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
What is the positive feedback loop in panic attacks?
Misinterpret normal physical sx Panic & anxiety- there must be something wrong
Management panic disorder
SSRIs (or TCA if ineffective)
CBT
No benzos
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).
Management agoraphobia
CBT- graded exposure.
Maybe SSRIs
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
Normal onset of social phobia?
Mid adolescence
M:F social phobia?
equal
Management social phobia?
CBT
Self help materials
Graded exposure
Social skills training
Second line: SSRIs
How do you manage specific phobias
Graded exposure and response prevention
If only encountered rarely (e.g. flying) could use benzos
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
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.
What is egosyntonic vs egodystonic?
Egosyntonic - more pleasing like fantasies
Egodystonic- patient doesn’t like
What happens if the compulsion in OCD is resisted?
Anxiety increases until it is performed
Are obsessions and compulsions time consuming?
Yes >1h/day
ICD-10 diagnostic for OCD?
- present most days for >2w
- distressing
- interfere w/activities
OCD usual onset?
Adolescence
What are the four subtypes of OCD
- O+Cs concerned with contamination - often hand washing (MOST COMMON)
- Checking compulsions in response to obsessive thoughts about potential harm e.g. leaving gas on
- Obsessions without overt compulsive acts
- Hoarding
What can OCD lead to?
Depression
Abuse of anxiolytics or alcohol
FHx of what can lead to OCD?
OCD itself or tics/tourettes
Imaging in OCD might show abnormality of which two structures?
Basal ganglia and cortex
What neurotransmitter is implicated in OCD?
Serotonin
sudden onset OCD and tics in children is called what?
childhood/paediatric acute neuropsychiatric syndrome (used to be PANDA)
Management OCD
CBT
SSRI or clomipramine
Rarely- psychosurgery or deep brain stimulation
Does drug therapy work immediately in OCD?
No can take up to 12w
What is the personality disorder similar to OCD called?
Obsessive compulsive or Anankastic PD
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.
PTSD usually occurs within how long of the incident
6m
Features of PTSD?
- Persistent intrusive thinking/re-experiencing the trauma (dreams or flashbacks)
- Avoidance of reminders
- Numbing, detachment and estrangement from others, loss of interest in significant activities, sense of foreshortened future.
- High arousal- autonomic Sx, hypervigilant, sleep disturbance, irritability, low concentration, high startle response
What bio/social factor might be a symptom or complication of PTSD?
Alcohol/substance misuse
What other disorder might be secondary to or co-morbid with PTSD?
Depression
Management PTSD
CBT
EMDR
ADs 2nd line if won’t engage in psych therapy
Does ‘debriefing’ after an event prevent PTSD?
No
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.
