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Psychiatry > Anxiety, Panic Attacks, Phobias and OCD > Flashcards

Anxiety, Panic Attacks, Phobias and OCD Flashcards

1
Q

Outline the physical symptoms of anxiety.

A
  • Sweating, hot flushes or cold chills
  • Trembling or shaking
  • Muscle tension or aches and pains
  • Numbness or tingling sensations
  • Feeling dizzy, unsteady, faint or lightheaded
  • Dry mouth (not due to medication or dehydration)
  • Feeling of choking
  • Lump in the throat, or difficulty in swallowing
  • Difficulty breathing
  • Palpitations/pounding heart, or accelerated heart rate
  • Chest pain or discomfort
  • Nausea/abdominal distress (e.g. churning in stomach)
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2
Q

Outline the cognitive symptoms of anxiety.

A
  • Fear of losing control, “going crazy or dying’’
  • Feeling keyed up, on edge or mentally tense.
  • Difficulty in concentrating, “mind going blank”
  • Feeling that objects are unreal - derealization
  • Feeling self is distant/ “not really here” -depersonalisation
  • Hypervigilance (internal and external)
  • Racing thoughts
  • Meta-worry (worry about everything, worrying about worrying)
  • Health anxiety
  • Beliefs about the importance of worry
  • Preference for order and routine
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3
Q

Outline the behavioural symptoms of anxiety.

A
  • Avoidance of certain situations
  • Exaggerated response to minor surprises or being startled
  • Difficulty in getting to sleep because of worrying
  • Excessive use of alcohol/drugs (prescription or “recreational”)
  • Restlessness and inability to relax
  • Persistent irritability
  • Seek reassurance from family/GP
  • Checking behaviours
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4
Q

What does exposure to stress result in?

A

Instantaneous and concurrent biological responses:

  • to assess the danger.
  • to organise an appropriate response.
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5
Q

What is the role of amygdala in stress?

A

Acts as the emotional filter of the brain for assessing whether a sensory material via the thalamus requires a stress or fear response (milliseconds).

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6
Q

After being filtered by the amygdala, what happens to sensory material?

A

It is modified by later-received cortically processed signal (ie. act first, think later).

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7
Q

What does acute stress lead to?

A

Dose-dependent increase in catecholamines and cortisol.

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8
Q

What is the role of cortisol in the stress response?

A

It acts to mediate (+ shut down) the stress response.
Through negative feedback, it acts on the pituitary, hypothalamus, hippocampus and amygdala.
These sites are responsible for the stimulation of cortisol release.
- acute stress therefore increases cortisol levels.

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9
Q

What can anxiety be pathological in?

A
  • In extent. Ie. anxiety is more extreme than ‘normal.’

* In context. Ie. anxiety in situations that are not ‘normally’ anxiety provoking.

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10
Q

If a person has an anxiety disorder, what does it cause?

A

Distress and impairment of social/occupational/other function

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11
Q

What is generalised anxiety disorder?

A

Anxiety that is generalized and persistent but not restricted, or even strongly predominating in, any particular environmental circumstances (i.e. it is ‘free-floating)

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12
Q

What are the dominant symptoms in generalised anxiety disorder?

A

(variable but include complaints of)

Persistent nervousness, trembling, muscular tensions, sweating, light-headedness, palpitations, dizziness and epigastric discomfort.

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13
Q

What is a generalised anxiety disorder not due to?

A

Substance misuse, or any other medical conditions (ie. hyperthyroidism).

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14
Q

For something to be classified as GAD, it needs to be serious enough to be….(3)

A
  • Long-lasting (most days for at least 6 months). .
  • Not controllable.
  • Causing significant distress/impairment in function.
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15
Q

What features is GAD typically associated with?

A
  • restlessness or feeling keyed up or on edge
  • being easily fatigued
  • difficulty concentrating or mind going blank
  • irritability
  • muscle tension
  • sleep disturbance (difficulty falling or staying asleep, restless unsatisfying sleep
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16
Q

What is the typical age of onset of GAD?

A

20-40

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17
Q

What is the course of GAD like?

A

Chronic + Fluctuating

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18
Q

What is the F:M ratio of GAD?

A

2:1

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19
Q

Where is GAD commonly seen?

A

Primary care and general medical settings

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20
Q

What is GAD associated with?

A

Disability, medically unexplained physical symptoms, and overutilisation of health care services and resources.

Often approached as “diagnosis of exclusion” with unnecessary medical investigations and delay of symptom improvement (but doesn’t need to be!)

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21
Q

What are 90% of GAD cases co-morbid with?

A

Other psychiatric disorders ie. Depression, substance abuse, other anxiety disorders

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22
Q

What is used in the treatment of GAD?

A
  • Cognitive Behavioural Therapy.
  • SSRIs/SNRIs.
  • Pregabalin.
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23
Q

What can be used in the short term management of GAD?

A

Benzodiazepines

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24
Q

What is CBT?

A

An evidence-based psychological treatment

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25
Q

What is CBT based on?

A

Identifying an individual’s automatic thoughts, cognitive biases and schemas.

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26
Q

What does CBT help an individual to identify?

A

Thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety

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27
Q

What is the essential feature of a panic disorder?

A

Recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable.

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28
Q

As with any other anxiety disorder, what do the dominant symptoms include?

A 
Sudden onset of palpitations. 
Chest pain. 
Choking sensations. 
Dizziness. 
Feelings of unreality (depersonalization or de-realization).
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29
Q

What is there a secondary fear of during panic attacks?

A

Dying, going mad or losing control

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30
Q

What may a panic attack occur with?

A

Agoraphobia

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31
Q

What is a panic attack NOT due to?

A

The direct physiological effects of a substance (drug) or general medication.
ie. hyperthyroidism, caffeine intoxication

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32
Q

What is a panic attack not better counted by?

A

Another mental disorder ie. depression

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33
Q

What is the typical age of onset for people with a panic disorder?

A

Late adolescence to mid-30’s

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34
Q

What is the usual course of a panic disorder like?

A

Chronic - waxing and waning

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35
Q

What do 50-60% of people with a panic disorder also have?

A

Agoraphobia

36
Q

What is the 10 year follow up of people with a panic disorder like - rule of thirds?

A
  • 1/3 – unchanged or worse.
  • 1/3 – modest improvement.
  • 1/3 – well.
37
Q

In susceptible people, what can panic attacks be triggered by?

A

Infusions of lactate (by-product of muscular activity).
OR
By re-breathing air (increased CO2).

38
Q

What is seen on a PET scan of someone during a panic attack?

A

Increased metabolism at anterior pole of the temporal lobe – parahippocampal gyrus.

39
Q

What are the treatment options for someone with a panic disorder?

A
  • CBT.

* SSRI’s/SNRI’s/Tricyclics.

40
Q

What can be used in the short-term treatment of someone with a panic disorder?

A

Benzodiazepines

41
Q

How many types of phobias are there?

A

3

42
Q

Name the 3 types of phobia

A
  • Agoraphobia.
  • Social phobia.
  • Specific phobia.
43
Q

When do phobias typically onset?

A

EARLY

44
Q

What behaviours are phobias characterised by?

A

Avoidance and anticipatory anxiety

45
Q

The fear in phobias is ___________

A

IRRATIONAL

46
Q

What is agoraphobia?

A

Well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public place, or travelling alone in trains, buses or planes

47
Q

What do people with agoraphobia often do?

A

Avoid situations

48
Q

Why do some people with agoraphobia experience little anxiety?

A

Because they are able to avoid their phobic situations

49
Q

What is a specific phobia?

A

A marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation.

50
Q

Give examples of situations which might act as clues for a specific phobia.

A

Flying, heights, animals or insects, receiving an injection or seeing blood.

51
Q

What does exposure to the phobic stimulus almost invariably do?

A

Provokes an immediate anxiety response, akin to a panic attack.

52
Q

What does a person with a phobia know about the fear?

A

That is is excessive and unreasonable

53
Q

How are specific phobias treated?

A

Usually with simple Behavioural Therapy – EXPOSURE

  • graded exposure/systematic desensitisation.
  • add in CBT if necessary
54
Q

What drugs can be used in the management of someone with a specific phobia?

A

SSRI’s
OR
SNRI’s

55
Q

What is a social phobia also known as?

A

A social anxiety disorder

56
Q

What is a social phobia?

A

A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

More than just being “shy.”

57
Q

What does someone with a social phobia fear?

A

That he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating

58
Q

Where does a social phobia typically occur?

A

In small social settings

59
Q

Give examples of some common anxiety symptoms.

A
  • Blushing or shaking.
  • Fear of vomiting.
  • Urgency or fear of micturition or defaecation.
60
Q

What can anxiety result in?

A

Poor school performance, school refusal, poor employment history.

61
Q

What is anxiety linked to?

A

Behavioural inhibition

62
Q

Describe behavioural inhibition.

A
  • Tendency to react to novel situations by avoidance and withdrawal to safety
  • Can be identified in toddlers / pre-school children
63
Q

How is anxiety treated?

A
  • CBT.

* SSRI’s/SNRI’s.

64
Q

How is anxiety treated in the short term?

A

Benzodiazepines

65
Q

What is OCD characterised by?

A

Recurrent obsessional thoughts +/or compulsive acts.

66
Q

What are obsessive thoughts?

A

Ideas, images or impulses entering the mind in a stereotyped way

67
Q

Although the thoughts in OCD are recognised as the patients own thoughts, they are?

A

Unpleasant, resisted and ego-dystonic

68
Q

What are compulsive acts?

A

Repeated rituals or stereotyped behaviours

69
Q

What is the criteria for the diagnosis of OCD to be made?

A

Obsessional symptoms or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and interference with activities.

  • Obsessions must be individuals own thoughts
  • Resistance must be present
  • Rituals are not pleasant
  • Obsessional thoughts/images/impulses must be repetitive
70
Q

What is the mean age of onset of OCD?

A

20

71
Q

What is the peak age of incidence for male with OCD?

A

13-15

72
Q

What is the peak age of incidence for females with OCD?

A

24-25

73
Q

What do 60-90% of people with OCD experience?

A

At least one major depressive episode

74
Q

What does OCD have significant co-morbidity with?

A

Schizophrenia, tourettes and other tic disorders, body dysmorphic disorder, eating disorders, trichotillomania.

75
Q

Does OCD have a genetic component?

A

Yes – it is familial, although no genes have been identified yet.

76
Q

What is the prognosis of OCD like? What does this depend on?

A

Variable – depends on duration at time of sx, co-morbidity

77
Q

How is OCD treated?

A
  • CBT – including response prevention.

* SSRIs/Clomipramine.

78
Q

How do benzodiazepines work?

A

They enhance the effect of GABA – allosteric modulation

79
Q

What type of receptor is the GABA-A receptor?

A

An inhibitory ionotropic receptor.

80
Q

In the presence of GABA, what does the ion channel allow?

A

Chloride ion influx

81
Q

What is the effect of membrane hyper-polarisation following Cl influx?

A

Membrane hyperpolarisation  results in inhibitory postsynaptic potential (ipsp).

82
Q

What substances also act upon the GABA-A receptor?

A

Alcohol and Barbiturates

83
Q

What do agonists at the BZD site do?

A

Relaxation and anticonvulsant effects

84
Q

What do antagonists at the BZD site do?

A

Cause anxiety, and are pro-convulsant

85
Q

List the advantages of BZD’s.

A
  • Rapid action.
  • Well tolerated.
  • Efficacious.
86
Q

What are the problems associated with using BZD’s?

A
  • Sedation and psychomotor impairment
  • Discontinuation/withdrawal problems
  • Dependency and abuse
  • Alcohol interaction
  • Can worsen co-morbid depression

Psychiatry (31 decks)

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