Neurotic, Stress-related and Somatoform disorders (F4) Flashcards
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Anxiety disorders
D/dx
GAD
Panic disorder
Social phobia, Agoraphobia
Specific phobia
MADD
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Stress-related disorders
Acute stress reaction (<1h – few days or 3d – 1m)
PTSD (onset <6m)
Adjustment disorder (<3m)
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Secondary stress disorders
Other psychiatric disorders: Eating disorder, depression, OCD, personality disorders, Schizophrenia
Medical: Thyroid, DYSPNEA, Brain trauma, Dementia BPSD
Drugs: stimulants, hallucinogens, alcohol
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Somatic and psychological symptoms of anxiety
6A
Apprehension, Arousal, Avoidance, Anticipatory avoidance, Autonomic Activation
History taking questions for anxiety
History taking questions for functioning in anxiety
Classification of anxiety disorders (ICD-10)
Phobic = Agoraphobia, Social, Specific
Others = Panic, GAD, MADD
GAD
Epidemiology
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GAD
Clinical features
Excessive persistent widespread worry
Psychological: Arousal, Irritability, poor concentration, noise sensitivity
Somatic: Autonomic Activation, Muscle tension, Hyperventilation, Sleep disturbance
GAD
Clinical course
Gradual onset chronic fluctuating low remission rate
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GAD
Diagnostic criteria (DSM-5)
REDIMS
GAD
Differentiation with depression
GAD
Differentiate with panic disorder
GAD
Differentiate with social anxiety disorder
GAD
Differentiate with OCD
GAD
Differentiate with stress-related disorder, hypochondriacal disorder, SA
GAD
Differentiate with physical illnesses
GAD
Biological factors/ pathophysiology
GAD
Psychological factors
GAD
Developmental factors
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GAD
Management
Stepped Care Approach
Self-help/ group psychoeducation»_space; CBT/ Applied relaxation»_space; Drugs
Acute: BZD, Buspirone, B-blocker
Chronic SSRI, SNRI, Pregabalin, Mirtazapine +/- SGA
GAD
Psychotherapy methods
GAD
Acute treatment
GAD
Long-term treatment
Panic disorder
Epidemiology
Panic disorder
Clinical features
Recurrent (>1/month), Unexpected panic attacks
+ Worries/ maladaptive behaviour about occurrence
+ Worries about consequences of panic: losing control, dying, being judged
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Panic attack
Somatic and psychological symptoms
Head to toe physical symptoms
Derealization
Depersonalization
Fear of losing control, going mad, dying, catastrophic outcome
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Panic disorder
DSM-5 diagnostic criteria
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Panic disorder
D/dx
Anxiety disorders
Somotoform disorders: with multiple physical symptoms
Psychotic disorder, depression
Substance abuse
Medical: Endocrine, Seizure, Dyspnea
Panic disorder
Course and prognosis
Panic disorder
Biological factors
Panic disorder
Psychological factors
Panic disorder
Social factor
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Panic disorder
Management
Acute: BZD
Stable: SSRI, SNRI, Mirtazapine, TCA, MAOI for >6 months
Psychotherapy: Relaxation training, CBT
Phobic anxiety disorder
Triggers
Key features
Clinical syndromes
Specific phobia
Epidemiology
Specific phobia
Clinical features
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Specific phobia
DSM-5 criteria
Marked fear/ anxiety about ____
____ provoke fear/ anxiety
____ is actively avoided or endured with intense fear/ anxiety
____ is out of proportion to actual danger posed by situation
Fear/ anxiety lasts at least 6 months
Causes clinically significant distress/ functional impairment
Not better explained by another mental disorder, Not due to SA
Specific phobia
D/dx
Specific phobia
Etiology
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Specific phobia
Management
Exposure- based psychotherapy
- Graded exposure: In vivo, Imaginary, VR
BZD for acute
Social phobia
Epidemiology
Social phobia
Clinical features
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Social phobia
DSM-5 criteria
Marked fear/ anxiety about ____
____ provoke fear/ anxiety
____ is actively avoided or endured with intense fear/ anxiety
____ is out of proportion to actual danger
Fear/ anxiety lasts at least 6 months
Causes clinically significant distress/ functional impairment
Not better explained by another mental disorder, Not due to SA
Social phobia
D/dx
Social phobia
Etiologies
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Social phobia
Management
CBT: Psychoeducation, Cognitive restructuring, Exposure therapy
Drugs: SSRI/ SNRI >6 months, BZD/ B-blocker for acute, Pregabalin/ Gabapentin
Agoraphobia
Epidemiology
Agoraphobia
Clinical features
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Agoraphobia
Diagnostic criteria
Agoraphobia
D/dx
Agoraphobia
Etiologies
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Agoraphobia
Management
CBT: Exposure-based psychotherapy
Drug: SSRI/ SNRI, BZD for acute, TCA/ MAOI if needed
OCD
Epidemiology
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OCD
Clinical features
Repetitive stereotyped thoughts and acts with
- Sense of compulsion, resistance, ego-dystonic (senseless)
- With anxiety, depression
- With avoidance of OC tiggers
- Functional impairment
Associated with PRIORS - phobia, rituals, impulse, obsessional rumination, slowness
Obsessional ruminations (Internal debates), Impulse (urge to perform act), Rituals (Mental or senseless behaviour), Slowness, Phobias (avoidance behaviours)
Define obsessional ruminations
Define Obsessional impulse
Define obsessional rituals
Define obsessional slowness and phobia
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Common themes of obsessions and compulsions
Orderliness: rearranging/ counting
Cleanliness/ Hygiene
Doubt/ Checking
Reprehensive thoughts: Aggression, Blasphemous, Sexual
Reprehensible acts: seeking reassurance, redemption, avoidance
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OCD
Diagnostic criteria
Obesession, Compulsion or both
Obsession
- Recurrent and persistent thoughts, urges or images
- Intrusive and unwanted
- Cause marked anxiety
- Tries to ignore/ suppress/ neutralize with other thoughts or action
Compulsion
- Repetitive behaviour or mental acts
- Feel driven to perform/ according to rigid rituals
- Acts prevent/ reduce anxiety or prevent dreaded event
- Not connected in realistic ways and clearly excessive
Both: Time consuming, significant distress, functional impairment
Not due to SA or medical or another mental disorder
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OCD
D/dx
Anxiety, Depression, Psychosis (Delusions)
Other specific OCD: Hoarding, Body dysmorphia
Tics/ Stereotyped movements
Encephalitis lethargica
OCD
Course and prognosis
OCD
Biological factors
OCD
Psychological and social factors
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OCD
Management
Psychosocial intervention: Psychotherapy, Exposure and Response Prevention therapy, Cognitive therapy
Drug: SSRI» SSRI/ SNRI»_space; Clomipramine»_space; SGA/ Combine Citalopram + Clomipramine
Surgery: Orbitomedial/ Cingulate lesioning, Deep brain stimulation
Define stress event
Define traumatic stress
Emotional response to stress
Coping strategies to stress
3 ways: Problem solving, emotion reducing, Maladaptive response
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Defence mechanisms to stress
R2D2 Is Stressed
Repress
Regress
Reaction formation
Rationalization
Denial
Displacement
Sublimation
Identification
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Define the stress-vulnerability model
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Classification of reaction to stressful event
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Define timing of stress disorders
Reaction <1h – few days
Disorder 3d – 1month
Adjustment <3months
PTSD <6months
Risk factors of acute stress disorder
Risk factors of PTSD
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PTSD
Clinical features
RAAA! Reaction After An Assault <6 months
Re-experience: Intrusive images, Dissociative flashbacks, Recurrent dreams
Avoidance: Dissociative amnesia, Emotional detachment, Avoidance of reminders
Arousal: Hypervigilance, Irritable, Behavioural
Associated: Depression, Dissociation
PTSD
Associated symptoms
Time frame
Course
Acute stress disorder
DSM-5 criteria
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PTSD
DSM-5 criteria
PTSD
D/dx
PTSD
Biological, psychological, social factors
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Acute stress disorder
Management
Trauma-focused CBT: Psychoeducation, Cognitive restructuring, Exposure therapy
Critical incident stress debrief
Pharmacotherapy
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PTSD
Management
Trauma- focused CBT
Eye movement desensitization and reprocessing (EMDR)
CBT: Coping skills, stress management, hypnotherapy, IPT
Drug: SSRI/ SNRI/ SGA/ a-blocker, BDZ
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Adjustment disorder
Clinical features
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Adjustment disorder
DSM-5 criteria
Adjustment disorder
D/dx
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Adjustment disorder
Management
Problem solving counselling
Psychotherapy
Pharmacotherapy - anxiolytics, hypnotics only
Somatoform disorder
Define medically unexplained symptoms
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D/dx medically unexplained symptoms
Somatoform
- Somatic symptom disorder: somatic symptom with distress/ functional impairment
- Conversion disorder: neurological symptoms unexplained
- Hypochondriacal disorder: fear of underlying serious disease
- Body dysmorphic disorder: defect in physical appearance (not weight)
Fake:
- Factitious disorder: Intentional fabrication of symptoms
- Malingering: fabrication for secondary gains
Secondary to:
- Delusion disorder
- Physical symptoms of depression and anxiety disorders
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Medically unexplained symptoms
Features
Somatoform disorder
Define somatization, functional somatic symptoms, medically unexplained symptoms
Somatoform related disorders
Classification
Somatoform disorder
Epidemiology
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Somatoform disorder
Clinical presentation
Somatoform disorder
Clinical course
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Conversion disorder
Pathogenesis
S/S
Mx
Neurological symptom +/- Belle indifference
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Somatoform disorder
DSM-5 criteria
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Somatoform disorder
D/dx
Somatoform disorder
Biological, psychological and social factors
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Somatoform disorder
Management
Reassurance: real symptoms, explain psychosocial factor, allow time for questions, agree on treatment plan, treatment of minor ailments and psychiatric disorder
Refractory: Relaxation training, CBT, Antidepressants
Hypochondiracal disorder
Epidemiology
Clinical presentation
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Hypochondriachal disorder
DSM-5 criteria
Preoccupation with having serious illness
Mild/ absent symptoms
Preoccupation is clearly excessive/ disproportionate
Anxiety about health, easily alarmed by personal health
Excessive health-related behaviours
Maladaptive avoidance
>6 months
Not another mental disorder
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Hypochondriachal disorder
Management
CBT
Mindfulness based cognitive therapy
Antidepressants
Compare somatoform, factitious disorder, malingering
Factituous disorder
Presentation
Malingering
Features
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Body dysmorphic disorder
Clinical features
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Body dysmorphic disorder
Diagnostic criteria
Management
