Anxiety disorders and phobias Flashcards
Define post traumatic stress disorder (PTSD)
Disorder that may develop from 4 weeks following “an event of exceptionally threatening or catastrophic nature, likely to cause pervasive distress in anyone”. (ICD10)
What 4 types of Sx characterise PTSD?
Intrusions, avoidance, negative alterations in mood and cognition, Alteration (increased) arousal or reactivity. The Sx must impair function for a diagnosis.
What is the epidemiology of PTSD?
6.8% life prevalence
More common in females than males
What is the aetiology of PTSD?
BIO: Pathology of emotional processing theory, genetics
PSYCH: Extreme traumatic stressors, dual representation theory, cognitive model of PTSD, degree of exposure + proximity, predisposing traits: neuroticism, FHx psych disorders, survivor guilt
SOCIAL: childhood abuse, poor early attachment, continuous exposure
What is the prognosis of PTSD?
Majority recover
Chronic cases may cause major personality change
Sx are precipitated by years and years or trauma
What are the Ix for PTSD?
PTSD checklist (cut off score 28-56) PTSD checklist for DSM-5 Impact of event scale - 35 Davidson Trauma scale - 40 Trauma screening questionnaire SPAN - self report measure -
What is the Mx for PTSD?
BIO: Mirtazapine (NASSA) /SSRI/Venlafaxine (SNRIs)
PSYCH: Trauma focussed CBT, EMDR - Eye movement Desensitisation and re-processing
SOCIAL: Support groups and help lines
What are the complications of PTSD?
- Increase in distress due to therapy
- Secondary anxiety, depression, psychosis
- Psychological barriers to therapy
- Substance misuse
- Suicide
What are the Ix for Generalised Anxiety Disorder?
Bedside: Collateral Hx, thyroid examination (to rule out hyperthyroidism), cardiac examination, neurological examination
Bloods: TFTs
Imaging: -
Other: Urine drug screen, ECG, Rating scales - GAD-7, PHQ-9 depression scale too as may be co-occurring (50% pts with GAD have both)
What are the DDx for a generalised anxiety disorder picture?
Depression, Dementia, Caffeine, Alcohol/drugs, organic causes
What is the management for generalised anxiety disorder?
BIO: SSRI, SNRI, pregabalin
PSYCHO: Low/high intensity psychological interventions - CBT
SOCIAL: Educate and actively monitor, support groups
Can also consider referral for a specialist assessment
What are the Ix for Panic disorder?
Bedside: collateral Hx, neurological, cardiac exam, thyroid exam (exclude hyperthyroid)
Bloods: TFTs
Imaging: -
Special: Urine drug screen, ECG
What is the Mx for Panic disorder?
BIO: SSRI/venlafaxine (benzodiazepines are not recommended by NICE because of tolerance and dependence)
PSYCH: CBT, relaxation training,
SOCIAL: Education about panic and anxiety
What is the Ix for phobia????
Bedside: collateral Hx, neurological, cardiac exam, thyroid exam (exclude hyperthyroid)
Bloods: TFTs
Imaging: -
Special: Urine drug screen, ECG
What is the Mx for phobia?
BIO: SSRI/venlafaxine, beta blockers (benzodiazepines to be avoided)
PSYCH: CBT + exposure therapy (12 weeks)
SOCIAL: patient support groups
