Anxiety Flashcards
(27 cards)
What is anxiety
Pathological anxiety is an excessive amount of anxiety which impairs function and occurs in the absent of any real threat
What is panic disorder
Discrete episodes of intense fear/discomfort +4 anxiety symptoms
Anticipatory anxiety may exist between episodes
At least one attack is followed by a month of
- persistent anxiety over having another attack
- worry over the consequences of another attack
- significant change in behaviour after the attack
What are the key psychological symptoms of anxiety
WATCHERS Worry Autonomic arousal - hyperventilation, sweating, headache, palpitations, racing heart, butterflies in stomach Tension in muscles Concentration difficulties Hyper-arousal - irritability Energy loss Restlessness/on edge Sleep disturbance/insomnia
What is agrophobia
Fear of places/situations where escape is difficult/impossible or in which help may be unavailable
Large crowds –> enclosed spaces –> stop leaving the house
How can symptoms of anxiety be classified
Cognitive and Physical
Cognitive
- worry
- Feelings of impending doom
- inability to concentrate
- irritability
- over arousal leading to hypervigilance and sleep disturbances
Physical
- autonomic arousal - hyperventilation, heart racing, palpitations, butterflies in stomach, headache
- tension in muscles
What is Generalised anxiety disorder
Persistent, excessive worry which is disproportionate and uncontrollable.
It is accompanied by physical symptoms
It is free floating - so it is not restricted to any environmental circumstances
Must persist for at least 6 months
What are the three characteristics of anxiety
Neurosis
Reaction - anxious response to an event or situation
State - temporary frame of mind as opposed to a more lasting trait
What are the symptoms of GAD
Psychological WATCHERS Worry Anxiety Tension in muscles Concentration difficulties Hyperarousal - irritability Energy loss Restlessness/on edge Sleep disturbances - insomnia
Physical
GI - dry mouth, butterflies in stomach, loose bowels
Resp - hyperventilation
Cardio - palpitations and chest pain
Genitourinary - Altered frequency of urination and amenorrhoea
Neuromuscular - headache, dizziness, tension in muscles, tremor, restlessness, inability to relax
Sleep disturbance - insomnia and nightmares
What are the predisposing factors to developing GAD
Biological: Genetics, physical or mental health problems
Psychological: Personality traits - avoidant, dependent, neuroticism
What are the precipitating factors to developing GAD
Biological
Psychological: Past childhood experiences
- abuse
- neglect
- losing a parent
- being bullied/ socially excluded
Social: controlling parenting, over protective parenting, emotionally inconsistent
What are the perpetuating factors to developing GAD
Social: substance misuse Alcohol misuse often a comorbidity Relationship issues Job loss and financial issues housing issues
How is GAD managed
Management of GAD with no comorbid psychological disorders, a stepped approach is supported
- active monitoring
- Low intensity psychological interventions - individual non-facilitated self help, individual guided self help, psychoeducational groups
- high intensity psychological interventions - CBT, applied relaxation
- highly specialist treatment - complex drug and/or psychological treatment regimes, input from MDT, crisis services, in patients etc.
Which drugs are first line in GAD
Sertraline
Or escitalopram or paroxetine
If no improvement with sertraline then increase the dose or use alternative SSRI or SNRI
Which drugs should only be considered in the short term in GAD
Benzodiazepines e.g. diazepam
Which other psychiatric and physical medical problems may anxiety present as part of
Psychiatric
- depression
- schizophrenia
- bipolar disorder
Physical (THINC MEED) Tumour Hormones Infection Nutrition CNS disorders e.g. MS Misc causes Electrolyte imbalances Environmental toxins Drugs
What is secondary anxiety disorder
anxiety disorder arising due to something else such as
- substance misuse
- another psychiatric illness
- physical illness
- medication
- psychosocial stressors such as adjustment disorders
What is the treatment for panic disorder
Pharmacological
- SSRIs - citalopram, fluoxetine, sertraline
- some TCAs - imipramine and clomipramine
- Some benzos - ONLY PRESCRIBED IN THE SHORT TERM
Psychological
- CBT
Same treatment for agoraphobia - may include graded exposure therapy
What is social anxiety
Marked, persistent and unreasonable fear of being observed/evaluated negatively by other people in social and performance situations
Physical and psychological symptoms present
Pt recognises fear is excessive and unreasonable
Worst in small groups of 6-8 people
Sometimes use alcohol as a coping mechanism in social situations in order to endure it
How is social phobia managed
managed through psychological therapy - CBT with exposure and supported self help CBT, psychotherapy Pharmacological therapy - SSRIs Monoamine oxidase inhibitors Venlafaxine Some Benzos - short term use
What is a specific phobia
Excessive/unreasonable fear of a specific object, person, type of person, animal etc
How are specific phobias managed
Graded exposure
- talk about feared stimulus
- show pictures
- show real thing
- touch real thing
- embrace
Flooding = patient is put in a room full of the stimulus
SSRIs or benzos if no effect and if stimulus is unavoidable
What Is obsessive compulsive disorder
A patient will have obsessions which are
- ego dystonic - intrusive and inappropiate (they do not want these thoughts)
- recurrent and persistent thoughts
- these thoughts cause marked anxiety and distress
- Attempts to ignore or suppress thought may/may not work
- obsessions are product of their own mind
Compulsions are aimed at decreasing or preventing distress/dreaded event. They are driven to perform action in response to the obsession. they are not often connected in a realistic way to the thing they want to suppress They are repetitive behaviours and acts - hand washing - correcting the order of things - checking - praying - hoarding - counting - repeating words silently in head
How is OCD managed
Psychological: graded exposure, response prevention therapy and CBT
Pharmacological:
- SSRIs - citalopram, paroxetine, fluoxetine, sertraline
- TCAs - Clomipramine
Augmentation of SSRIs with antipsychotic meds in resistant cases
What is PTSD and what the clinical features
Exposure to trauma/near death experience/threat of death leading to a response of intense fear, feeling of helplessness or horror
TRAUMA
Traumatic event
Recurrent recollections of event - intrusive flashbacks/dreams
Avoidance - avoid activities/places that provoke memory
Unable to function
Month long symptoms - usually occurs within 6 months of trauma
Arousal increased - hyperarousal, hypervigilance and exaggerated startle response, disturbed sleep
