2: Anxiety Disorders Flashcards
(117 cards)
1
Q
Define generalised anxiety disorder (GAD)
A
At least 6-months of excessive anxiety and worry, with apprehension and tension about everyday life events
2
Q
What is the time-frame for GAD
A
6-months
3
Q
What gender is GAD most common
A
Female (2:1)
4
Q
What is the genetic concordance of GAD
A
5-10%
5
Q
What model describes aetiology of GAD
A
Triple vulnerability model
6
Q
Describe the triple vulnerability model
A
- Biological
- Psychological
- Social
7
Q
What biological factors contribute to GAD
A
- High cortisol
- Genetic
8
Q
What psychological factors contribute to GAD
A
- Lack of perceived control: trauma, insecure attachment
- Parenting: over-protective, lack of warmth
9
Q
What social factors contribute to GAD
A
Trauma
Marital problems
10
Q
What are two risk factors for GAD
A
Stressful life events
Difficult marital relationships
11
Q
What is the ICD-10 diagnostic criteria for GAD
A
Requires at least 4 of the following, one must be autonomic symptoms:
- Psychological - excessive worrying
- Autonomic - sweating, palpitations, dry-mouth
- Physical - breathing difficulties, nausea, abdominal distress
- General - tingling, numbness
- Muscle tension - restlessness, feeling on edge
- Other: exaggerated response to minor surprises, insomnia, concentration difficulties
12
Q
What is the investigation for GAD
A
Suspect GAD in people who present to GP with:
- Repeatedly present with excessive worrying
- Present with wide-range somatic symptoms
- Chronic physical health problems
13
Q
What is first-line management for GAD
A
- Eduction
- Low-intensity psychosocial education
14
Q
What are three low-intensity psychosocial interventions
A
- Non-facilitate self-help
- Guided self-help
- Psychoeducational groups
15
Q
What is second-line for GAD
A
High-intensity psychosocial intervention
16
Q
What high-intensity psychosocial interventions are used
A
- CBT
- Applied relaxation
17
Q
What is first-line medication for GAD
A
SSRI
18
Q
What should young people be warned of when starting SSRI
A
Increase risk of suicide
19
Q
Explain monitoring of young people on SSRIs
A
See them weekly for the first-month
20
Q
If SSRI ineffective, what should be done
A
Alternative SSRI or SNRI
21
Q
What is an alternative to SSRI or SNRI
A
Pregabalin
22
Q
Explain benzodiezapines for GAD
A
Benzodiazepines can be used in short-term crisis for anxiety, but should not be used long-term
23
Q
What is fourth-line for GAD
A
Combination medication and high-intensity psychoeducation
24
Q
Define a panic attack
A
Period of intense anxiety reaching peak-intensity at 10-minutes. Usually do not persist beyond 20-30 minutes. Can be spontaneous or precipitated
25
How long do panic attacks usually last
20-30min
26
What can cause panic attack
Spontaneous or situational
27
Define panic disorder
Recurrent tendency to experience panic attacks, not secondary to medical conditions, substance mis-use or psychiatric disorder
28
What is the problem with panic disorder
Individual fears about having another panic attack, which can lead to them avoid a particular situation
29
In which gender is panic disorder more common
Females (2:1)
30
When is panic disorder most common
15-25 or 45-55
31
What are 5 risk factors for panic disorder
- Living in a city
- Widow
- Early parental loss
- Limited education
- Sexual or physical abuse
32
What disorders are associated with panic disorder
1. Agraphobia (75%)
2. Depression (70%)
3. Other anxiety disorders (50%)
33
What is a mnemonic to remember clinical presentation of panic attacks
STUDENTS FEAR 3C's
34
Explain clinical presentation of panic attacks
```
Sweating
Trembling
Unsteadiness
Derealisation
Elevated HR, palpitations
Nausea
Tingling
```
FEAR of dying
Choking (Globus hystericus)
Chest pain
Chills
35
What is fear of dying called
Angor Amnii
36
What is choking due to psychological causes referred to as
Globus hystericus
37
Explain diagnosis of panic disorder
If individual presents to A+E with panic attack - need to exclude underlying physical causes (eg. MI, AF). Can distinguish panic disorder from the history
38
What is first-line for panic disorder
Low-intensity psychoeducational interventions
39
What are two low-intensity psychosocial interventions
Individual non-facilitated self-help
Individual facilitated self-help
Monitor 4-8W and use panic sub scale to measure effectiveness
40
What is a high-intensity psychological intervention
CBT
41
What pharmacological intervention is first-line for panic disorder
SSRI
42
What is second-line medication for panic disorder if SSRIs are ineffective
TCA: imipramine, clomipramine
43
When are TCAs indicated for panic disorder
If no improvement on SSRIs after 12W
44
What is fourth-line for panic disorder
Pharmacological and CBT
45
Define specific phobic disorder
Excessive unreasonable fear caused by presence of anticipation of a specific event
46
In which gender is phobic disorder more common
Female (4:1)
47
What is the life-time prevalence of phobic disorder
5%
48
What is genetic concordance of phobic disorder
25%
49
What are two theories of phobic disorder
Learning theory: due to operant or classical conditioning
Psychoanalytical theory: unresolved subconscious conflict manifests as phobias
50
Explain clinical presentation of specific phobic disorder
Sudden increase in anxiety in exposure of anticipation of specific event. This can lead to avoidance which impacts person's life
51
Define agoraphobia
Fear of being alone in spaces where unable to escape
52
What is problem with agoraphobia
Often leads to individuals not leaving their house, can become overly dependent
53
What is claustrophobia
fear enclosed spaces
54
What is acrophobia
fear heights
55
what is first-line for specific phobic disorders
behavioural therapies
56
what behavioural therapy is indicated for phobic disorder
Wolpe's systematic desensitisation
57
what is wolpe's systemic desensitisation
Based on classical conditioning - aims to remove fear response and substitute relaxation
58
what are other types of behavioural therapy
- Flooding
- Graded-exposure
- Relaxation
59
what is second-line for specific phobic disorder
CBT
60
what is the risk with specific phobic disorder
Increases risk other mental-health conditions
61
what is social anxiety disorder referred to as in the ICD-10
social phobia disorder
62
define social phobia
fear of scrutiny by others leading to avoidance of social situations
63
what are severe social phobia's usually associated with
low self-esteem and fear of criticism
64
explain how social phobia presents
in social situations individual develops blushing, sweating, tremor - individuals often believe these are the primary problems and results in avoidance of social situations
65
when is SAD more common
25-35 years-old
66
in which gender is SAD more common
Female
67
explain clinical presentation of SAD
Blushing, Tremor, Sweating during social interaction which is worse when noticed by others
68
what two questions should someone with SAD ask
1. Do you get fearful or embarrassed in social situations
| 2. Do you find yourself avoiding social situation s
69
what scoring system is used as a screening tool for social anxiety disorder
mini-SPIN (social phobia inventory)
70
what score on the mini-SPIN indicates social anxiety disorder
>6
71
what should happen is someone scores more than 6 on the social-anxiety disorder
refer for full comprehensive assessment of social anxiety disorder
72
what comprehensive assessments are used for social anxiety
SPIN: social-anxiety phobia inventory
LSAS: liebowitz social anxiety scale
73
what is first-line for SAD
CBT for SAD
74
what two CBT models exist for SAD
- Heimberg
| - Clark and Wells
75
what is second-line for SAD
self-help CBT
76
what is third-line for SAD
pharmacological interventions
77
what SSRIs are used for SAD
Sertraline or Escitalopram
78
what is fourth-line for SAD
Psychodynamic psychotherapy
79
Define OCD
Recurrent obsessional thought and compulsive act
80
Define obsessive thoughts
Idea, Image or impulse that enters patient's mind again and again in a stereotyped form. Often distressing and patient tries to resist them
81
Define compulsive acts
Stereotyped behaviours repeated again and again. They are not enjoyable or useful. Function is to prevent some perceived harm patient feels will happen I they do not perform them.
82
What happens if compulsive event is resisted
If resisted anxiety worsens
83
In which age-group is OCD more common
20-years
84
In which gender is OCD. more common
Female
85
What is genetic concordance for OCD
57%
86
What is neurobiological correlate for OCD
Increased matter in orbitofrontal cortex and anterior cingulate gyrus
87
What is the brief definition of obsessions
Intrusive thoughts
88
What is a brief definition of compulsions
Repetitive actions used to minimise obsessions
89
What does ICD-1O state must be present for diagnosis of OCD
- Occupies significant amount of time: more than one hour a day
- Causes social or occupational impairment
90
What are the 6 screening questions for OCD
1. Do you clean or wash a lot
2. Do you get upset by mess or when things aren't in a certain order
3. Do you check things a lot
4. Do you take a long time to finish daily activities
5. Are there thoughts bothering you, that you can't get rid of
6. Do these symptoms trouble you
91
What formal classification system is used for OCD
Yale-Brown obsessive-compulsive scale (Y-BOCS)
92
How is mild functional impairment in OCD managed
IAPT
| Exposure-Response Prevention Therapy
93
How is moderate impairment in OCD managed
ERP therapy
| SSRIs (or TCA)
94
What is an alternative for moderate functional impairment in OCD
TCA
95
What is indicated for severe functional impairment in OCD
Refer to secondary-care, Give ERP and SSRI whilst waiting
96
What can SSRIs in the first trimester of pregnancy cause
Congenital heart defects
97
What can SSRIs after 20-weeks cause
Persistent pulmonary HTN of the new-born
98
Define acute stress reaction
Transient disorder lasting hours-days as an Immediate response (within 1h) to an exceptional stress
99
Define acute stress disorder
Onsets in 4W of stress and persisted from 3d-4W
100
Define adjustment disorder
Onsets in 1 month of psychological stress, does not persist beyond 6-months. Symptoms cause marked distress of impaired functioning
101
Define post-traumatic stress disorder
Onsets within 6-months of a stress and persistent for at least 1-month. Cause clinically significant distress and impairment in social, occupational or other area of functioning
102
What gender is more likely impaired by PTSD
Male (4:1)
103
what causes PTSD
Stressful life events that are threatening or catastrophic in nature
104
what is type I trauma
Single, dangerous, overwhelming event
105
what is type II trauma
Repeated ordeal stressors
106
what is the most common type of trauma causing PTSD
Sexual abuse
107
what other traumas can cause PTSD
Physical abuse
War
Natural accidents
108
What are 4 risk factors for PTSD
Initial severe reaction
Lack of support
Psychiatric co-morbidities
Low socio-economic status
109
What is the triad of symptoms in PTSD
1. Hyper-arousal
2. Re-experiencing
3. Avoidance
110
Give 5 symptoms of hyper arousal
```
Hyper-Vigilant
Sleep disturbance
Heightened startle reflex
Sleep disturbance
Irritable
Poor concentration
```
111
What are 2 symptoms of avoidance
Avoid memories, thoughts and feelings
| Avoid external reminders
112
What are 4 symptoms of re-experiencing
Flashbacks
Recurring, intrusive dreams
Distress related to external causes
113
If symptoms have persisted less than four-weeks what is recommended in PTSD
Observation
114
What is NOT recommended for PTSD
Single-session de brief
115
What are other interventions that can be offered for PTSD
Eye-movement desensitisation and reprocessing
116
Explain eye movement desensitisation and reprocessing
Individual recalls the trauma in as much details as possible, whilst focusing eyes in therapists finger
117
What medication is licensced for PTSD
SSRI: paroxetine and mertazapine
