Psychiatry Flashcards
Physical signs of anxiety
- Tachycardia
- Palpitations
- Hypertension
- SOB/tachypnoea
- chest pain
- choking sensation
- tremors/shaking
- muscle tension
- dry mouth
- sweating
- cold skin
- nausea/vomiting
- diarrhoea
- ‘butterflies in the stomach’
- dizziness, lightheadedness
- mydriasis
Risk factors and triggers for Hyperventilation Syndrome
- Female
- Age 15-55
- Emotional distress
- Sodium lactate
- Caffeine
Clinical features of hyperventilation syndrome
- agitation
- confusion
- dizziness
- weakness
- depersonalisation
- visual hallucinations
- syncope
- parasthesia: usually bilateral upper limbs
- peri-oral numbness
- atypical chest pain
- tachypnoea
- hyperpnoea
- dyspnoea
- wheeze
- bloating
- belching
- flatus
- epigastic pressure
- dry mouth
- acute hypocalcaemia
- acute hypokalemia
- acute hypophosphatemia
Investigations to rule out an organic cause of hyperventilation syndrome
- FBC
- U&Es
- TFTs
- glucose
- calcium
- ABG: normal pH, normal CO2, low bicarb
- Toxicology
- ELISA
- D-dimer
- ECG
- CXR
- V/Q scan
Acute management of hyperventilation syndrome
- Reassurance
- alleviation of anxiety e.g. benzos
- establishment of normal breathing pattern
Long-term management of hyperventilation syndrome
- Education
- Formal breathing retraining
- B-blockers and benzos
- Treatment of any underlying medical disorder
Prevalence of GAD
3%
Risk factors for GAD
- family history
- female
- age 35-54
- divorced/separated
- living alone
- single parents
- unemployment
- childhood phobias
Description of GAD
Long-standing, free-floating excessive anxiety - excessive worries about minor matters on most days for 6 months, not limited to specific situations
Symptoms of GAD
- Edginess/restlessness
- difficulty concentrating
- irritability
- GI upset
- muscle aches/tension
- difficulty sleeping and chronic fatigue/easy fatiguability
ICD-10 criteria for diagnosis of GAD
Key elements:
1) Apprehension
2) Motor tension
3) Autonomic overactivity
Diagnosis requires at least 4 of the following criteria (with at least 1 from autonomic arousal):
- symptoms of autonomic arousal
- physical symptoms of anxiety
- mental state symptoms
- generalised symptoms
- symptoms of tension
- other: exaggerated response to minor startles
- concentration difficulties
Management of GAD
- CBT
- SSRIs
- beta-blockers for symptomatic relief
- benzos
Prevalence of panic attacks
8%
Describe a panic attack
A sudden period of intense fear or discomfort that something bad is going to happen and there is some imminent threat or danger, often accompanied by physical symptoms. Symptoms peak in the first 10-20 minutes.
Physical symptoms of a panic attack
- Pounding heart/tachycardia
- chest pain
- sweating
- trembling
- SOB
- nausea
- dizziness
- chills or hot flushes
- numbness/tingling
- feelings of choking
- derealisation or depersonalisation
- fear of losing control
- fears of dying
Acute management of a panic attack
- Reassurance
- Consider benzos if symptoms are severe and distressing
- Exclusion of medical causes if first presentaiton
Describe a panic disorder
Recurrent panic attacks that occur unpredictably and are not restricted to any particular situation or objective danger.
Not secondary to substance misuse, a medical condition or other psychiatric disorder.
Prevalence of panic disorders
2%
Risk factors for panic disorder
- Female sex
- Family history
- Age: 15-24, 45-54
- Widowed
- Divorced/separated
- Living in a city
- Limited education
- Early parental loss
- Physical/sexual abuse
Investigations to rule out a organic cause in panic disorder
- FBC
- U&Es
- glucose
- TFTs
- ECG
- Toxicology
- Calcium
- Echo
- EEG
Describe anticipatory anxiety
When patients get anxious about the possibility of having a panic attack
Management of panic disorder
- CBT
- SSRIs
- Benzodiazepines
- continue treatment for 12-18 months before trial discontinuation with tapering doses
Poor prognostic factors for panic disorder
- very severe initial symptoms
- marked agoraphobia
- low SES
- low education level
- long duration of untreated symptoms
- restricted social networks
- personality disorder
Prevalence of phobic disorders
10%