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4th year psych > Neurotic disorders > Flashcards

Neurotic disorders Flashcards

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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?

A

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

24
Q

Management panic disorder

A

SSRIs (or TCA if ineffective)

CBT

No benzos

25
Q

What is agoraphobia

A

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
Q

Management agoraphobia

A

CBT- graded exposure.

Maybe SSRIs

27
Q

What is social phobia

A

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
Q

Normal onset of social phobia?

A

Mid adolescence

29
Q

M:F social phobia?

A

equal

30
Q

Management social phobia?

A

CBT

Self help materials

Graded exposure

Social skills training

Second line: SSRIs

31
Q

How do you manage specific phobias

A

Graded exposure and response prevention

If only encountered rarely (e.g. flying) could use benzos

32
Q

What are obsessions in OCD

A

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
Q

What are compulsions in OCD?

A

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
Q

What is egosyntonic vs egodystonic?

A

Egosyntonic - more pleasing like fantasies

Egodystonic- patient doesn’t like

35
Q

What happens if the compulsion in OCD is resisted?

A

Anxiety increases until it is performed

36
Q

Are obsessions and compulsions time consuming?

A

Yes >1h/day

37
Q

ICD-10 diagnostic for OCD?

A
  • present most days for >2w
  • distressing
  • interfere w/activities
38
Q

OCD usual onset?

A

Adolescence

39
Q

What are the four subtypes of OCD

A
  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
Q

What can OCD lead to?

A

Depression

Abuse of anxiolytics or alcohol

41
Q

FHx of what can lead to OCD?

A

OCD itself or tics/tourettes

42
Q

Imaging in OCD might show abnormality of which two structures?

A

Basal ganglia and cortex

43
Q

What neurotransmitter is implicated in OCD?

A

Serotonin

44
Q

sudden onset OCD and tics in children is called what?

A

childhood/paediatric acute neuropsychiatric syndrome (used to be PANDA)

45
Q

Management OCD

A

CBT

SSRI or clomipramine

Rarely- psychosurgery or deep brain stimulation

46
Q

Does drug therapy work immediately in OCD?

A

No can take up to 12w

47
Q

What is the personality disorder similar to OCD called?

A

Obsessive compulsive or Anankastic PD

48
Q

what is anankastic/OC PD?

A

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
Q

PTSD usually occurs within how long of the incident

A

6m

50
Q

Features of PTSD?

A
  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
Q

What bio/social factor might be a symptom or complication of PTSD?

A

Alcohol/substance misuse

52
Q

What other disorder might be secondary to or co-morbid with PTSD?

A

Depression

53
Q

Management PTSD

A

CBT

EMDR

ADs 2nd line if won’t engage in psych therapy

54
Q

Does ‘debriefing’ after an event prevent PTSD?

A

No

55
Q

How long does it take to recover from PTSD? When is it classed as chronic?

A

Few months. If persists over 1-2y may become chronic and possibly life long.

4th year psych (15 decks)

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