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Psychiatry > Anxiety > Flashcards

Anxiety Flashcards

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
Q

What is a specific phobia

A

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

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26
Q

How can you treat a phobia

A

Behavioural Therapy – exposure
Graded exposure / systematic desensitisation
Add in CBT if necessary

SSRIs or SNRIs can be added if needed

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27
Q

What is a social phobia/social anxiety

A

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

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28
Q

What anxiety symptoms are commonly seen in social phobia

A

blushing or shaking
fear of vomiting
urgency or fear of micturition or defaecation.

29
Q

How can you treat a social phobia

A

Cognitive Behavioural Therapy
SSRIs / SNRIs

Benzodiazepines (short term only)

30
Q

What is obsessive compulsive disorder

A

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
Q

Describe the obsessive thoughts seen in OCD

A

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
Q

Describe compulsive actions seen in OCD

A

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
Q

What are the diagnostic criteria of OCD

A

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
Q

When does OCD usually present

A

Average age of onset
Peak incidence for males is 13-15
Peak incidence for women is 24-25

35
Q

What other conditions does OCD often exist alongside

A 
Schizophrenia 
Tourette's and other tic disorders 
Body dysmorphic disorder 
Eating disorder
Trichtillomania - hair pulling
36
Q

How can you treat OCD

A

Cognitive Behavioural Therapy
Including response prevention
SSRIs / Clomipramine

37
Q

What is intentional vs unintentional trauma

A

Intentional = when the event was intended such as robbery, assault or rape

Unintentional - a traumatic accident such as car crash

38
Q

What type of trauma can affect a whole community

A

Disasters
Can be human made such as a plane crash or bomb
Or natural like an earthquake or hurricane

39
Q

What is a centrifugal disaster

A

When the people affected are only together for the moment of disaster - plane/train crash

40
Q

What is a centripetal disaster

A

When the disaster affects an existing community

Seen in natural disasters

41
Q

What is type 1 trauma

A

Where there is a single traumatic incident

Sudden and unexpected

42
Q

What is type 2 trauma

A

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
Q

Which type of trauma has the highest risk of PTSD

A

Type 2

44
Q

Which societal groups are more at risk of trauma

A

Poor & marginalised are much more likely to be victims

45
Q

In a traumatic event, do people usually panic

A

Surprisingly panic is rare
Most people behave rationally
Activism following the event is also common with people starting reconstruction quickly

46
Q

What other mental health conditions can childhood trauma lead on to

A

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
Q

Does PTSD have an impact on physical health

A

Raises mortality from all causes

High incidence of chronic disease

48
Q

How does the body respond to anxiety

A

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
Q

What is tonic immobility

A

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
Q

How is cortisol affected in PTSD

A

Levels are low

this is a paradox as cortisol is usually increased in the stress response

51
Q

Does everyone who experiences trauma get PTSD

A

NOPE
Up to 50% will recover without intervention
However, some will just get worse or develop chronic symptoms

52
Q

What are the trauma related risk factors for PTSD

A 
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
Q

What are the patient related risk factors for PTSD

A 
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
Q

What are the environmental related risk factors for PTSD

A 
Lack of support network 
Ongoing life stress 
Reaction of others 
Economic resources 
Displacement - MASSIVE risk
55
Q

How can vulnerability affect the response to trauma

A

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
Q

List some of the normal reactions to trauma

A 
Numbness or shock 
Depression and hopelessness 
Anger 
Fear 
Guilt
Impaired sleep 
Flashbacks
57
Q

When does a normal trauma reaction become PTSD

A

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
Q

What are some of the psychological symptoms of PTSD

A 
Depression
Grief Reactions
Panic Attacks +/- agoraphobia
Alcohol/Drug Dependence
Brief Hypomania
Specific Phobias - related to initial trauma
59
Q

Which traumatic events have the highest rates of PTSD

A

Rape and sexual assault

60
Q

Which anxiety disorder has the highest association with suicide

A

PTSD

61
Q

Which psychiatric conditions are commonly co-morbid with PTSD

A

Depression, drug and alcohol abuse, and other anxiety disorders

62
Q

What intrusive phenomena are sometimes seen in PTSD

A

Recurrent distressing recollections
Nightmares - may make them sleep avoidant Flashbacks
Physiological reactions - heart racing, nausea etc

63
Q

What avoidance symptoms are sometimes seen in PTSD

A 
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
Q

What hyperarousal symptoms are sometimes seen in PTSD

A 
sleep disturbance
irritability / anger
concentration difficulties
hypervigilance
exaggerated startle response
65
Q

What dissociative symptoms are sometimes seen in PTSD

A

Depersonalisation
Out of body experience
Derealisation
Loss of awareness of surrounding

66
Q

Which areas of the brain are affected in PTSD

A

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
Q

Describe brain activity during a visual flashback

A

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
Q

How do you manage PTSD

A

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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