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Psychiatry > Anxiety disorders and management > Flashcards

Anxiety disorders and management Flashcards

1
Q

Biological (physical) symptoms of anxiety?

A 
Sweating, hot flushes or cold chills
Trembling or shaking
Muscle tension or aches and pains
Numbness or tingling sensations
Feeling dizzy, unsteady, faint or lightheaded 
Dry mouth 
Feeling of choking
Sensation of a lump in throat 
Difficulty breathing
Palpitations or pounding heart
Chest pain or discomfort
Nausea or abdo distress
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2
Q

What are the pathological cognitive symptoms of anxiety?

A

Derealization
Depersonalisation
Meta-worry

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3
Q

Behavioural symptoms of anxiety?

A 
Aviodance of certain situations
Exaggerated response to minor suprises or being startled
Difficulty in getting to sleep due to worry
Excessive use of alcohol/ drugs 
Restlessness and inability to relax
Persistent irritability 
Seek reassurance from family/ gp 
Checking behaviours
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4
Q

What is the stress response?

A

Exposure to stress results in instantaneous and concurrent biological responses (to assess danger and organise an appropriate response)

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5
Q

What is the emotional filter of the brain?

A

Amygdala; emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response
Modified by later-received cortically processed signals

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6
Q

Which hormone is particularly active in stress?

A

Cortisol and catecholamines via adrenal gland

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7
Q

Different types of anxiety disorders?

A 
GAD
Panic disorder
Agoraphobia
Social phobia
Specific phobia
OCD
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8
Q

What is generalised anxiety disorder?

A

Anxiety that is generalised and persistent but not restricted to, or even strongly predominating in any particular environmental circumstances (free floating)

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9
Q

What is a buzzword for GAD?

A

Free-floating

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10
Q

What are the dominant symptoms of GAD?

A 
Persistent nervousness
Trembling
Muscle tensions 
Sweating 
Lightheadedness
Palpitations
Dizziness
Epigastric discomfort
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11
Q

Criteria for diagnosis of GAD?

A

Long lasting; most days for at least 6 months
Not controllable
Causing significant distress/ impairment in function

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12
Q

What is the lifetime prevalence of GAD?

A

9%

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13
Q

Typical age of onset of GAD?

A

20-40

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14
Q

Treatment of GAD?

A

1st line: CBT
2nd line: SSRI/SNRI
Long term anxiety disorder: pregabalin
Benzodiazepines (short term only)

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15
Q

What is CBT?

A

An evidence based psychological treatment based on identifying an individual’s automatic thoughts, cognitive biases and schemas
Helps the individual identify thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety

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16
Q

What is panic disorder?

A

Recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable

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17
Q

Dominant symptoms in panic disorder?

A

Sudden onset of palpitations
Chest pain
Choking sensations
Dizziness
Feelings of unreality (depersonalization, derealization)
Secondary fear of dying, losing control or going mad

18
Q

What will panic order tend to occur with?

A

Agoraphobia
Direct physiological effects of a substance or general medical condition; hyperthyroidism, caffeine intoxication
Can get panic in depression

19
Q

What % of those with panic disorder will have concurrent agoraphobia?

A

50-67%

20
Q

What can trigger a panic attack in susceptible individuals?

A

Infusion of lactate

Re-breathing air (inc CO2)

21
Q

What can be seen on the PET scan of someone who has panic disorder?

A

Increased metabolism in the anterior pole of the temporal lobe; parahippocampal gyrus

22
Q

What is the treatment for a panic disorder?

A

1st line: CBT
2nd line: SSRI/SNRI/tricyclics
Benzodiazepines (short term only)

23
Q

What are the 3 types of phobia?

A

Agoraphobia
Social phobia
Specific phobia

24
Q

What is agoraphobia?

A

Well-defined cluster of phobia embracing fears of leaving home, entering ships, crowds and public places, or travelling along in trains, buses or planes

25
Q

Will people with phobias recognise that their phobia is irrational?

A

Yes

26
Q

What is a specific phobia?

A

Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation

27
Q

What is the treatment for a specific phobia?

A

Behavioural therapy; exposure
Graded exposure/ systematic desensitisation
Add in CBT if necessary
SSRI/ SNRI if required

28
Q

What is a social phobia?

A

Persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others

29
Q

What are common anxiety symptoms of social phobia?

A

Blushing or shaking
Fear of vomiting
Urgency or fear of micturition or defecation

30
Q

When does social anxiety tend to start?

A

In school; results in poor school performance, school refusal, poor employment history

31
Q

What is the biological basis of social phobia?

A

Increased bilateral activation of the amygdala and increased rCBF to the amygdala (and related limbic areas) that normalizes on successful treatment (pharma or psychological)

32
Q

Treatment of social phobia?

A

CBT
SSRI/ SNRIs
Benzo (short term only)

33
Q

What are examples of obsessional thoughts?

A

Ideas, images or impulses entering the mind in a stereotyped way
Recognised as the patients own thoughts
Unpleasant, resisted and ego-dystonic

34
Q

Buzzword for obsessional thoughts?

A

Ego-dystonic

35
Q

What are examples of compulsive acts?

A 
Repeated rituals or stereotyped behaviours
Not enjoyable
Not functional 
Often view as neurtralising
Recognised as pointless
Resistance may diminish over time
36
Q

Criteria for diagnosis of OCD?

A

Obsessional thought or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and interference with activities
Obsessions must be own thoughts
Resistance must be present
Rituals are not pleasant
Obsessional thoughts/ images/ impulses must be repetitive

37
Q

What does OCD commonly co-exist with?

A 
Schizophrenia
Tourettes and other tic disorders
Body dysmorphic disorder
Eating disorders
Trichtillomania
38
Q

Treatment for OCD?

A

CBT; including response prevention

SSRI/ clomipramine

39
Q

Mode of action of benzodiazepines?

A

Act on GABA-A receptor (inhibitory ionotropic receptor) to cause chloride influx and membrane hyperpolarisation and therefore inhibitory post-synaptic potential

40
Q

Problems with benzodiazepines?

A

Sedation and psychomotor impairment
Dependency and abuse
Alcohol interaction
Can worsen co-morbid depression

Psychiatry (35 decks)

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