Anxiety - F41 Flashcards
What is some epidemiology for anxiety?
Generalised anxiety disorder is found in 5.9/100 people in the UK (2016)
Women are 2x more likely to be diagnosed with anxiety disorders than men
Accounts for 1/3rd of all psychiatric diagnosis and 10% of GP consultations
Closely related to depression - often co-occur and patients can fluctuate between the two states, similar genetic and neurochemical overlap
What is the aetiology for anxiety?
Many factors similar to depression: genetics; stressful life events
i) Difference is with anxiety – perceived as a ‘stress’ whereas in depression, perceived as a ‘loss’
Environment
i) Lack of confiding relationships, small social circle
What is the pathophysiology of anxiety?
Increased sympathetic activity - over activity of ascending noradrenergic neurons
i) Esp in the limbic system and neocortex -
increased levels of arousal; fear, apprehension and other unpleasant emotions
Excessive activity of 5-HT neurons leads to enhanced responses to nerve stimuli
How does anxiety present?
Cognitive: persistent nervousness; worry – often every day matters i.e. work, money, family etc; apprehension; hypervigilance – irritability, insomnia, poor concentration
Autonomic: trembling; muscular tensions – tension headaches, inability to relax, restlessness; sweating; light-headedness; palpitations; dizziness; epigastric discomfort, urgency of micturition
What is somatisation?
Manifestation of psychological distress by the presentation of bodily symptoms
This can lead to stress over those symptoms so every time they’re felt a patients anxiety grows and the anxiety further fuels the symptoms
What are ‘panic attacks’/panic disorder?
Episodic paroxysmal anxiety – F41.0
Recurrent severe attacks of anxiety (panic), not restricted to a particular set of circumstances and are therefore unpredictable
Sudden onset
i) Palpitations
ii) Chest pain
iii) Choking sensations
iv) Dizziness
v) Feelings of unreality – depersonalisation or derealisation
vi) Often a secondary fear of dying, losing control or going mad
> 4 week for >4 weeks
Managed with CBT and SSRIs (NOT benzodiazepines)
What is generalised anxiety disorder?
F41.1
Some of the general symptoms noted that are generalised and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances, are ‘free-floating’
> 6 months
Also oftentimes feeling that person or person close to the individual will become ill or be involved in an accident
What is mixed anxiety and depression?
When symptoms of both are present but neither predominates enough to allow for formal diagnosis of either type
i) If both are present enough to justify diagnosis of both separately, then this category not used
What are phobic anxiety disorders?
F40
Group of disorders in which anxiety is evoked only or predominantly in certain, well-defined circumstances that are not currently dangerous
i) Consequently situations/things are often avoided or endured with dread, even contemplation of the phobic situation may prompt symptoms
What are some examples of phobic anxiety disorders?
Agoraphobia
i) Fears of leaving home, entering shops, crowds, public places, travelling alone
ii) Panic disorder is a feature of episodes
iii) Also a relationship with depressive, obsessional and social phobic symptoms
Social phobia
i) Fear of scrutiny leading to avoidance of social situations
ii) Associated with low self esteem and fear of criticism
iii) Also: blushing, hand tremor, nausea, micturition urgency, possible panic disorder
Specific isolated phobias
i) Highly specific scenarios i.e. claustrophobia, acrophobia, fears of certain animals
ii) Similar panic attacks possible
What are some differentials for anxiety?
Psychiatric - depression, OCD, any psychotic illness
Medical - hyperthyroidism, phaeochromocytoma (rare), other differentials for palpitations
Other - drug/alcohol abuse/withdrawals
How do you treat anxiety?
As anxiety and depression often co-exist, the treatment plan will often follow that of depression
In cases of mild-moderate GAD only - CBT>pharmacology
i) 1st line - patient guided through self-taught CBT by a clinician
ii) 2nd – referral to CBT therapist
iii) 3rd – anxiolytics
Pharmacology - propanolol – can help reduce some of the sympathetic stimulation and therefore those symptoms; benzodiazepines – generally now not used
Other - yoga, relaxation classes, meditation
How do you manage a panic attack?
At the early signs, sit down, try to relax
Controlling breathing rate – count to 4 between each breath
What is the prognosis for anxiety?
Most acute cases remit but recurrence is common
Many patients with chronic anxiety states have social problems that need to be resolved with proper social intervention
Chronic illness often develops into depression
