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Flashcards in 3 - PSY - Anxiety Disorders Deck (33):
1

Which four features distinguish pathological anxiety from normal anxiety

autonomy - no/min env trigger
intensity - exceeds pt capacity to deal with discomfort
Duration = Sx are persistent
Behaviour - impairs function +/or results in disabling behaviours

2

2 classifications of anxiety disorders?

constant - GAD
episodic - Phobias, panic, PTSD, OCD

3

Psych arousal Sx

worrying thoughts
irritable
noise sensitive
restless
fearful anticipation
poor concentration

4

Sleep disturbance Sx

insomnia
night terrors

5

Muscle tension Sx

tremors
aches

6

Autonomic arousal Sx

dry mouth
diarrhoea
difficulty breathing
palpitations
chest discomfort
frequent and urgent urination

7

4 components of the cycle of anxiety?

thoughts
behaviour
emotions
bodily responses

8

Generalised Anxiety Disorder - criteria

neither situational or episodic
Sx involve elements of - Apprehension, Motor tension, Autonomic over activity
general and persistent psych and somatic anxiety Sx on most days for at least several weeks

9

Panic disorder - ICD 10 criteria

-several attacks within one month
-circumstances with no objective danger
-not confined to known or predictable situations
-relatively free from anxiety Sx between attacks

10

Panic disorder - Sx

unpredictable panic attacks
sudden crescendo of severe anxiety
catastrophic cognition (im dying)
Short lived (<10 mins normally)

11

Agoraphobia - icd criteria

psych and auto Sx primarily from anxiety and not secondary to other Sx
Anxiety restricted to at least two of following - crowds, public places, travelling alone, travelling away from home
avoidance of phobic situation = prominent feature

12

Social phobia - Sx

fear of being focus of attention
Sx restricted to situation/thinking about situation
Common Sx - blushing, shaking, fear of vomiting, urgency/frequency
Avoidance

13

Characteristics of OCD

obsessive Sx (thoughts, impulses, images) +/or compulsive acts or rituals - causing distress + interferes with activities

14

What do OCD Sx frequently co exist with

schizophrenia
tourette's
depression

15

Obsessions - describe

-thoughts ideas images
-repetitive
-excessive/unreasonable
-unpleasant (no pleasure)
-originate in mind of patient

16

Compulsions - describe

-physical act
-excessive/unreasonable
-repetitive
-resisted by patient
-unpleasant (may relieve tension/anxiety)
-originates in mind of pt

17

rule these out as causes of anxiety before reaching a psych diagnosis

drugs
drug withdrawal
cardiac arrhythmias
neuro (seizures)
hypoxia (CHF, COPD, angina, anaemia)
Metabolic (acidosis, hyper/hypo thermia)
endocrine (thyroid)

18

How do patients manage their own anxiety?

Avoidance and Safety behaviours

19

NICE step care approach - 4 steps

1 - psychoeducation and active monitoring
2 - guided self help and low intensity psych interventions
3 - high intensity psych Tx (CBT) or drug Tx
4 - referral to secondary care - MDT approach

20

CBT methods for phobias and OCD

OCD - exposure and response prevention
Phobias - systematic desensitisation or graded exposure

21

4 types of meds used to Tx anxiety

Antidepressants
Beta Blockers
Benzos
Antipsychotics (beneficial in severe cases)

22

Antidepressants use in anxiety + counselling

all are anxiolytic
warn pt of possible increase in anxiety in initial period

23

Benzos - short and long half life examples - use - beware of...?

short half life - lorazepam
long half life - diazepam

use in short term acute management (<4 weeks) as can be addictive

can reduce psych Tx efficacy

24

Acute stress reaction - describe briefly

brief response to severely stressful events

25

acute stress reaction Sx

anxiety/depression
pts may already use coping strategies (denial, avoidance)
alcohol excess common
(numbness, detachment, derealisation, insomnia, restless, nger etc)

26

Management of Acute stress reaction

reduce emotional response by talking about it
encouraging but not forcing recall
learn coping skills
anxiolytic if severe anxiety
hypnotics if severe sleep disturbance

27

Adjustment disorder - describe briefly

psych reaction to new circumstance
related to and in proportion to stressful event
most lasts a few months

28

Adjustment disorder - Sx

anxiety/depression/irritable
autonomic arousal Sx
occasional outbursts
Alcohol/drug abuse common
impaired social Fx
more gradual onset than acute stress reaction

29

Adjustment disorder - mgmt

help resolve change
prevent avoidance and denial
relieve anxiety through talk
consider talking therapy referral

30

Sx indicating abnormal reaction to loss (abnormal grief)

-guilt about things other than actions at time of death
-'im better off dead/i shouldve died with them'
-morbid preoccupation with worthlessness
-psychomotor retardation
-prolonged + serious Fx impairment
-hallucinations beyond hearing/seeing deceased person transiently

31

PTSD core triad of Sx

hyperarousal
re-experiencing
avoidance

32

Other Sx of PTSD

depressive + guilt
substance use for coping
Sx may begin quickly after, rarely >6months after

33

PTSD management

Psych Tx - education, CBT, Eye movement desensitisation and reprocessing
bio - antidepressants
social - avoid substances, educate family, reintegration to society

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