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Year 4 - 2. Psychiatry > Anxiety disorders > Flashcards

Anxiety disorders Flashcards

1
Q

Name the curve that describes the effect of anxiety on performance

A

Yerkes-Dodson Law bell curve

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2
Q

List the psychological theory behind anxiety to a threat

A
  • Reduced perception of ability to cope with threat
  • Reduced perception of ability to cope with the symptoms of arousal
  • Tendency to react to stress with arousal response
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3
Q

List the ICD-10 classifications of neurotic and stress-related disorders

A

Acute stress disorders:
- Acute stress reaction
- PTSD (post-traumatic stress disorder
- Adjustment disorder

Phobic anxiety disorders:
- Agoraphobia (with or without panic disorder)
- Social phobia
- Specific phobia

Other anxiety disorders:
- Panic disorder
- GAD (generalised anxiety disorder)
- Mixed anxiety and depressive disorder

Obsessive–compulsive disorder

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4
Q

State the 1 year prevalence of anxiety disorders

A

14%

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5
Q

Outline the features of generalised anxiety disorder (GAD), according to ICD-10 classification

A
  • Anxiety that is generalised and persistent
  • ‘Free floating’ = does not strongly predominate in any particular environmental circumstances

Worrying most days about most things, for a period of 6 months

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6
Q

List some psychological and physical symptoms of generalised anxiety disorder (GAD)

A

Psychological:
- Anxious thoughts
- Fearful anticipation
- Poor concentration
- Irritability
- Sensitivity
- Avoidance behaviour

Physical:
- Sleep disturbance
- Weight loss
GI - dry mouth, diarrhoea
Respiratory - tachypnoea, tight chest
CVS - tachycardia
Urinary - frequent urination
Neuromuscular - headache, tingling, tremor

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7
Q

State some proposed risk factors for development of anxiety disorders

A

Often an initial precipitant
- Genetic
- Upbringing
- Personality type e.g. more likely to worry or due to personality disorder

Often maintained by stressful life events or patterns of thinking

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8
Q

State the 3 factors involved in the CBT model

A
  1. Thoughts
  2. Feelings
  3. Behaviours
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9
Q

List some factors to consider when prescribing SSRIs for anxiety

A
  • Short term increase in anxiety and suicide
  • Review within a month, then 3 monthly thereafter
  • Drug interactions
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10
Q

List some potential drug interactions for SSRIs

A
  • Cough medication (drowsiness)
  • NSAIDs (bleed risk)
  • Alcohol (increased potency of alcohol)
  • Cocaine (serotonin syndrome)
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11
Q

Outline the management of generalised anxiety disorder (GAD)

A

Stepwise treatment plan, escalating as appropriate

Step 1: Education (lifestyle measures) + active monitoring

Step 2: Low intensity psychological interventions

Step 3: High intensity psychological intervention
- CBT
- First line medications: antidepressants SSRIs / SNRIs
- Avoid Benzodiazepines (risk of addiction)
(continue treatment after remission for at least 6 months to ensure remission)

Step 4: highly specialist treatment e.g. high intensity psychological intervention, drug treatment, MDT involvement and crisis team

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12
Q

Outline agoraphobia (features from ICD-10 classification) and how it differs from social phobia

A

Fears of:
- Leaving home
- Entering shops / crowds / public places
- Travelling alone in trains, buses or planes
Co-morbid panic disorder, depressive symptoms, obsessional symptoms and social phobias often

Different from social phobia, fine with social situations, as long as at home

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13
Q

Briefly state what a social phobia is (features from ICD-10 classification)

A
  • Fear of scrutiny by other people, leading to avoidance of social situations
  • General anxiety symptoms present
  • Symptoms may progress to panic attack
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14
Q

Outline the management of phobias (agoraphobia, social phobia, specific phobia)

A
  • Self-help techniques
  • CBT and other talking therapies
  • SSRIs
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15
Q

Briefly state what a panic disorder is, based on ICD-10 classification

A
  • Recurrent attacks of severe anxiety (panic)
  • Not restricted to any particular situation / circumstances (unpredictable)
  • Secondary fear of dying, losing control, or going mad
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16
Q

Briefly state how panic disorder is managed

A
  • First line: SSRIs (DON’T prescribe benzodiazepines), second line: TCA
  • CBT
  • Self-help methods, support groups and exercise
17
Q

List general features of PTSD, according to ICD-10 classification (triad plus other features)

A

Delayed response to an event of exceptionally threatening nature

3 key features:
- Re-experiencing event (flashbacks or nightmares)
- Hyperarousal
- Avoidance behaviours

Other features:
- Anxiety and depression (commonly associated)
- Insomnia
- Anhedonia
- Numbness
- Detachment from others

Symptoms last for > 4 weeks, (generally > 6 months)

The course is fluctuating but recovery can be expected in the majority of cases

18
Q

Outline the management for post-traumatic stress disorder (PTSD)

A

Biological:
- Consider SSRIs if patient preference (avoid Benzodiazepines) e.g. Paroxetine or Mirtazepine
- Consider antipsychotics e.g. Risperidone, if severe and disabling

Psychological:
- Individual trauma-focused CBT interventions
- Consider eye-movement desensitisation and reprocessing (EMDR) if non-combat trauma

Social:
- Watchful waiting (if < 4 weeks)
- Support groups

19
Q

Outline the features of obsessive compulsive disorder (OCD), according to ICD-10 classification

A
  • Recurrent obsessional thoughts
  • Compulsive acts
  • Distressing thoughts (egodystonic) and try to resist them
  • Recognised as patient’s own thoughts
20
Q

Suggest some factors which may contribute to OCD

A

Precipitated by life event, maintained by avoidance or rituals
- Genetics
- Early experiences
- Organic e.g. PANDA syndrome

21
Q

List 3 key features of PTSD

A
  • Re-experiencing event (flashbacks or nightmares)
  • Hyperarousal
  • Avoidance behaviours
22
Q

Briefly state the management options for patients with obsessive compulsive disorder (OCD)

A
  • Psychoeducation
  • Exposure and response therapy
  • CBT

Moderate-severe or treatment resistant:
- Antidepressants (SSRIs)
- More intensive CBT

23
Q

Briefly outline somatisation disorder (what it is and how it presents)

A

‘Briquet disorder’
- Multiple, recurrent and frequently changing physical symptoms
- Present for at least 2 years
- Symptoms may be referred to any system / part of body

  • Often complicated history of contact with both primary and specialist services
24
Q

Briefly outline hypochondriacal disorder (what it is and how it presents)

A
  • Persistent preoccupation with the possibility of having one or more serious and progressive physical disorders
  • ‘Normal’ sensations often interpreted by patients as abnormal
  • Attention is usually focused upon 1 or 2 organs / systems of the body
25
Q

Briefly outline medically unexplained symptoms and how they are managed

A
  • Persistent symptoms for which examinations fail to reveal sufficient explanatory structural or other specified pathology
  • Often presents as: generalised pain, fatigue or altered organ systems (e.g. stomach ache, breathlessness)
  • Usually present for > 3 months, with impaired functioning.

Management:
- Reassurance and careful communication
- Screen for underlying mental health problems e.g. anxiety
- Psychosocial support and therapies such as CBT
Extensive investigations are unlikely to add to the diagnosis

26
Q

Briefly outline somatoform disorder (what it is and how it presents)

A
  • Physical symptoms that cannot be explained by a medical condition, drug or other mental health disorder
  • Unconscious process
  • Common presenting symptoms: GI symptoms and abdominal pain, fatigue, weakness and MSK symptoms
27
Q

Briefly outline conversion disorder (what it is and how it presents)

A
  • Psychiatric condition
  • Presentation of neurological symptoms without any underlying neurological cause e.g. paralysis, pseudo-seizures, sensory changes
  • Unintentional process, symptoms are very much “real” to the patient
  • Linked to emotional stress
28
Q

Outline the difference between Munchausen’s syndrome and malingering

A

Munchausen’s syndrome
- Patients intentionally fake signs and symptoms (e.g. adding blood to urine and complaining of pain)
- Aim is to gain attention and play “the patient role”

Malingering
- Patients intentionally fake or induce illness for secondary gain e.g. drug seeking

Difference is that both conditions have a different aim to why they are deliberately faking illness

29
Q

Outline the features of adjustment disorder, according to ICD-10 classification

A
  • Subjective distress and emotional disturbance, in response to a significant life change or a stressful life event
  • Usually to level of interfering with social functioning and performance
  • Persists for no longer than 6 months after stressor
30
Q

State how a adjustment disorder can present and give some examples of some potential causes of adjustment disorders

A

Manifestations vary and include:
- depressed mood
- anxiety or worry
- feeling of inability to cope, plan ahead, or continue
May struggle to carry out ADLs

Examples:
- Bereavement
- Separation
- Migration / refugee
- Going to school
- Becoming a parent
- Failure to attain personal goal
- Retirement

Key difference: assumed that the condition would not have arisen without the stressor

31
Q

Suggest the difference between adjustment disorder and acute stress disorder

A

In adjustment disorders, the stressful event (losing a job, relationship ending) is typically less traumatic than an event that causes acute stress disorder (sexual assault, mass shooting)

32
Q

Suggest some management steps for adjustment disorders

A

Formal treatment is often not needed

Support:
- Help managing the stressful situation e.g. if bullied, contact the school / work
- Psychoeducation
- CBT or psychodynamic therapy

33
Q
A

Year 4 - 2. Psychiatry (12 decks)

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