(PM3B) Anxiety Disorders Flashcards
What is anxiety?
Prolonged or exaggerated response
To a real or imagined threat
Interferes with normal life
Cannot be attributed to any known neurological or organic dysfunction
What percentage of the population have anxiety?
~15%
Is long-term drug treatment for anxiety recommended?
No
Which molecules in the blood mediate anxiety?
(1) Serotonin
(2) Noradrenaline
(3) Dopamine
(4) GABA
What types of symptoms are associated with anxiety?
(1) Psychiatric
(2) Somatic
What are some psychiatric symptoms of anxiety?
(1) Fear/ tension/ apprehension/ panic/ terror
(2) Hyper-arousal excitability + outbursts of hostility
(3) Insomnia
(4) Circling thoughts + lapses of memory
(5) Inability to concentrate + easily distracted
What are some somatic symptoms of anxiety?
(1) Cardiovascular: palpitations/ increased BP/ tachycardia/ bradycardia/ flushing/ pallor
(2) Respiratory: rapid shallow breathing (hyperventilation)/ breathlessness (dyspnoea)
(3) GI: diarrhoea/ dyspepsia/ dysphagia/ churning stomach
(4) Musculoskeletal: agitation/ restlessness/ tremor/ muscle tension
(5) Metabolic: high blood glucose/ high glucocorticoids
(6) Excessive sweating/ urge to defecate or urinate
What is dyspnoea?
Breathlessness
What is hyperventilation?
Rapid shallow breathing
What are some different types of anxiety disorder?
(1) Generalised anxiety disorder – GAD
(2) Obsessive Compulsive Disorder – OCD
(3) Post-traumatic Stress Disorder – PTSD
(4) Panic Disorder – PD
(5) Specific phobias
(6) Social phobias
Describe the aetiology of anxiety?
No evidence of pathology of anxiety
OCD may be partially due to disturbed circuits
Some evidence for a genetic factor in some anxiety disorders – e.g. OCD
What are the treatment aims for anxiety therapy?
(1) Discover + remove cause
(2) Assess severity of anxiety response
(3) Relieve distress
(4) Implement long-term measures to prevent recurrence
What are some of the common psychological treatments for anxiety?
(1) Counselling
(2) Cognitive Behavioural Therapy (CBT)
(3) Exposure therapy
(4) Mindfulness + relaxation therapy
What is the phramacological treatment for acute anxiety?
Benzodiazepines
e.g. lorazepam/ diazepam/ alprazolam
Fast-acting relief
What is the usual first line treatment for most anxiety disorders?
(1) SSRIs – selective serotonin reuptake inhibitors
Recommended for long-term therapy
When is pregabalin indicated for treatment?
(1) Epilepsy
(2) Generalised anxiety disorder – GAD
When are tricyclic antidepressants indicated for treatment?
(1) Obsessions
(2) Phobias
e. g. clomipramine
When is bus-irons indicated for treatment?
(1) Generalised anxiety disorder – GAD
(2) Acute anxiety
When are beta-blockers indicated for treatment?
Treatment of somatic symptoms of anxiety disorder
(1) Social phobias
(2) Panic disorders
How is generalised anxiety disorder (GAD) diagnosed?
(1) DSM-V
(2) ICD-10
(3) GAD-7
What is the maximum total score using the GAD-7 assessment scale?
21
7x3 points for ‘nearly every day’
Using the GAD-7 scale, what are the cut-off points for mild, moderate, and severe generalised anxiety disorder?
(1) Mild: 5 points
(2) Moderate: 10 points
(3) Severe: 15 points
What are the assessment criteria for GAD-7?
(1) Feeling afraid, as if something awful might happen
(2) Becoming easily annoyed or irritable
(3) Being so restless that it is hard to sit still
(4) Trouble relaxing
(5) Worrying too much about different things
(6) Not being able to stop or control worrying
(7) Feeling nervous, anxious, or on edge
What are the stepped escalations of therapy for GAD?
(1) All known and suspected presentations of GAD
(2) Diagnosed GAD that has not improved after education and active monitoring in primary care
(3) GAD with an inadequate response to step 2 interventions or marked functional impairment
(4) Complex treatment-refractory GAD and very marked functional impairment, such as self-neglect or a high risk of self-harm
What is usually the most beneficial and effective treatment for GAD?
Cognitive Behavioural Therapy – CBT
What is the first line pharmacological treatment for GAD?
SSRIs – e.g. sertraline
12 weeks then reassess
What is a recommended alternative to SSRIs for first line pharmacological treatment of GAD?
SNRIs
