Overview of Anxiety Disorders Flashcards
What is Anxiety?
Anxiety is an unpleasant emotional state involving subjective fear and somatic symptoms. It becomes an illness when it’s excessive or inappropriate
What is the ICD-10 classifications of Neurotic and Stress-related disorders?
- Phobic anxiety disorders: agoraphobia, social phobia, specific phobia
- Other anxiety disorders: panic disorder, generalized anxiety disorder, mixed anxiety and depressive disorder
- Obsessive-Compulsive disorder: predominantly obsessional thoughts, predominantly compulsive thoughts, mixed
- Reaction to Severe stress and adjustment disorders: acute stress reaction, post-traumatic disorder, adjustment disorder
What are common symptoms of Neuroses?
- Psychological: anticipatory fear of impending doom, worrying thoughts, exaggerated startle response, restlessness, poor concentration and attention, irritability, depersonalization and derealization
- Cardiovascular: palpitations, chest pain
- Respiratory: hyperventilation, cough, chest tightness
- Gastrointestinal: abdominal pain, loose stools, nausea and vomiting, dysphagia, dry mouth
- Genitourinary: increased micturition frequency, failure of erection, menstrual discomfort
- Neuromuscular: tremor, myalgia, headache, paraesthesia, tinnitus
What is the definition of Generalised Anxiety Disorder?
- Syndrome of ongoing, uncontrollable, widespread worry about many events or thoughts that the patient recognizes as excessive and inappropriate. Symptoms must be present on most days for at least 6 months.
What is the pathophysiology/aetiology of Generalised Anxiety Disorder?
- Genetic: 5x increase in GAD if its present in first degree relative.
- Neurophysiological: dysfunction of autonomic nervous system, exaggerated responses in amygdala and hippocampus. Alterations in GABA, serotonin and noradrenaline
- Environmental: stressful life events like child abuse, relationship problems, finances and work life. Substance dependence or exposure to organic solvent
What is the presentation of Generalised Anxiety Disorder?
- Worry (excessive, uncontrollable)
- Autonomic hyperactivity (sweating, hot flushes, ↑pupil size, ↑HR)
- Tension in muscles/Tremor
- Concentration difficulty/Chronic aches
- Headache/Hyperventilation (choking, breathlessness)
- Energy Loss
- Restlessness
- Startled easily/Sleep disturbance (difficulty getting to sleep then intermittent awakening and nightmares)
What is the ICD-10 criteria for diagnosis of GAD?
- Period of at least 6 months with prominent tension, worry, and feelings of apprehension about everyday events and problems
- At least four of the symptoms
- At least one symptoms of autonomic arousals (Symptoms of autonomic arousal: palpitations, sweating, shaking/tremor, dry mouth)
What is the investigation of Generalised Anxiety Disorders?
- Blood Tests: FBC (infection/anaemia), TFTs (hyperthyroidism), Glucose (hypoglycaemia)
- ECG: may show sinus tachycardia
- Questionnaires: GAD-2, GAD-7, Beck’s Anxiety Inventory, Hospital Anxiety and Depression scale
What is the stepwise approach to managing Generalised Anxiety Disorders?
- Step 1: psychoeducation about GAD + active monitoring
- Step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
- Step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment.
- Step 4: highly specialist input e.g. Multi agency teams
What is the biological management of GAD?
- 1st line is SSRI (sertraline).
- If this doesn’t work, then SNRI (duloxetine and venlafaxine) can be offered. The next step is pregabalin if both fail.
- Medication should be continued for at least a year
- Benzodiazepine can be used in the short term (dependence)
- For patients under the age of 30 years NICE recommend warning patients of the increased risk of suicidal thinking and self-harm. Weekly follow-up recommended for the first month
What is the psychosocial management of Generalised Anxiety Disorder?
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Psychological: psychoeducation groups are low intensity form of psychological intervention. High intensity includes cognitive behavioural therapy and applied relaxation
- Co-morbid depression and substance misuse should be treated
- Social: Self-help methods and support groups. Exercise encouraged
What is Agoraphobia?
Literally means a fear of the marketplace. It is a fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack. Maintained by avoidance which prevent deconditioning and sets up vicious cycle of anxiety
What is Social phobia?
Fear of social situation which may lead to humiliation, criticism or embarrassment. Uncertain aetiology but usually begins in late adolescence.
What is Specific phobia?
- Fear restricted to specific object or situation (excluding agoraphobia and social phobia).
- Results from conditioning event in early life and possibly a role for learned behaviour
What is the ICD-10 Criteria for Agoraphobia?
ICD-10 For Agoraphobia
- Marked and consistently manifest fear in or avoidance of at least two of the following: (1) Crowds; (2) Public spaces; (3) Travelling alone; (4) Travelling away from home
- Symptoms of anxiety in the feared situation with at least 2 symptoms present together (an at least one symptoms of autonomic arousal)
- Significant emotional distress due to avoidance or anxiety symptoms. Recognized as excessive or unreasonable
- Symptoms restricted to or predominated in feared situation
