Anxiety Flashcards
(95 cards)
1
Q
What is anxiety?
A
Emotional response to a threat
2
Q
What is depression?
A
Emotional response to loss
3
Q
What are the two broad temporal forms anxiety can take?
A
Chronic
Episodic
4
Q
What are the three chronic forms of chronic anxiety?
A
Generalised anxiety disorder
PTSD
OCD
5
Q
What is generalised anxiety disorder?
A
Persistent anxiety
6
Q
What sex is more affected by GAD?
A
Women
7
Q
What are the three categories of symptoms seen in GAD?
A
Somatic
Behavioural
Psychological
8
Q
What are some somatic symptoms of GAD?
A
Headache Presyncope SOB -> Hyperventilation -> Paresthesia Tremors Palpitations and chest pain GI upset- N+V, diarrhoea, 'Butterflies' and dry mouth Urinary frequency/urgency Restlessness/insomnia Globus hystericus- 'Lump in throat'
9
Q
What are some behavioural symptoms of GAD?
A
Trigger avoidance Withdrawal DSH Self medication- Alcohol/drugs Reassurance seeking
10
Q
What are some psychological symptoms of GAD?
A
Fearful anticipation or dread Irritability Worrying/repetitive/intrusive thoughts Poor concentration Memory issues Hypervigilance Depersonalization/detachment
11
Q
How do you treat GAD?
A
Listen to them Exercise Meditation CBT Anxiolytics- Paroxetine Pharma- SSRI, BB, Bzd, Venlafaxine
12
Q
What is the course of GAD?
A
Generally resolves or lessens >50YO
13
Q
What is PTSD?
A
Protracted response to stressful event or situation of exceptionally threatening nature. Will affect anyone in that situation.
14
Q
WHat things can prolong the course of PTSD?
A
Personality, previous unresolved traumas, other psychiatric illness
15
Q
What are some symptoms of PTSD?
A
Flashbacks Insomnia with nightmares Emotional blunting/numbness Extreme anxiety at triggers Avoidance of triggers Emotional detachment from others Hypervigilance Extreme startle response
16
Q
What can flashbacks trigger in PTSD?
A
Intrusive memories
17
Q
What does emotional blunting/numbness alternate with in PTSD?
A
Extreme anxiety
18
Q
What does extreme anxiety alternate with in PTSD?
A
Emotional blunting/numbness
19
Q
What are some complications of PTSD?
A
Depression
Substance misuse
20
Q
What is the treatment of acute PTSD?
A
Watch and wait
2/3 resolve in a year
21
Q
How do you treat chronic PTSD?
A
Antidepressants- Paroxetine and Olanzapine
Psychotherapy
22
Q
What antidepressants are used in PTSD?
A
Paroxetine
Olanzapine
23
Q
What is the progression of PTSD?
A
Acute stress reaction (48h)
Acute stress disorder (4w)
Acute PTSD (3m)
Chronic PTSD (>3m)
24
Q
How long does the acute stress reaction last for?
A
48h
25
How long does an acute stress disorder last for?
4w
26
How long does acute PTSD last for?
3m
27
How long does it need to be for chronic PTSD?
>3m
28
What are some symptoms of OCD?
Obsessional ruminations
Compulsive rituals- Some need to be repeated a certain number of times
Constant and non-reassurable worry
Thought-action fusion
29
What are obsessional ruminations?
Time consuming and intrusive so as to interfere with daily life.
Often out of character thoughts such as violence or sexual
30
What are compulsive rituals?
Time consuming and intrusive so as to interfere with daily life.
Some need to be repeated a certain number of times.
31
What is thought-action fusing?
Thinking something = doing it
32
What is primary OCD?
OCD with no underlying cause?
33
What is secondary OCD?
OCD with underlying cause?
34
What conditions can cause OCD?
Depression
Tourette's
Basal Ganglia Dysfunction- Parkinson's, Huntington's and Trauma
35
What are some symptoms of mild OCD?
```
Over-conscientiousness
Tidiness
Punctuality
Inflexibility
Perfectionist
```
36
What can precipitate mild OCD?
Stress
37
Is there a genetic link to OCD?
Probably yes
38
What basal ganglia dysfunction can cause secondary OCD?
Parkinson's
Huntington's
Trauma
39
How do serotonin/5-HT levels vary in OCD?
Low
40
How do you psychologically treat OCD?
CBT
Thought stopping
COmpulsion prevention
41
What is thought blocking?
Use sudden intrusion such as snapping and elastic band to interrupt thoughts
42
How does compulsion prevention work?
Exposure to obsessional stimuli
| Prevent doing compulsive behaviour
43
What are some pharmacological treatments of OCD?
SSRI- Fluoxetine
| TCA- Clomipramine
44
How does SSRI dose differ in OCD from depression?
Much higher in OCD
45
What is psychosurgery used for?
Occasionally for severe chronic OCD
46
What are the two forms of episodic anxiety?
Panic disorders
| Phobias
47
What is a phobia?
Irrational fear response to specific trigger
48
What are the symptoms of phobias?
Same as GAD but only in response to trigger
49
What is the pathology of phobias?
Conditioning- Negative event associated with cue
Imagines threat- Ghost stories etc
Genetics
50
What are some common phobias?
Agoraphobia
Social phobias
Simple phobias- arachnophobia
51
What are simple phobias?
Arachnophobia etc
52
WHat are simple phobias?
Particular object as a trigger
53
What are complex phobias?
Phobia of a particular situation
54
What are some examples of complex phobias?
Agoraphobia
| Social phobias
55
What is agoraphobia?
Fear of open places/being away from home
56
What is a social phobia?
Fear of social situations
57
What are panic disorders?
Anxiety onset with no specific trigger
58
What are some symptoms of panic disorders?
Multiple panic attacks
59
What are some symptoms of panic attacks?
Sudden onset
Reaches maximum on a few minutes
Think they're about to die
60
What condition does a panic attack mimic?
MI but no raised Troponin T and GTN does not help
61
What can cause the symptoms of a panic attack?
Overactive sympathetic NS
Hyperventilation
Increased muscle tone
62
How do you treat panic attacks?
Paroxetine
| CBT
63
What are some natural forms of anxiety?
Acute stress reaction
Adjustment disorder
Normal grief
64
What is an acute stress reaction?
Response to a stressful situation that can last several days. Generally severe response but in proportion to stimuli.
65
How can acute stress reactions progress?
Resolve in a few days or progress to adjustment disorder
66
What are some symptoms of an acute stress reaction?
Feel dazed/numb
| Inability to comprehend situation
67
How do you treat an acute stress reaction?
Reassure them
68
What is an adjustment disorder?
Normally follows on from acute stress reaction.
| Low mood joins initial shock but not bad enough to be anxiety disorder or depression.
69
How long can an adjustment disorder last for?
Upto 6 months
70
How do you treat an adjustment disorder?
Supportive counselling
71
What is a specific form of adjustment disorder?
Pathological/abnormal grief
72
What is pathological grief?
Excessive or prolonged grief or absence of grief with denial
73
What are some symptoms of pathological grief?
```
Grief
Insomnia
Dreams of the dead person
Anger
Inability to deal with personal effects
```
74
How do you treat pathological grief?
Guided mourning
75
What are the three stages of normal grief?
Shock and disbelief
Emotions
Acceptance and resolution
76
How long does normal grief last?
Up to a year?
77
What is the general first line treatment for anxiety?
CBT
| SSRI
78
What is the generalised second line treatment for anxiety?
SNRI
| TCA
79
What are some psychological treatments for anxiety?
```
Talking it through
Relaxation
Anxiety management/phobia training
Biofeedback
Behavioural therapies
CBT
```
80
How does anxiety management work?
Give verbal/mental cues to show link with symptoms
| Relaxation/distraction/reassurance to dispel anxiety
81
What is an example of biofeedback and what is it use for?
Skin resistance
| To show not relaxed
82
What are behavioural therapies?
Change behaviour and therefore symptoms
83
What is an example of behavioural therapies?
Graded exposure/systematic desensitization
84
How does Graded exposure/systematic desensitization work?
Rank stimuli
Gradually expose to least threatening stimuli
Progress up ladder
85
How does CBT work?
ID mental cues
| Change way of thinking
86
What are some pharmacological treatments for anxiety?
Reduce anxiety inducing drugs- alcohol and caffeine
Bzd
SSRI
BB
87
What are SSRI and BB used for in anxiety?
Symptomatic treatment
88
Who should not get propranolol?
The young
89
Where do Bzd work?
Centrally
90
Give some examples of Bzd
Diazepam
Alprazolam
Chlordiazepoxide
91
What are some side effects of Bzd?
Sedation- Do NOT drive
Memory impairment
Dependence
Withdrawal syndrome
92
What should you not do while on Bzd?
Do NOT drive!!!
93
How long can Bzd dependence take to form?
4-6 weeks in those with dependent personality
94
How should Bzd be given?
PRN
95
What are some symptoms with Bzd withdrawal syndrome?
```
Insomnia
Anxiety
Tremulousness
Muscle twitchings
Perceptual distortions
Hallucinations (which may be visual)
Hypersensitivities (light, sound, touch)
Convulsions
```
