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Anxiety Flashcards

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1
Q

Is anxiety normal

A

It can be!

Not in itself pathological - can be a normal response to a stressful situation

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2
Q

List some biological 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
Feeling of choking
A sensation of a lump in the throat, or difficulty in swallowing
Difficulty breathing
Palpitations or pounding heart, or accelerated heart rate
Chest pain or discomfort
Nausea or abdominal distress
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3
Q

What is the cause of biological symptoms of society

A

Due to autonomic activation

Seen in the normal flight or flight response but also pathologically in anxiety disorders

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4
Q

List some of 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 that the self is distant or “not really here” -depersonalisation
Hypervigilance (internal and external)
Racing thoughts
Meta-worry
Health anxiety
Beliefs about the importance of worry
Preference for order and routine

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5
Q

What is meta-worry

A

Worrying about everything

Worrying about worrying

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6
Q

List 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 
Restlessness and inability to relax
Persistent irritability
Seek reassurance from family/GP
Checking behaviours
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7
Q

What is the role of the amygdala in the stress response

A

It acts as the emotional filter of the brain
Assesses whether sensory material via the thalamus requires a stress response
This is later modified by the cortex - act first think later

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8
Q

which hormone is most involved in the stress response

A

Catecholamines and cortisol

They both increase in acute stress responses

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9
Q

When does anxiety become abnormal

A

When it is pathological - more extreme than normal
When it occurs in situations that are not normally anxiety inducing
When it causes significant distress and impairment of social / occupational / other function

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10
Q

List the most common anxiety disorders

A 
Generalised Anxiety Disorder
Panic Disorder
Agoraphobia
Social Phobia
Specific Phobia
Obsessive Compulsive Disorder
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11
Q

Describe generalised anxiety disorder

A

Anxiety that is generalised and persistent but is not restricted to a specific circumstance - worry about a lot of different things all of the time
Physical symptoms are also persistent - trembling, nausea, palpitations
Fears of illness or accidents are common

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12
Q

What are the criteria for diagnosis of generalised anxiety disorder

A

Needs to be present most days for at least 6 months
Not controllable
Causes significant distress or impairment in function

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13
Q

Which symptoms are common in generalised anxiety disorder

A 
Being restless or feeling on edge 
Being easily fatigued 
Difficulty concentrating or mind blanks 
Irritability 
Muscle tension 
Sleep disturbance
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14
Q

Who typically presents with GAD

A

2:1 female to male
Typical age of onset between 20-40
Commonly seen in primary care - may present with unexplained

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15
Q

How do you treat GAD

A

Cognitive Behavioural Therapy
SSRIs / SNRIs
Pregabalin
Benzodiazepines - short term use only

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16
Q

Why can benzodiazepines not used long term

A 
Because they are very addictive 
Sedation and psychomotor impairment
Discontinuation/withdrawal problems
Alcohol interaction
Can worsen co-morbid depression
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17
Q

What is a panic disorder

A

Recurrent attacks of severe anxiety/panic which are not restricted to a particular situation
Unpredictable attacks
Lots of severe physical symptoms are often have fears or dying, losing control etc

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18
Q

What are the common physical symptoms

A 
Sudden onset palpitations
Chest pain 
Choking sensations
Dizziness 
Feelings of unreality  
Overwhelming and severe
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19
Q

Panic disorder commonly occurs alongside which other conditions

A

Other anxiety disorders
Agoraphobia
Depression
Drug and alcohol misuse

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20
Q

What age does panic disorder commonly present

A

Typical onset is in late adolescence to mid-30s

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21
Q

How do you treat a panic disorder

A

Cognitive Behavioural Therapy
SSRIs / SNRIs / Tricyclics

Benzodiazepines (short term only)

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22
Q

What can be used to trigger a panic attack

A

Infusions of lactate - if a susceptible individual

Re-breathing - increased CO2

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23
Q

What is a phobia

A

A fear which is recognised as irrational

Typified by avoidance and anticipatory anxiety

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24
Q

What is agoraphobia

A

A well-defined cluster of phobias around leaving home, being in crowded public areas or confined areas
Avoidance of the phobic situation is often prominent

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25
What is a specific phobia
A marked and persistent fear which is unreasonable or excessive Caused by the presence or anticipation of a specific object or situation - spiders, heights etc Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response Normal functioning is impaired by the avoidance or distress caused
26
How can you treat a phobia
Behavioural Therapy – exposure Graded exposure / systematic desensitisation Add in CBT if necessary SSRIs or SNRIs can be added if needed
27
What is a social phobia/social anxiety
A persistent fear of one or more social or performance More than just shyness They fear that they will humiliate themselves and be judged by others Exposure to the feared situation almost always promote an anxiety response or panic attack
28
What anxiety symptoms are commonly seen in social phobia
blushing or shaking fear of vomiting urgency or fear of micturition or defaecation.
29
How can you treat a social phobia
Cognitive Behavioural Therapy SSRIs / SNRIs Benzodiazepines (short term only)
30
What is obsessive compulsive disorder
Recurrent obsessional thoughts and/or compulsive acts Obsessive part is where you have repeated but unpleasant thought The compulsion is a repeated action/ritual that is done in an attempt to keep the anxiety at bay
31
Describe the obsessive thoughts seen in OCD
Repetitive thoughts Ideas, images or impulses entering the mind in a stereotyped way Recognised as the patients own thoughts But unpleasant, resisted and ego-dystonic (makes them uncomfortable)
32
Describe compulsive actions seen in OCD
They are repeated rituals or stereotyped behaviours It is not enjoyable or functional Often viewed as keeping the worry at bay or even that it will stop it from happening They recognise it as irrational
33
What are the diagnostic criteria of OCD
Must be present for most days for at least 2 weeks Needs to be a source of distress and interfere with activities Obsessions must be individuals own thoughts Resistance must be present Rituals are not pleasant Obsessional thoughts/images/impulses must be repetitive
34
When does OCD usually present
Average age of onset Peak incidence for males is 13-15 Peak incidence for women is 24-25
35
What other conditions does OCD often exist alongside
``` Schizophrenia Tourette's and other tic disorders Body dysmorphic disorder Eating disorder Trichtillomania - hair pulling ```
36
How can you treat OCD
Cognitive Behavioural Therapy Including response prevention SSRIs / Clomipramine
37
What is intentional vs unintentional trauma
Intentional = when the event was intended such as robbery, assault or rape Unintentional - a traumatic accident such as car crash
38
What type of trauma can affect a whole community
Disasters Can be human made such as a plane crash or bomb Or natural like an earthquake or hurricane
39
What is a centrifugal disaster
When the people affected are only together for the moment of disaster - plane/train crash
40
What is a centripetal disaster
When the disaster affects an existing community | Seen in natural disasters
41
What is type 1 trauma
Where there is a single traumatic incident | Sudden and unexpected
42
What is type 2 trauma
Repetitive trauma that becomes almost expected/routine Often affects development E.g. abuse, being taken hostage May involve betrayal of trust from a primary-care giver - if they are the abuser
43
Which type of trauma has the highest risk of PTSD
Type 2
44
Which societal groups are more at risk of trauma
Poor & marginalised are much more likely to be victims
45
In a traumatic event, do people usually panic
Surprisingly panic is rare Most people behave rationally Activism following the event is also common with people starting reconstruction quickly
46
What other mental health conditions can childhood trauma lead on to
Common in chronic depression and indicates that it will need psychotherapy High % of those with bipolar report child abuse or deprivation High rates of trauma in psych inpatients
47
Does PTSD have an impact on physical health
Raises mortality from all causes | High incidence of chronic disease
48
How does the body respond to anxiety
It will wither freeze - if the threat is distant or inescapable Or flee - if threat is near and escapable Can be a combination of responses dependant on situation - flight, fight, hide etc
49
What is tonic immobility
involuntary state of profound (but reversible) motor inhibition Seen in the fear response if threat is inescapable - an attempt to increase chance of survival Common in sexual assault
50
How is cortisol affected in PTSD
Levels are low | this is a paradox as cortisol is usually increased in the stress response
51
Does everyone who experiences trauma get PTSD
NOPE Up to 50% will recover without intervention However, some will just get worse or develop chronic symptoms
52
What are the trauma related risk factors for PTSD
``` Sudden or unexpected event Man-made event Prolonged exposure to the trauma Perceived threat to life More grotesque events - multiple deaths/injuries and often the involvement of kids makes it worse Personal involvement - losing a child ```
53
What are the patient related risk factors for PTSD
``` Severe acute stress reactions Low serum cortisol Family/personal history of mental disorder Past experience of trauma Loss of daily function Serious physical injury Personality traits and coping skills Lifestyle Female gender ```
54
What are the environmental related risk factors for PTSD
``` Lack of support network Ongoing life stress Reaction of others Economic resources Displacement - MASSIVE risk ```
55
How can vulnerability affect the response to trauma
If a person is extremely vulnerable then more minor trauma will cause a big response More likely to have PTSD Severe trauma can still affect everyone
56
List some of the normal reactions to trauma
``` Numbness or shock Depression and hopelessness Anger Fear Guilt Impaired sleep Flashbacks ```
57
When does a normal trauma reaction become PTSD
All dependant on frequency, severity and duration – increased levels in any of the normal symptoms would be considered abnormal Symptoms must last at least a month but not necessarily the month after the event
58
What are some of the psychological symptoms of PTSD
``` Depression Grief Reactions Panic Attacks +/- agoraphobia Alcohol/Drug Dependence Brief Hypomania Specific Phobias - related to initial trauma ```
59
Which traumatic events have the highest rates of PTSD
Rape and sexual assault
60
Which anxiety disorder has the highest association with suicide
PTSD
61
Which psychiatric conditions are commonly co-morbid with PTSD
Depression, drug and alcohol abuse, and other anxiety disorders
62
What intrusive phenomena are sometimes seen in PTSD
Recurrent distressing recollections Nightmares - may make them sleep avoidant Flashbacks Physiological reactions - heart racing, nausea etc
63
What avoidance symptoms are sometimes seen in PTSD
``` Avoid talking or thinking about event Avoiding reminders such as places or people Amnesia of the trauma Isolation Loss of interest in activities Emotional numbing ```
64
What hyperarousal symptoms are sometimes seen in PTSD
``` sleep disturbance irritability / anger concentration difficulties hypervigilance exaggerated startle response ```
65
What dissociative symptoms are sometimes seen in PTSD
Depersonalisation Out of body experience Derealisation Loss of awareness of surrounding
66
Which areas of the brain are affected in PTSD
Hippocampus - involved in memory and stress response - gets smaller in PTSD ``` Amygdala - role of fear during both trauma & its recollection - activity increases - important in emotional event memory Deactivation of Broca's area Right hemisphere lateralisation ```
67
Describe brain activity during a visual flashback
Visual cortex will become active when a visual flashback occurs – feels like you're there again Sensory memories can be triggered by the flashback
68
How do you manage PTSD
Ensure safety before starting - manage ongoing trauma Can treat acute symptoms with medication – e.g. sleeping tablets Long term, many different psychological therapies can be used (trauma focussed) Patient's preference

Psychiatry (14 decks)

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