Psych - Anxiety Disorders Flashcards

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1
Q

What is anxiety?

A
  • Unpleasant emotional state involving subjective fear, badly discomfort and physical sx.
  • It may or may nor be in response to a recognisable threat
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2
Q

What would be your differential for someone presenting with anxiety?

A
  • Acute panic disorders (ie panic attacks)
  • Phobias (agoraphobia, social phobia, specific phobias)
  • Generalised anxiety
  • Somatic symptom disorders
  • OCD
  • PTSD
  • Hypochondriasis
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3
Q

What is panic disorder?

A
  • 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
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4
Q

What are sx of panic attacks?

A
  • Palpitations, tachycardia
  • Sweating, trembling, breathlessness
  • Feeling of choking
  • Chest pain/discomfort
  • nausea/parasthesia
  • Chills and hot flushes
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5
Q

What is the mechanism of panic attacks?

A
  • ‘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
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6
Q

What are the treatments available for panic attacks?

A
  • 1st line: SSRI + CBT
  • 2nd line: TCA (imipramine and clomipramine)
  • Avoid benzos
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7
Q

What is generalised anxiety disorder?

A

-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

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8
Q

Name some associated features of GAD

A
  • 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
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9
Q

What differential should you consider when assessing someone for GAD?

A
  • 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
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10
Q

Outline the treatment structure for GAD

A
  • 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
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11
Q

What is OCD? What treatments are available for OCD?

A
  • 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)
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12
Q

What sort of questions should you ask someone who you suspect is suffering from OCD?

A
  • 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?
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13
Q

What is PTSD? What differential would you consider for it?

A

-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)
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14
Q

What are the cardinal features of PTSD?

A
  • 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
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15
Q

What other features/behaviours might you see in a pt suffering from PTSD?

A
  • Depression
  • Drug/alcohol misuse
  • Anger
  • Unexplained physical sx
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16
Q

What is the management for PTSD?

A
  • Trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR)
  • Drug treatment: not used routinely 1st line. If drugs are tried, go for venlafaxine or SSRI (sertraline) or can also used risperidone
17
Q

What is somatic symptoms disorder?

A
  • Defined by extreme focus on physical symptoms (ie sleep or fatigue) that causes major emotional distress and can severely impact functioning
  • Treatment is based on CBT, mindfulness therapy and SSRIs
  • Often these patients are quite difficult to treat