ANX, sleep disorder Flashcards
1
Q
anxiety
A
- body’s response to “stress” – overpowering pressure adverse force/ influence exerted on body
- Psychological and physical sx (somatic)
- Adaptive response
○ Caused by perception of real or perceived danger
○ Fear, fight or flight response to perceived threat/ stimulus - Common, natural, self-limiting emotion
○ ANX sx generally subsides after trigger subsides
2
Q
anx disorder
A
- Is a disorder if: severe, excessive, persistent anxiety and irrational fears that impairs functioning with everyday living
○ Obsession: irrational fear, persistent thoughts
○ Compulsion: behaviour used to suppress obsession but is unhealthy - When anxiety is out of proportion to actual danger or threat of situation
- Persists long after original trigger disappeared (> 6mnths)
○ Incr risks for developing CVS, CBS, GI, RESP disorders
○ LT tachycardia –> ventricular hypertrophy –> HTN –> end stage organ failure –> stroke
3
Q
ANX sx consists of both
A
1) Physical sx: BZP can be used to relief
a. Muscle tense, palpitation, butterflies in stomach (unwell), chest pain
2) Mental sx: BZP will not help.
a. Constant worrying, worry circuit
b. Serotonergic antidep
4
Q
ANX 3 causes
A
- FEAR/ WORRY circuits activated by
* fear: sx regulated by amygdala
* worry: sx regulated by cortico-striatal thalamic cortical loop - neurochemical dysregulation
* defense
* behavioural inhibition system
* neurotransmitters (NE, 5HT, GABA) - perinatal trauma, genetics
5
Q
2nd causes
A
- medical conditions
* CVS (HF)
* endocrine/ metabolic (hyperTHY)
* neurologic (dementia, delirium)
* pulmonary (asthma, COPD)
* others - drug-induced
* sympathomimetics - pseudoephedrine
* stimulants (drug abuse)
* methylxantine: theophylline, caffeine
* levothyroxine , CS, antidep (sudden incr in neurotransmitters)
* DA agonist, beta-adrenergic agonists - drug withdrawal, drug intoxication , akathisia (APS)
6
Q
panic attack clinical presentation
different from disorder
A
- Discrete period of intense fear/ discomfort
- =/> 4 sx developed abruptly
○ Palpitation, PR
○ Sweating
○ Trembling, shaking
○ SOB
○ Feeling of choking
○ Chest pain/ discomfort
○ N, ab distress
○ Dizzy, unsteady, lightheaded, faint
○ Derealisation, depersonalisation
○ Fear of losing control
○ Fear of dying
○ Paresthesia (numb, tingling sensation)
○ Chills, hot flushes - Sx can be expected/ unexp
- Reaches peak in 10mins (lasts 20-30min)
7
Q
Agoraphobia “fear of marketplace” clinical presentation
A
- Places/ situations from which escape might be difficult
- Help not available when sudden panic attack/ sx
- Hence: situation avoided, endured with marked distress
- Not accounted for by another mental disorder
8
Q
Generalised anxiety disorder clinical presentation
A
- Excessive anxiety and worries =/> 6mnths
- Affect function: feel tensed, unwell
- Find it difficult to control
- ANX and worry assoc w/ =/> 3 of following sx (some present for more days)
- Restlessness, feel keyed up, on edge
- Easily fatigue
- Difficulty concentrating, mind goes blank
- Irritable
- Muscle tension
- Sleep disturbance (insomnia, restless sleep)
- Focus of ANX/ worry not confined to features of another mental disorder
- Sx cause sig functional impairment
- Sx not due to another mental condition/ direct physiological effect of sub (drugs)
9
Q
panic disorder with or w/o agoraphobia
- Anticipatory anxiety of recurrent panic attacks
- Miss out in life in fear of when attack can occur again
A
- Recurrent unexp panic attacks and
- =/> 1 panic attacks followed by =/> 1mnths of the =/> 1 of the following
a. Persistent anticipatory ANX of having another panic attack
b. Worry about implications of panic attacks
c. Sig change in behaviours related to panic attacks
- Absence/ presence of agoraphobia
- Panic attacks not due to direct physiological effects of a sub (drug), medical condition
- Not better accounted for by another mental disorder
10
Q
social anxiety disorder clinical presentation
A
- Fear of being scrutinised or humiliated by others in public
- stressed over social settings, wants to exit ASAP
- Marked and persistent fear of =/> 1 social/ performance situation in which the person is exposed to unfamiliar perople/ scrutiny of others
○ Fear they act in a way (ANX sx) = humiliating or embarassing - Exposure to phobic stimulus provokes an ANX response (situational/ predisposed panic attack)
- Duration > 6mnths
- Feared social/ performance situation avoided, endured with intense ANX/ distress
○ Avoidance, anxious anticipation or distress in feared situation sig impairs functioning
- Sx not due to another mental condition/ direct physiological effect of sub (drugs)
- Differental: AVODIANT PERSONALITY DISORDER
11
Q
Obsessive compulsive disorder
Either obsessions or compulsions
clinical presentation
A
- Obsessional thoughts/ impulses that causes marked distress/ ANX
- Recurrent intrusive thoughts
○ Smth will go wrong if you don’t ___ - Person attempts to ignore, suppress such thoughts/ impulses/ images. Neutralise them with some other action/ thought
- Person recognises that the obsessional thoughts are a product of their own mind
- Recurrent intrusive thoughts
- f/b Compulsive behaviours to relieve ANX
- Unhealthy coping method to relief thought (rituals, symmetry etc)
- Repetitive behaviours or mental acts (pray, count, repeating words) in response to an obsession
- Behaviours to prevent/ reduce the distress are NOT CONNECTED in a realistic way with what they are designed to neutralise
○ Or are clearly excessive
- Recognise that the O/C are excessive or unreasonable
- O/C causes marked distress, time-consuming (=/>1hr/day), impairs functioning
- If another mental condition is present, content of O/C is not restricted to it
- Sx not due to another mental condition/ direct physiological effect of sub (drugs)
12
Q
PTSD clinical presentation
A
- stressor (direct exposure, witness, indirect, repeated exposure to details of event)
- intrusion sx (traumatic event persistently re-experienced: recurrent, dissociative reactions)
- avoidance (trauma related stimuli)
- negative alterations in cognitions and mood (dissociative amnesia, negative beliefs, loss interest)
- alterations in arousal and reactivity (irritable, hypervigilance etc)
13
Q
PTSD dx
A
- Persistence of sx for > 1mnth
○ Full diagnosis not met until at least 6 mnths after trauma
○ Although onset of sx may occur immediately
○ Significant sx-related distress or functional impairment — Social, occupational - Other dissociative sx: depersonalisation, derealisation, delayed expression
- Disturbance not due to another mental condition/ direct physiological effect of sub (drugs)
14
Q
phobias
A
- Fear + avoidance behaviour (disabling)
- specific phobia can be marked, persistent fear
* excessively/ unreasonable cued by PRESENCE/ ANTICIPATE object or situation
* immediate anxiety response - avoidance (anxious anticipation, distress) sig impairs functioning
- sx not due to another mental condition
15
Q
hamilton anxiety scale
A
○ 18-20: sig anxiety
○ Response = 40-50% reduction
○ Recovery = score < 7
16
Q
non pharm for ANX
A
- Psychotherapy
- Pt must have clear mind, therapists help them process
- BZP: makes their brain slow, numb, ineffective psychotherapy
- CBT used in combi with medications
- Relaxation techniques
- Coping with stressors
- OCD: exposure and response prevention
17
Q
pharm for GAD
A
- escita, paroxetine (SSRI)
- venlafaxine, duloxetine (SNRI)
- hydroxyzine
. - pregabalin
- TCA?, bb, buspirone
. - CBT, psychotherapy, relaxation, ANX management
18
Q
panic disorder pharm
A
flouxetine, sert, paroxetine (SSRI)
venlafaxine (SNRI)
TCA?
(MAOi, SV?)
CBT
