Psychiatry - Level 2 Flashcards
Definition of adjustment disorder?
- Adjustment disorders are states of emotional distress and disturbance, usually interfering with social functioning, arising in period of adaptation to a significant life event (bereavement/separation)
- Must occur within 1 month of stressor and most do not occur after 6 months
Risk factors of adjustment disorder?
o Younger age
o Increased suicidal behaviour
Aetiology of adjustment disorder?
o The integrity of an individual’s social network (bereavement, separation experiences)
o The wider system of social supports and values (migration, refugee status)
o Major developmental transition or crisis (going to school, becoming a parent, failure to attain a cherished personal goal, retirement)
Symptoms of adjustment disorder?
o Sadness o Hopelessness o Lack of enjoyment o Crying spells o Nervousness o Anxiety o Desperation o Trouble sleeping o Difficulty concentrating o Performing poorly at work/school
Subtypes of adjustment disorder?
o Brief/Prolonged (>6m) depressive disorder
o Mixed anxiety and depressive disorder
o Disturbance of affect, conduct
o Grief/Bereavement reactions
Types of grief reaction?
Normal grief
• Typical disbelief, sadness, shock, numbness, anger, guilt, disturbed sleep, appetite
• Symptoms gradually reduce which usually lasts less than 12 months
Abnormal Grief
• Very intense, prolonged, delayed or where symptoms outside of normal
• Worthlessness, excessive guilty, marked slowing of thoughts and movements, not functioning normally
Management of adjustment disorder - psychological?
o Supportive psychotherapy
o Talking therapy
o Counselling
o Verbalization
Management of adjustment disorder - pharmacological?
o SSRIs
o Anxiolytics
Management of adjustment disorder - bereavement?
o Groups such as CRUSE for counselling
Prognosis of adjustment disorder?
- 20% develop major psychiatric illness within 5 years
- Most recover within 5 years
Definition of neurosis?
- Neurosis is abnormal psychogenic reactions with two components:
o Vulnerable personality
o Stress factors triggering the reaction
What is normal anxiety?
o Anxiety is a common, normal mood
o An evolutionary response to threatening situation due to adrenaline release which causes physical symptoms
o Fight or flight response
o It becomes problematic when it starts to interfere with daily life/out of proportion to the threat
What is generalised anxiety disorder?
o Persistent free-floating worry and feelings of apprehension about everyday events causing significant functional impairment
o Most days for 6 months
o Comorbidity with panic disorder, social phobias, depression and substance misuse
Epidemiology of generalised anxiety disorder?
- Lifetime prevalence 1 in 5
- Females 2:1 Males
Risk factors of generalised anxiety disorder?
o Unemployed
o Single
o Stressful events in childhood
Aetiology of generalised anxiety disorder?
o Genetic
o ANS hyperresponsiveness
o Experience of unexpected negative stressors (death of parent, rape, war, family dysfunction)
ICD-10 criteria of generalised anxiety disorder?
At least 4 symptoms (with at least 1 from autonomic arousal):
o Autonomic Arousal
Palpitations, tachycardia, sweating, trembling, dry mouth
o Physical symptoms
Breathing difficulties, choking sensation, chest pain, nausea, abdominal pain
o Mental state
Feeling dizzy, unsteady, faint, derealisation, fear of losing control, passing out, dying
o General symptoms
Hot/Cold flushes, numbness or tingling
o Tension
Muscle aches/tension, restlestness, feeling on edge
o Other
Exaggerated response to minor surprises, concentration difficulties, sleep problems
Assessment of generalised anxiety disorder?
- History and MSE
- Diagnosis made on clinical symptoms (ICD-10)
- Assess severity using GAD-7 questionnaire
- Enquire about:
o Comorbid depressive, anxiety, medical conditions
o Substance misuse
o Environmental stressors
Management of generalised anxiety disorder - general advice?
o Sleep problems
Use sleep hygiene advice - avoid caffeine, alcohol, bedtime routines
o Regular exercise
o Counselling
o Self-help books on relaxation and leaflets
Management of generalised anxiety disorder - psychological 1st line ?
o CBT
Based on idea that thoughts and feelings are maintaining problems
Individual recognises thoughts and finds more helpful ways to view them, also replaces automatic morbid anticipatory thoughts with realistic cognition
o Applied relaxation
Management of generalised anxiety disorder - pharmacological 2nd line?
o SSRIs/SNRIs
Start at low dose and increase
o Beta-blockers
For palpitations and tremor
o Benzodiazepines
Avoid if possible
Only short-term use, best to avoid – risk of dependence
Management of generalised anxiety disorder - if severe or risk to harm self or others?
o Admission, acute CRISIS assessment, CMHT
Prognosis of generalised anxiety disorder?
- The more chronic, the worse the prognosis
- 1 in 3 remits after 3 years with treatment
- In 6 years, 1 in 10 have severe persistent impairment
Definition of panic disorder?
o Recurrent panic attacks which are not secondary to substance misuse, medical conditions or another psychiatric disorder
o Frequency may be attacks every day to a few a year
o Persistent worry about having attacks and persistent behaviour changes due to this
o Can be with or without agoraphobia