Psych - Anxiety Disorders Flashcards
What is anxiety?
- Unpleasant emotional state involving subjective fear, badly discomfort and physical sx.
- It may or may nor be in response to a recognisable threat
What would be your differential for someone presenting with anxiety?
- Acute panic disorders (ie panic attacks)
- Phobias (agoraphobia, social phobia, specific phobias)
- Generalised anxiety
- Somatic symptom disorders
- OCD
- PTSD
- Hypochondriasis
What is panic disorder?
- Recurrent episodic severe panic (anxiety attacks) which occur unpredictable and are not restricted to any particular situation
- DSM and ICD10 agree need at least 3 panic attacks in 3 weeks
What are sx of panic attacks?
- Palpitations, tachycardia
- Sweating, trembling, breathlessness
- Feeling of choking
- Chest pain/discomfort
- nausea/parasthesia
- Chills and hot flushes
What is the mechanism of panic attacks?
- ‘Anticipatory fear’ of having an attack
- Mechanism of panic attack: catastrophic misinterpretations of ambiguous physical sensations (SOB or raised HR) increase arousal, creating a positive feedback loop that results in panic
What are the treatments available for panic attacks?
- 1st line: SSRI + CBT
- 2nd line: TCA (imipramine and clomipramine)
- Avoid benzos
What is generalised anxiety disorder?
-Generalised, persistent, excessive anxiety or worry about a number of events that the individual finds difficult to control, last for at least 3 weeks, or longer than 6 months
Name some associated features of GAD
- Subjective apprehension (fears/worries)
- Increased vigilance
- Feeling restless/on edge
- Sleeping difficulties (initial, middle, fatigue on waking)
- motor tension
- Autonomic hyperactivity (sweating/tachycardia/bowel issues)
- Difficulty concentrating
- Altered appetite
What differential should you consider when assessing someone for GAD?
- Other anxiety disorders: panic attacks, phobias, somatic disorders, OCD, PTSD, hypochondriasis
- Withdrawal from drugs/alcohol
- Excessive caffeine consumption
- Depression
- Psychotic disorders
- Organic causes: thyrotoxicosis, parathyroid disease, hypoglycaemia, pheochromocytoma, carcinoid syndrome
Outline the treatment structure for GAD
- Assess severity with GAD questionnaire
- Mild/moderate anxiety: refer for self help or for guided self help
- Moderate/severe: refer for CBT and commence SSRI (sertraline) as 1st line
- Avoid benzodiazepines
What is OCD? What treatments are available for OCD?
- Defined as obsessions or compulsions, or both, persistent for greater than 2 weeks.
- There is a big range in severity, some patients are mildly affected while others have serious difficulty with normal functioning as a result of these thoughts.
- Tx include: exposure and response prevention therapy, CBT and then SSRI (Sertraline - usually at higher doses than for depression/anxiety)
What sort of questions should you ask someone who you suspect is suffering from OCD?
- Through which behaviours is the OCD manifested?
- Is it their own thoughts or is it intrusive thoughts?
- Describe their rituals
- What would happen if they didn’t do their rituals?
What is PTSD? What differential would you consider for it?
-PTSD: stress reaction with sx lasting more than 1/12 (within 6/12 of the trauma)
Differential
- All of the anxiety disorders mentioned previously
- Acute stress disorder: short term reaction to a recent stressful event (usually lasts 3-4 days and is within 1/12 of trauma)
What are the cardinal features of PTSD?
- Re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
- Avoidance: avoiding people, situations or circumstances resembling or associated with the event
- Hyper-arousal: hyper-vigilance for threat, exaggerate startle response, sleep problems, irritability and difficulty concentrating
- Emotional numbing: lack of ability to experience feelings, feeling detached
What other features/behaviours might you see in a pt suffering from PTSD?
- Depression
- Drug/alcohol misuse
- Anger
- Unexplained physical sx
