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4th year psych > Neurotic disorders > Flashcards

Neurotic disorders Flashcards

(55 cards)

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1
Q

Neurotic disorders have symptoms based in _____

A

reality

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2
Q

Do people with neurotic disorders normally have insight?

A

Yes

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3
Q

neurotic disorders often precede development of?

A

Depression

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4
Q

If first presentation of a neurotic disorder is age 35-40yrs, what do you suspect?

A

Depressive disorder or underlying organic disease

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5
Q

Learning theory of aetiology of neurotic disorders?

A

Learned maladaptive behaviour with temporary decrease in anxiety

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6
Q

Prognosis neurotic disorders?

A

Generally quite good

50% recover w/o Rx, 70% with. In 2yrs

Still increased rate suicide

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7
Q

What is the most common neurotic disorder?

A

Mixed A&D

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8
Q

Least common neurotic disorder?

A

Panic (also the most disabling)

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9
Q

What is ‘trait’ vs ‘state’ anxiety?

A

Trait is lifelong personality characteristic

State is temporal disorder with discernible time of onset

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10
Q

What is GAD?

A

unrealistic/excessive anxiety and worry, generalized and persistent and not restricted to particular environmental circs (‘free floating’)

Get somatic symptoms

Lasting >/= 3w

F:M 2:1

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11
Q

Which group of pts is more likely to present with the somatic symptoms?

A

Male and low SES

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12
Q

What two delusions might people with GAD also get?

A

Depersonalisation and derealisation

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13
Q

Pathophysiology of GAD

A

decreased GABA

Amygdala

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14
Q

What type of personality disorder can predispose to GAD

A

anxious (avoidant) PD

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15
Q

Does childhood attachment relate to GAD?

A

Yes poor attachment in childhood can predispose

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16
Q

What are some organic causes of GAD?

A

Drug/alcohol withdrawal

High caffeine

Thyrotoxicosis

Parathyroid disease

Early dementia

Epilepsy (esp TLE)

phaeochromocytoma

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17
Q

Alcohol and benzo abuse can ____ GAD

A

Worsen

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18
Q

Differentials GAD

A

Depression and psychotic disorder

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19
Q

Management GAD

A

Bio: SSRIs, SNRIs. Sometimes pregabalin second line. Benzos in crisis only (no more than 2-4w course).

Psycho: counselling, CBT, marital/family therapy if appropriate

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20
Q

What is panic disorder?

A

Recurrent, unpredictable panic attacks. Unrelated to situation.

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21
Q

How do panic attacks feel?

A

Intense fear, impending doom and physical symptoms- chest pain, nausea, palpitations, dizzy, chills/hot flushes, fear dying etc.

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22
Q

How long does a panic attack last?

A

A few mins

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23
Q

What is the positive feedback loop in panic attacks?

Study These Flashcards
A

Misinterpret normal physical sx Panic & anxiety- there must be something wrong

24
Q

Management panic disorder

Study These Flashcards
A

SSRIs (or TCA if ineffective)

CBT

No benzos

25
What is agoraphobia
Fear and avoidance of place/situation from which escape may be difficult or help may not be available if panic attack (is often with a panic disorder).
26
Management agoraphobia
CBT- graded exposure. Maybe SSRIs
27
What is social phobia
Fear of social situations where they are exposed to new/unfamiliar people or possible scrutiny by others. Fear they will be humiliated or embarassed
28
Normal onset of social phobia?
Mid adolescence
29
M:F social phobia?
equal
30
Management social phobia?
CBT Self help materials Graded exposure Social skills training Second line: SSRIs
31
How do you manage specific phobias
Graded exposure and response prevention If only encountered rarely (e.g. flying) could use benzos
32
What are obsessions in OCD
Unwelcome, intrusive, senseless thoughts/images/impulses etc. Individual attempts to suppress or neutralise them as absurd (egodystonic) and a product of their own mind
33
What are compulsions in OCD?
Repetitive, purposeful physical /mental behaviours performed reluctantly in response to the obsession. Not connected to the obsession in a realistic way (and the pt realises this) Distinguished from rituals/'normal' superstitious behav which have a magical quality and are culturally sanctioned e.g. touch wood.
34
What is egosyntonic vs egodystonic?
Egosyntonic - more pleasing like fantasies Egodystonic- patient doesn't like
35
What happens if the compulsion in OCD is resisted?
Anxiety increases until it is performed
36
Are obsessions and compulsions time consuming?
Yes >1h/day
37
ICD-10 diagnostic for OCD?
- present most days for >2w - distressing - interfere w/activities
38
OCD usual onset?
Adolescence
39
What are the four subtypes of OCD
1. O+Cs concerned with contamination - often hand washing (MOST COMMON) 2. Checking compulsions in response to obsessive thoughts about potential harm e.g. leaving gas on 3. Obsessions without overt compulsive acts 4. Hoarding
40
What can OCD lead to?
Depression Abuse of anxiolytics or alcohol
41
FHx of what can lead to OCD?
OCD itself or tics/tourettes
42
Imaging in OCD might show abnormality of which two structures?
Basal ganglia and cortex
43
What neurotransmitter is implicated in OCD?
Serotonin
44
sudden onset OCD and tics in children is called what?
childhood/paediatric acute neuropsychiatric syndrome (used to be PANDA)
45
Management OCD
CBT SSRI or clomipramine Rarely- psychosurgery or deep brain stimulation
46
Does drug therapy work immediately in OCD?
No can take up to 12w
47
What is the personality disorder similar to OCD called?
Obsessive compulsive or Anankastic PD
48
what is anankastic/OC PD?
Rigid thinking Perfectionist Preoccupied with rules Excessively clean and ordered Objectively high standards Tend to hoard Emotionally cold Egosyntonic life traits with no obvious onset.
49
PTSD usually occurs within how long of the incident
6m
50
Features of PTSD?
1. Persistent intrusive thinking/re-experiencing the trauma (dreams or flashbacks) 2. Avoidance of reminders 3. Numbing, detachment and estrangement from others, loss of interest in significant activities, sense of foreshortened future. 4. High arousal- autonomic Sx, hypervigilant, sleep disturbance, irritability, low concentration, high startle response
51
What bio/social factor might be a symptom or complication of PTSD?
Alcohol/substance misuse
52
What other disorder might be secondary to or co-morbid with PTSD?
Depression
53
Management PTSD
CBT EMDR ADs 2nd line if won't engage in psych therapy
54
Does 'debriefing' after an event prevent PTSD?
No
55
How long does it take to recover from PTSD? When is it classed as chronic?
Few months. If persists over 1-2y may become chronic and possibly life long.

4th year psych (15 decks)

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