Psychiatry Flashcards
Geralised Anxiety Disorder
Mental health condition that cause excessive and disporportional anxiety and worry, significant impact on person’s everyday acitvities.
Symptoms should be persistant, occuring most days for at least 6 months and not caused by substances or another condition.
Secondary causes of anxiety
- Substance use (e.g., caffeine, stimulants, bronchodilators and cocaine)
- Substance withdrawal (e.g., alcohol or benzodiazepine withdrawal)
- Hyperthyroidism
- Phaeochromocytoma
- Cushing’s disease
Clinical features of anxiety
- Emotional + cognitive: excessive worrying, unable to control, restlessness, difficulty relaxing, easily tired, poor concentration
- Physical symptoms (sympathetic overactivity): muscle tension, palpitations, sweating, tremor, GI symptoms (e.g. abdo pain/diarrhoea), headaches, poor sleep
Questionnaire for Generalised Anxiety Disorder
Generalised Anxiety Disorder Questionnaire (GAD-7):
- 5-9 indicates mild anxiety
- 10-14 indicates moderate anxiety
- 15-21 indicates severe anxiety
Management of Generalised Anxiety Disorder
- Mild - active monitoring, self-help strategies (e.g. mindfulness), sleep, diet, exercise, avoid alcohol/caffeine/drugs
- Moderate/severe: above + CBT and medication, 1st line is SSRI e.g. sertraline
- Propranolol for physical symptoms (contraindicated in asthma > bronchospasm)
< 30 = FU within a week of starting SSRI to monitor, increased suicide and self-harm risk
Panic disorder
Recurrent panic attacks, unexpected without trigger and results in maladaptive begaviour to prevent further attacks.
Panic disorder: panic attacks
Panic attacks are a manfestation of panic disorder, but do not indicate panic disorder
Sudden onset of intense physical and emotional symptoms of anxiety.
Lasts about 10 mins.
Physical - tension, palpitations, tremors, sweats, dry mouth, chest pain, SOB, dizziness and nausea
Emotional: panic, fear, depersonalisation, loss of control
Treatment for panic disorder
- 1st line = CBT
- 1st line medical = SSRI
- Propranolol for physical symptoms (except asthma)
Phobia
Extreme fear of situations or things causing symptoms of anxiety and panic.
Common phobias:
- Claustrophobia (fear of closed spaces)
- Acrophobia (fear of heights)
- Arachnophobia (fear of spiders)
- Glossophobia (fear of public speaking)
-Trypanophobia (fear of needles) - Agraphobia (fear of being unable to escape)
- Social phobia (fear of social situations)
Managment of phobias
- 1st line: CBT
Exposure techiques for systemic desensitisation
- Flooding - exposing the person to the phobia
- Modeling - indivduals observe therapist interacting with phobic stimulus
- Medical - SSRI if above ineffective, or propranolol for physical symptoms
Obsessive Compulvise Disorder
Characterised by obsessions and complusions, significant impact on QoL, present daily.
Obsession - unwanted and uncontrolled thoughts and images that the patient finds difficult to ignore e.g. oberwhelming fear of germs or violent images appearing in their mind
Complusions are repetitive actions the patient feels they must do to handle the obsessions. Anxiety if not done. Not enjoyable.
The OCD cycle
- Obsessions
- Anxiety
- Complusions
- Temporary relief
ICD-11 criteria for OCD (supposed to use ICD10 according to med school but so difficult to understand)
- Presence of obsessions, compulsions, or both.
- Time-consuming (more than one hour a day) or causes significant impairment.
- Not attributed to another medical or mental disorder.
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess severity.
Mangement of OCD
Mild = education and self-help resources
Moderate/severe =
- CBT with exposure and response prevention (ERP) - gradually facing obsessive thoughts and anxiety without completing complusions
- SSRI
- Clomipramine (TCA)
Self-harm and suicide
Self-harm = intentional self-injury without suicidal intent, more common in females and < 25
Suicide = causing own death, more common in men and those over 50
Cycle of self-harm
- Emotional suffering
- Emotional overload
- Panic
- Self-harm
- Temp relief
- Shame and gulit
Suicide and risk assessment
- Aims to determine suicide risk and suitable mx plan.
- Ranges from passing suicide ideation to active plan
Some things to look out for on presentation:
- Previous attempts
- Escalating self harm
- Implusiveness
- Hopelessness
- Feeling like a burden
- Suicide plan in place
- Making final arrangements (note, giving away pets etc.)
Background risk factors for suicide
- Mental/physical health conditions
- Hx abuse/trauma
- FHx
- Finanical difficulties
- Criminal problems
- Lack of social support
- Access to means e.g. firearms
Protective factors include: social support, sense of responsibility e.g. children, coping mechanims, access to mental health support
Management of self harm, suicidal thoughts/attempt
Tailored to individual, seek senior advice
- Safety plan (to use when suicidal feelings are overwhelming), safety-netting, follow-up
- Referral to A+E after suicide attempt if injured, overdose or safety concerns
- Mental health team will decide further mx, e.g. informal admission
Management of self-harm
- Empathic communication
- Identify triggers
- Remove self-harm means
- Identify coping strategies
- Tx underlying mental health condition
- CBT
- Crisis support service details
Treatment of common overdoses
Activated charcoal if presentation within an hour (e.g. aspirin, SSRIs, TCAs, antipsychotics, benzos)
- Paracetamol - acetylcysteine
- Opoids - naloxone
- Benzo - flumazenil
- Beta blockers - glucagon if HF or cardiogenic shock, atropine if symptomatic brady
- Cocaine - diazepam
- Methanol (e.g. solvents)/ ethylene glycol (antifreeze) - ethanol
- Carbon monoxide - 100% O2
Alcohol dependence
- Daily alcohol consumption,
- Strong urges and cravings,
- Diffculty controlling consumption
- Tolerance
- Withdrawal when stopping
Alcohol = depressant, stimulates GABA receptors, inhibit glutamate (NMDA) receptors > relaxing effect on brain
Long-term use = GABA system downregulated, glutamate system upregulated
Formula for alcohol units
Volume (ml) x Alcohol Content (%) ÷ 1000 = Units of Alcohol
UK ecommendations:
- No more than 14 units per week
- Spread over 3 days or more
- No more than 5 units in one day
Complications of alcohol excess
- Alcoholic liver disease
- Cirrhosis
- Alcohol dependence and withdrawal
- Wernicke-Korsakoff syndrome (WKS)
- Pancreatitis
- ↑ CVD risk
- ↑ cancer risk (breast/mouth/throat)
