Anxiety Flashcards

(40 cards)

1
Q

what are Sx of anxiety

A
sweating
tremor
SOB
dizziness
heart racing 
seeking reassurance
lump in the throat (globus hystericus)
feeling like you're chocking
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2
Q

what acts as the emotional filter of the brain for assessing whether sensory material needs a stress or fear response

A

amygdala

via the thalamus

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3
Q

what are the types of anxiety disorders

A
Generalised Anxiety Disorder (GAD)
Panic Disorder
Agoraphobia
Social Phobia
Specific Phobia
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4
Q

what is the definition of GAD

A

Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances

i.e. it is “free-floating”

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5
Q

what are the Sx of GAD

A
persistent nervousness
trembling
muscular tensions
disturbed sleep 
sweating 
lightheaded
palpitations
dizziness
epigastric discomfort
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6
Q

what requirements need to be met to call it GAD

A

long-lasting (most days for at least 6 months)

not controllable

causing significant distress / impairment in function

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7
Q

what is the definition of 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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8
Q

Sx of a panic attack

A
sudden onset of palpitations
chest pain
choking sensation
dizziness
feeling of unreality (depersonalisation and derealisation)

fear of dying, losing control or going mad during the attacks

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9
Q

what is the definition of a panic attack

A

discrete periods of intense fear along with physical and psychological anxiety symptoms that come on quickly i.e. within a few mins

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10
Q

what is agoraphobia

A

extreme or irrational fear of open or public places.

can include leaving home, entering shops/crowds, travelling on public transport

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11
Q

what can trigger a panic attack (physiologically)

A

susceptible individuals by infusions of lactate

re-breathing air (increased CO2)

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12
Q

what is seen on a PET whilst someone is going through a panic attack

A

increased metabolism anterior pole of temporal lobe – parahippocampal gyrus

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13
Q

what features are seen in phobias

A

fear recognised as irrational

typified by avoidance and anticipatory anxiety

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14
Q

what is the definition of 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

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15
Q

what happens in specific phobia when the stimulus is seen

A

invariably provokes an immediate anxiety response, akin to a panic attack

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16
Q

what features are important in a specific phobia

A

person recognises that the fear is excessive or unreasonable

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17
Q

what is a social phobia or social anxiety disorder

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

18
Q

what does someone with SAD often worry about

A

that he/she will act in a way that will be embarrassing and humiliating

19
Q

what Sx are seen in SAD

A

common anxiety Sx

  • blushing or shaking
  • fear of vomiting
  • urgency or fear of micturition or defaecation
20
Q

what is seen on a CT scan of someone with SAD

A

Increased bilateral activation of the amygdala and increased rCBF to the amygdala

21
Q

what characterises heath anxiety

A

excessive or disproportionate preoccupations with having or acquiring a serious illness

22
Q

what is extinction principle

A

If we have exposure to the stimulus but the anxiety is manageable and we don’t avoid it, we slowly learn that the stimulus doesn’t signal fear and the anxiety lessens

23
Q

what is Tx using the extinction principle called

A

graded exposure

24
Q

what is flooding Tx

A

full exposure to the feared stimulus an staying with it until fear reduces

25
what is the cognitive triangle
``` thoughts produce emotions >> emotions create behaviour >> behaviour reinforces thoughts ```
26
what is the principle of CBT
asking patients to question/test their thoughts, to influence emotions and behaviours
27
what are the psychological Tx for PTSD
EMDR | trauma focused CBT
28
what are the medical Tx options for PTSD
1st line - SSRI = paroxetine, fluoxetine, sertraline 2nd line - SNRI or Benzodiazepines = Phenelzine, Clonaxepam 3rd line - Anticonvulsant = gabapentin, pregabalin
29
what is the psychological Tx for OCD
Exposure and Response Prevention (ERP) ≥ 20 hours CBT (with heavy emphasis on exposure)
30
what is the medication options for OCD
1st line = clompiramine or fluoxetine (TCA or SSRI) 2nd line = risperidone, Aripiprazole (anti-psychotic drugs) 3rd line = lamotrigine
31
Tx pathway for OCD
mild Sx = brief CBT + ERP < 10 hours moderate = intensive CBT + ERP > 10 therapist hours OR course of SSRI severe = 1st line CBT + ERP + SSRI 2nd line different SSRI or clomipramine 3rd line add antipsychotic to SSRI or clomipramine
32
what is the psychological Tx of GAD
guided self -help (if mild) CBT relaxation
33
what are the medication options for Tx of GAD
1st - SSRI (sertraline) 2nd - SNRI (Venlafaxine, duloxetine) 3rd - Pregabalin
34
what is the psychological Tx of social phobia
CBT with emphasis on exposure cognitive restructuring social skills training
35
what are the medication options for social phobias
1st line: SSRIs 2nd line: SNRIs (Venlafaxine, phenelzine) 3rd line: Benzodiazepines (bromazepam, clonazepam) or Anticonvulsants (gabapentin, pregabalin)
36
what are the psychological Tx options for specific phobia
exposure therapy - graded exposure - flooding
37
what are the medication Tx options for specific phobia
1st - SSRI only if anxiety is moderate/severe and they haven't responded to behavioural therapy
38
what are the psychological options for Tx of panic disorder (with or without agoraphobia)
CBT | Graded
39
what are the medication Tx of panic disorder (with or without agoraphobia)
1st line: SSRIs 2nd line: TCAs (Clomipramine, Imipramine) or Venlafaxine 3rd line: Anticonvulsants (Gabapentin, valproate)
40
how long are patients treated for
``` GAD (≥ 18 months) Panic disorder (≥ 6 months) Social phobia (≥ 6 months) PTSD (≥ 12 months) OCD (≥ 12 months) ```