochromocytoma, hypoglycaemia)
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14
Q

What is an acute stress reaction?

A

An acute response to a highly threatening or catastrophic experience (eg RTA, assault). Transient disorder.

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15
Q

What is PTSD?

A

Post traumatic stress disorder - protracted and delayed response to a highly threatening or catastrophic experience (eg combat exposure, sexual assault)

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16
Q

Describe the presentation in PTSD.

A

Numbing, detatchment, FLASHBACKS, NIGHTMARES, partial/complete amnesia for event, avoidance of reminders, anxiety symptoms.

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17
Q

What is EMDR?

A

Eye movement desensitisation and reprogramming. (PTSD)
Client recalls distressing memories while receiving one of several types of bilateral sensory inputs, including side to side eye movements.
Allows processing, reduce lingering effects of and cope with distressing memories.

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18
Q

What is the ADx of choice for PTSD?

A

Mirtazipine or Paroxetine

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19
Q

What is the definition of obsessional thought?

A 
Recurrent idea/impulse/image
From own mind
Perceived as senseless/irrational
Can't resist
Causes anxiety
Impairs functioning
20
Q

What is the definition of a compulsion?

A 
Recurrent behaviour (stereotyped)
Reduces anxiety
Isn't helpful/enjoyable
Perceived as senseless
Impairs functioning
21
Q

Give examples of obsessional thoughts.

A 
Doubt
Contamination
Orderliness & symmetry
Safety
Physical symptoms
Aggression
Sex
22
Q

Give examples of compulsions

A

Washing and cleaning
Arranging and ordering
Checking
Mental rituals eg counting/repeating a phrase

23
Q

What is the biological model for the aetiology of OCD?

A

Pathology in the CAUDATE NUCLEUS failing to suppress signals from the orbito-frontal cortex.
Resulting in overexcitation of the thalamus
Thalamus sends strong signals back to the orbitofrontal cortex etc etc

24
Q

What is the management for OCD?

A

CBT & SSRI together = most effective.

CBT - exposure and response prevention (ERP) - repeated exposure to anxiety-provoking stimuli, learning to delay responding to urges/distraction.
Adjuncts that can be used include lamotrigine, gabapentin, olanzapine, risperidone.
Last resort = ECT

25
Q

What is the function of compulsive (repeated) acts in OCD?

A

To prevent some unlikely event, which may cause danger to the patient and/or be caused by the patient eg leaving oven on.

26
Q

What is the definition of an Adjustment Disorder?

A

Protracted response to a significant life change, with a px of depression/anxiety not severe enough to meet criteria for depressive or anxiety disorder, but causing an impairment of social functioning. Often accompanied with angry outbursts. Feelings of being unable to cope. Lasts <6/12.

27
Q

What is the best management of an adjustment disorder?

A

Use clinical judgement based on Px to determine best Rx.
ADx(/benzodiazepines) for depression/anxiety symptoms.
Brief psychotherapy (eg psychodynamic, CBT, counselling)
Keep all therapy brief rather than long term due to time-limited nature of disorder.

28
Q

What is the presentation of an abnormal bereavement reaction?

A 
Particularly prolonged
Unusually intense (ie meets criteria for depressive disorder)
Lasts >6/12
Also if delayed/inhibited/distorted
29
Q

What is the definition of a conversion/dissociative disorder?

A

The development of a disorder of physical function under voluntary control, or loss of movement.
Px often represents patient’s concept of how an illness will manifest (eg not conforming to dermatomal distribution).
Ex/Ix don’t reveal presence of known physical/neuro disorder.
Often an en expression of emotional conflict/needs.

eg fugue, amnesia, stupor, motor disorder, convulsions, trance and possession states, anaesthesia, sensory loss.(eg no longer able to walk, no longer able to feel things in body)

30
Q

Though terms are mostly used interchangeably, what is the difference between conversion and dissociation disorders?

A

Difference = how aware of symptoms pt is.
Dissociation - out of touch with reality. Mostly to do with memory and reality, eg depersonalisation/derealisation, amnesia, fugue, multiple personality.
Conversion - in touch with reality (though often bizarrely indifferent to alarming symptoms) eg psychogenic deafness/blindness, paralysis, aphonia, sensory loss, impairments of voluntary movements.

31
Q

What is the definition of a fugue?

A

General amnesia with loss of identity, often with relocation (sudden, unexpected journey that may last several months). Pt often assumes another personality whilst experiencing memory loss and confusion about personal identity.

32
Q

What is the definition of dissociative amnesia?

A

Loss of autobiographical memory - partial or total - following a traumatic or stressful event

33
Q

What is depersonalisation?

A

Patient perceives self as somehow changed or unreal.

34
Q

What is derealisation?

A

Patient perceives the surrounding world as changed or unreal, though they themselves have stayed the same.

35
Q

What is a dissociative stupor?

A

Although a patient is conscious, they are motionless, mute and unresponsive.

36
Q

What is dissociative motor disorder?

A

Paralysis of muscle groups, eg paralysis of limb, hemiparesis.

37
Q

What is dissociative sensory loss?

A

Loss of sensation/anaesthesia in certain areas, which are not in line with normal dermatome distributions. Typically ‘glove and stocking’ distribution.

38
Q

What is PNES? (/dissociative convulsions)

A

Pseudoseizures/psychogenic non-epileptic seizures. Seizures have no organic basis (DC) or are inconsistent with normal epilepsy physiology (eg atypical or no EEG changes, retain consciousness/no drop in O2 sats during prolonged shaking, no raised prolactin 10-20 mins post seizure as with epilepsy).

39
Q

What is the best management for dissociation and conversion disorders?

A

Acceptance and support
Physical rehabilitation if indicated
Treatment of co-morbid psych disorders

GOOD prognosis

40
Q

What are the 3 kinds of somatoform disorders?

A

Somatisation disorder
Hypochondrial disorder
Persistent somatoform disorder

41
Q

What is the presentation of somatisation disorder?

A 
Px with:
-Multiple, recurrent, freq changing physical symptoms for ≥2y. 
- Significant disruption of life
- Many Ix in primary and secondary care.
F>M, onset <30 y/o
42
Q

What is the best management for medically unexplained symptoms?

A

CBT (to help cope with pain/symptoms)
ADx/rx of comorbid psychiatric disorders
Clear explanation of symptoms, though being careful not to reinforce false beliefs.
Ix kept to a minimum.

43
Q

What is hypochondriasis?

A

Persistent pre-occupation with the possibility of having ≥1 serious and progressive physical disorder. I.e. patient ‘worries’ they may develop an illness.
Pre-occupations are non-psychotic.
Don’t always px with symptoms (as with somatisation).
≥6/12, w/ functional impairment.
Not reassured by negative Ix or medical evidence.

44
Q

What is persistent somatoform disorder?

A

Chronic pain that cannot be accounted for by a physical disorder or other psychiatric disorder.

45
Q

What is factitious disorder?

A

Presenting with MUS, but symptoms are NOT REAL - psychiatric or physical symptoms are manufactured for purpose of ASSUMING THE SICK ROLE.

46
Q

What is malingering?

A

Psychological and physiological symptoms manufactured for a purpose other than assuming the sick role - eg avoiding police, obtaining compensation.

Psychiatry (7 decks)

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