Neurotic disorders Flashcards
Neurotic disorders have symptoms based in _____
reality
Do people with neurotic disorders normally have insight?
Yes
neurotic disorders often precede development of?
Depression
If first presentation of a neurotic disorder is age 35-40yrs, what do you suspect?
Depressive disorder or underlying organic disease
Learning theory of aetiology of neurotic disorders?
Learned maladaptive behaviour with temporary decrease in anxiety
Prognosis neurotic disorders?
Generally quite good
50% recover w/o Rx, 70% with. In 2yrs
Still increased rate suicide
What is the most common neurotic disorder?
Mixed A&D
Least common neurotic disorder?
Panic (also the most disabling)
What is ‘trait’ vs ‘state’ anxiety?
Trait is lifelong personality characteristic
State is temporal disorder with discernible time of onset
What is GAD?
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
Which group of pts is more likely to present with the somatic symptoms?
Male and low SES
What two delusions might people with GAD also get?
Depersonalisation and derealisation
Pathophysiology of GAD
decreased GABA
Amygdala
What type of personality disorder can predispose to GAD
anxious (avoidant) PD
Does childhood attachment relate to GAD?
Yes poor attachment in childhood can predispose
What are some organic causes of GAD?
Drug/alcohol withdrawal
High caffeine
Thyrotoxicosis
Parathyroid disease
Early dementia
Epilepsy (esp TLE)
phaeochromocytoma
Alcohol and benzo abuse can ____ GAD
Worsen
Differentials GAD
Depression and psychotic disorder
Management GAD
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
What is panic disorder?
Recurrent, unpredictable panic attacks. Unrelated to situation.
How do panic attacks feel?
Intense fear, impending doom and physical symptoms- chest pain, nausea, palpitations, dizzy, chills/hot flushes, fear dying etc.
How long does a panic attack last?
A few mins