Neurotic, stress-related and somatoform disorders Flashcards
Define anxiety & Define neurosis.
Anxiety: an unpleasant emotional state involving subjective fear and somatic symptoms.
Neurosis: is a collective term for psychiatric disorders characterised by distress, that are non-organic, have a discrete onset and where delusions and hallucinations are ABSENT.
Everyone experiences anxiety, but if these anxieties become excessive or inappropriate, they are described as an illness.
ICD-10 classification of neurotic and stress-related disorders
POOR
Phobic anxiety disorders
- Agoraphobia (with or without panic disorder)
- Social phobia
- Specific phobia (Acrophobia, Animal phobias, Claustrophobia, Simple phobia)
Other anxiety disorders
- Panic disorder
- Generalised anxiety disorder
- Mixed anxiety and depressive disorder
Obsessive compulsive disorder
- Predominantly obsessional thoughts or ruminations
- Predominantly compulsive ACTS (obsessional rituals)
- Mixed
Reaction to severe stress and adjustment disorders
- Acute stress reaction
- PTSD
- Adjustment disorder
Rumination: Repetitively mulling over the same thoughts to the extent that other mental activity is impaired. A feature of PTSD.
Clinical features of neuroses:
Cognitions: worries or fears that are inappropriate/excessive
Behaviours: avoidance or escape from the situation that causes anxiety!
Depressive symp are very common
what 2 catagories can anxiety be divided into?
Generalized (free floating) anxiety: Present most of the time and NOT associated with specific objects or situations. Excessive or inappropriate worry about normal life events. Typically longer duration (days, months or even years).
Episodic (paroxysmal) anxiety: Has an abrupt onset and occurs in discrete episodes. The episode of anxiety is severe with strong autonomic symptoms, but usually short-lived (typically less than one hour). Can occur in response to specific threats.
what conditions are associated with anxiety?
- Medical: hyperthyroidism, pheochromocytoma, anemia, hypogylcemia, cushings, COPD, CHF, Malignancies
- Substance-related: intoxication/withdrawl/SE
- Psychiatric: eating disorders, depression, schizophrenia, OCD, PTSD, Adjusment disorder, anxious (avoidant) personality disorder
which medication cause anxiety as a SE?
Steroids, thyroxine, adrenaline
GAD
what are the phobia disorders? define them
PASS
Phobia: an intense, irrational FEAR of an OBJECT, SITUATION, PLACE or PERSON that is recognized as EXCESSIVE or unreasonable
Agoraphobia: “fear of marketplce”, FEAR of PUBLIC SPACES or fear of entering public space from which immediate escape would be difficult in the event of a panic attack
Social Phobia ((social anxiety disorder): FEAR of SOCIAL SITUATIONS which may lead to humilitation, criticism or embarrassment
Specific (isolated) phobia: FEAR restricted to a SPECIFIC OBJECT or SITUATION (ex: spiders)
Name some common specific phobias?
Animals: spiders, insects, dogs, birds
Nature/forces: thunder, stroms, water
Blood/injection/injury: sight of blood, needles, injury
Situational: claustraphobia, heights( acro-), dark (nycto-) hospitals (nocosome-)
causes of Agrophobia, social phobia, sepecific phobias?
and their epidemiology?
Agoraphobia: early adulthood (25-30 yrs)
social phobia (adolescence )
Specific phobia’s: Usually childhood but can develop in later in life
name the conditions assoc. w/ reactions to stressful events
Abnormal Bereivment
PTSD
adjusment disorder
Acute stress reaction
Risk factors for PTSD
exposure to a traumatic event: professions at risk (army, police, fire fighter, doctors)
Pre-trauma: prev. trauma, Hx of MH illness, females, childhood abuse
Per-trauma: severity? adverse emotional reaction?
Post-trauma: concurrent life stressors, absence of social support
Clinical features of PTSD
time frame of developing it?
Reliving the situation : Flashbacks, vivid memories, nightmares,
Avoidance: Avoiding reminders of trauma (e.g. associated people or locations), excessive rumination about the trauma)
Hyperarousal: Irritability or outbursts, difficulty with concentration, difficulty with sleep, hypervigilance, exaggerated startle response.
Emotional numbing: Negative thoughts about oneself, difficulty experiencing emotions, feeling of detachment from others, giving up previously enjoyed activities.
ICD-10 Criteria for the diagnosis of PTSD?
- *TRAUMA**
- *T**raumatic event
- *R**e-living
Avoidance
Unable to function
6 Month or more of symptoms
Arousal increased
questions to ask in the history of PTSD?
‘Has there been any traumatic incident or event in your life recently which may account for how you are feeling?’ (exposure to stressful event)
‘Do you ever get any flashbacks, vivid memories or nightmares about the events that took place?’ (reliving the situation)
‘Do you find yourself constantly thinking about the same thing?’ (rumination)
‘Have you had any problems with sleep since the event?’, ‘Are you feeling more irritable or having trouble concentrating?’, ‘Do you get startled easily?’ (hyperarousal)
Ix, DDx, Mx of PTSD
Kübler–Ross stages of grief.
Adjustment disorder
Identifiable (non-catastrophic) psychosocial stressor (ex: redundancy, divorce) within one month of onset of symptoms.
The manifestations vary and include depressed mood, anxiety or worry (or mix), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some degree of disability in the performance of daily routine
redundancy : state of being no longer needed
Acute stress reaction=
what if symptoms for ASR persist? what other diagnosis should u consider?
An acute stress reaction that occurs in the first 4 weeks after a person has been exposed to a traumatic event–> followed by IMMEDIATE ONSET of symp which usually subsides within hours or days.
This is in contrast to (PTSD) which is diagnosed AFTERRR 4 weeks.
possible symptoms:
- GAD symptoms
- initial DAZE
- narrowed attention
- disorientation
- Autonomic signs of panic anxiety
this state may be followed either by….
- further withdrawal from the surrounding situation or
- Agitation and Over-activity & Anger
- Partial or complete amnesia for the episode may be present.
- hopelessness, uncontrollable or excessive grief.
if prolonged…
Acute:
- crisis reaction
- reaction to stress
- Combat fatigue
- Crisis state
- Psychic shock
Mx: trauma-focused cognitive-behavioural therapy (CBT)
what is OCD?
is characterized by recurrent obsessional thoughts or compulsive acts or both.
Obsessions are unwanted intrusive thoughts, images or urges that repeatedly enter the individuals mind. they r distressing for the individual who attempts to resist them and recognize them as absurd (egodystonic)
Compulsions: repetitive, stereotypical behaviour or mental acts that a person feels DRIVEN into performing, they are OVERT (seen by others) or COVERT (not observable)
causes, epidemiology, RF of OCD
BIOLOGICAL: low serotonin in the frontol cortex and BG, Twins, childhood group A beta-haemolytic strep infection, PANDAS
BEHAVIOURAL: Compulsive behaviour is learned and maintained by operant conditioning. The anxiety made by the obsession is reduced by performing the compulsion, and so the need to perform the compulsion is increased.
EPidem: most common in early adulthood, equal in men and women .
RF: FHx, Developmental factors ex: neglect, abuse, bullying , social isolation
OCD has strong associations with other psychiatric disorders? what r they?
- depression (30%)
- schizophrenia (3%)
- Sydenham’s chorea
- Tourette’s syndrom
- Anorexia nervosa.
ICD-10 Criteria of OCD
- Either obsess or comp(or both) present on most days for a period of at least 2 weeks.
- Obsessions or compulsions share a number of features, ALL of which must be present!
- The obs or comp cause DISTRESS or INTERFERE with the ptx SOCIAL or individual functioning, usually by wasting time.
NOTE: The dx can be specified as ‘predominantly obsessional thoughts or ruminations’, ‘predominantly compulsive acts’, or ‘mixed obsessional thoughts and acts’.
Clinical features of OCD
what is the most common obsession? compulsion?
- most common obsession is that of being contaminated
- most common compulsion is checking followed by washing/ cleaning
MUST SHOW ALL–> FORD Car:
FAILURE to resist: at least ONE O or C is present & cannot be resisted
ORIGINATE: from ptx mind (Acknowledged that the O or C originate from THEIR own mind)
REPETITIVE and DISTRESSING: At least ONE O or C must be present which is acknowledged by the patient as excessive or unreasonable.
CARRYING out the O thought or C act is NOT pleasurable, but reduces anxiety.
