Anxiety Flashcards
what are the 3 main areas that may cause anxiety?
- Genetic
- Environment (childhood, divorce, lifestyle)
- Development
what are the subtypes of anxiety?
o Generalised anxiety disorder (GAD)
o Panic disorder
o Social phobia / social anxiety disorder (this is the main one)
o Obsessive compulsive disorder (OCD) [not examinable]
o Post-traumatic stress disorder (PTSD) [not examinable]
o Agoraphobia [not examinable]
o Other phobias [not examinable]
what are the psychological symptoms of anxiety?
Worrying thoughts Fearful anticipation Poor memory Insomnia Poor concentration Avoidance behaviours Irritability Sensitivity to noise and light
what are the physical symptoms of anxiety?
Palpitations, SOB Tremor Sexual difficulties Problems with urinary/faecal excretion Fatigue Dizziness, headache Poor swallowing / dry mouth
how do you diagnose anxiety?
- When someone presents with symptoms of anxiety, general screening can be performed with the generalised anxiety disorder scale (GAD-2) to determine whether further investigation is required
- GAD-2 questions. How often have you experienced the following over the last 2 weeks?
- Feeling nervous/anxious/on edge
- Uncontrollable worrying
- If they score above 3 they will be asked further questions
what are the specific symptoms of GAD?
- excessive worrying about a number of issues
- preoccupation, seeking reassurance
- over arrousal and irritabiliity
- insomnia
- poor concentration
what are the specific symptoms of panic disorder?
- worrying and fearful thoughts
- surge of intense panic
- poor memory
what are the specific symptoms of social anxiety?
- overwhelming fear of social situations
- excessive worrying
- panic attacks
what are the psychological options of GAD?
Education and active monitoring important first step
Self-help (either non-facilitated or guided) and group education are considered as first line treatments for GAD if education ineffective
High intensity psychological intervention can be used if group education/self help not effective or marked functional impairment
o CBT
o Applied relaxation
what are the pharmacological options for GAD?
Offered to those who have marked functional impairment or education/self-help not effective
Treatment choice:
Selective Serotonin Reuptake Inhibitor (SSRI) first line – sertraline (unlicensed)
o Response increases over time
o If effective treat for one year
Alternative SSRI or SNRI second line
Offer pregabalin 3rd line
Benzodiazepines for short term use only in severe anxiety state (crisis)
DO NOT use antipsychotics
what are the psychological therapy options for panic disorder?
Offer individualised cognitive behavioural therapy (CBT)
o Over 1-2 hours for each weekly session
o Max 4 months of treatment
Facilitated or non-facilitated self help materials – groups and exercise
If not effective, add in pharmacotherapy
what are the pharmacological therapy options of panic disorder?
- Selective Serotonin Reuptake Inhibitor (SSRI) first line – any licensed for panic disorder
- Second line – use imipramine or clomipramine
- If treatment successfully used for 6 months dose can be tapered and stopped
- DO NOT use benzodiazepines (BZDs), antipsychotics, sedating antihistamines
what are considerations you need to take into account with antidepressants?
- may take up to 2 weeks to work
- there are side effects which you need to warn patient
- may be a period where they make the depression / anxiety worse
- need to review within a week of starting
- doses tend to be much lower for anxiety then for depression
what is a major DDI with anti depressants?
fluvoxamine and warfarin
which are short acting benxos?
lorazepam, oxazepam
