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Y5 Psych > Anxiety > Flashcards

Anxiety Flashcards

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1
Q

What are theories for anxiety?

A
  • Underactive neurotransmitter (serotonin, noradrenaline, GABA)
  • Psychological - behaviour, cognitive therapies (classical conditioning, negative reinforcement, cognitive theories)
  • Neuroatomical - hyperactivity of amygdala, leading to anxiety
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2
Q

What is generalised anxiety disorder (GAD)?

A

continuous, generalised anxiety for >6 months NOT triggered by a specific stimulus
Minimum 4 symptoms
Causes worrying about anything

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3
Q

What are differential diagnoses for GAD?

A

Organic: hyperthyroidism, substance misuse (intoxication,withdrawal), excess caffeine

Depression/mixed anxiety and depression
> anxiety symptoms are common in depression
> diagnose whichever came first

Another anxiety disorder
- panic disorder / social anxiety disorder / PTSD

Anxious/avoidant Personality Disorder

Dementia

Schizophrenia

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4
Q

What are symptoms of GAD?

A

Psychological:

  • fears/worries
  • poor concentration
  • irritability
  • unreality (depersonalisation, derealisation)
  • insomnia
  • night terrors

Motor symptoms:

  • restless, fidgety
  • unable to relax

Neuromuscular:

  • trembling, tremor
  • headache (tension headache)
  • muscle ache
  • dizziness
  • tinnitus

GI

  • dry mouth, difficulty swallowing
  • nausea
  • indigestion, stomach pains
  • butterflies in stomach
  • flatulence
  • frequent, loose stool

CV
-palpitations

Resp

  • difficulty inhaling
  • tight,constricted chest

GU

  • urinary frequency
  • erectile dysfunction
  • amenorrhoea
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5
Q

What are phobic anxiety disorders?

A

Intermittent anxiety occurring in SPECIFIC but ordinary circumstances

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6
Q

What does the seriousness of a phobia depend on?

A

On how easily the person can avoid the thing they fear

So on what kind of disability it causes

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7
Q

What is agoraphobia?

A

fear of being unable to escape to a safe place

> fear of open spaces /confined places

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8
Q

What are examples of places someone with agoraphobia will struggle with?

A

trains, planes, lifts, supermarkets, large crowds

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9
Q

What are symptoms of agoraphobia?

A

Overwhelming urge to return to safety
Prospect of leaving home generates anxiety
Presence of dependable companion helps

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10
Q

What are differentials for agoraphobia?

A

Depression (social withdrawal)
Social phobia (fear of scrutiny, humiliation)
OCD (rituals can confine people to their homes)
Schizo (confined to home, esp if paranoid)

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11
Q

What is a social phobia?

A

Social anxiety disorder

The fear of being scrutinised or criticised by others

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12
Q

What situations are hard for those with social phobia?

A

Small groups, where the focus is on them

Dinner parties, board meetings, public speaking

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13
Q

How do patients with social phobia self medicate?

A

With alcohol/drugs

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14
Q

What are differentials for social phobia?

A

Shyness
Agoraphobia (getting to safe space > social scrutiny)
Anxious PD (PPP)
ASD

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15
Q

When do specific phobias develop?

A

In childhood

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16
Q

What is panic disorder?

A

Intermittent anxiety with no obvious trigger and recurrent panic attacks for several months

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17
Q

What are patients with panic disorder like in between episodes?

A

Free of anxiety

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18
Q

How do you investigate anxiety disorder?

A

history and physical exam
Anxiety Rating scale
Social and occupational assessment for QoL assessment
COllateral hx

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19
Q

What are examples of anxiety rating scales?

A

GAD7 questionnaire

Beck anxiety inventory

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20
Q

What is the benefit of using anxiety rating scales?

A

They provide a baseline score for measuring treatment response

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21
Q

How do you manage anxiety disorders without medication?

A

Mild - advice and reassurance
Basic counselling
Problem-solving (to help deal with stressors)
Relaxation techniques, breathing exercises
CBT - provided by IAPT

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22
Q

What kind of therapy is good for phobias?

A

Exposure therapy

  • gradual exposure to threat > desensitisation
  • Habituation
  • Extinction
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23
Q

What is pharm management for anxiety disorders?

A

Antidepressants:

  • SSRI - therapeutic dose for anxiety higher than for depression and response takes longer (6-8 weeks)
  • SNRI
  • TCA

Anxiolytics:

  • Buspirone (increases action of SSRI)
  • Pregabalin
  • Benzodiazepines

Beta-blockers (for adrenergic sx)

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24
Q

What is the MOA of Buspirone?

A

Serotonin Partial Agonist

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25
What do you need to keep in mind when prescribing Benzos?
Tolerance builds quickly, dependence is an issue | Give for SHORT TERM anxiety treatment only
26
How long can you prescribe Benzos for?
2-4 weeks MAX
27
What are Side Effects of Benzos?
amnesia ataxia resp depression
28
What is the prognosis in anxiety disorders?
Rule of 3s 1/3 recover 1/3 improve partially 1/3 do poorly > have considerable disability
29
How do you diagnose OCD?
Either obsessions or compulsions (or both), present on most days for a period of at least two weeks.
30
What is an obsession?
Recurrent unwanted obtrusive thought/images/impulses that enter the pt's mind despite attempts to resist them
31
How are obsessions different to delusions?
Patient is aware obsession is untrue/irrational and their own (not a thought insertion)
32
What is a compulsion?
repeated and stereotyped rituals that the patient feels compelled to carry out, even though it is irrational and may not be associated to the obsession
33
What are ddx for OCD?
Organic causes (Tourette's, Sydenam's, Huntington's) Anxiety disorders Depression (50% of OCD patients have depressive sx - depression takes priority) Anakastic personality disorder Autism - repetitive behaviour, need for routine Schizophrenia
34
How do you manage OCD?
Education and self help, mindfulness (notice thoughts, r rather than avoid them) CBT - Exposure and response prevention Medication - SSRI, clomipramine (TCA). second gen antipsychotic if resistant So: 1. CBT with ERP 2nd line: add SSRI 3rd line (after 12 weeks): clopiramine or alternative SSRI
35
What are symptoms of an acute stress reaction?
Transience (starts in mins, resolves in hours) Dazed/detached Amnesia Depersonalisation, derealisation Disorientation, agitation, irritability, panic, aggression
36
How do you manage Acute Stress Reaction?
Exclude injury Support and Reassurance Benzos (short term)
37
What does PTSD occur following?
Follows exposure to a stressful situation of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.
38
What is the latency period of PTSD?
Usually within 6months of trauma
39
What is clinical presentation of PTSD?
RE-EXPERIENCING - Flashback s - Nightmares - Intrusive memory AVOIDANCE - avoids reminders (e.g. specific setting) of event - avoids thinking about it HYPERAROUSAL - persistent inability to relax - hypervigilance - enhanced startle reflex - insomnia - poor concentration - rritability EMOTIONAL CHANGES - Emotional detachment - Powerful emotions e.g. anger, loss of control, shame, crying - Decreased interest in activities
40
Ddx for PTSD
Anxiety disorders Depression Adjustment
41
Mx for PTSD
Trauma-Focused CBT Eye movement desensitisation and processing (EMDR) Group therapy SSRI(paroxetine)/Venlaxafine
42
What is adjustment disorder?
Person's reaction to life changes that require adaptations to cope is greater than usually expected Symptoms start within 1 month of stressor, resolve within 6m
43
What are risk factors for generalised anxiety disorder?
Physical or emotional trauma Low socioeconomic status Substance abuse Chronic painful illness
44
What is the management for GAD?
1. Social: - relaxation training, - meditation training, - sleep hygien - exercise 2. Psych: CBT for 4-12 weeks 3. Medication: Sertraline (2nd line: other SSRI or SNRI, 3rd line: Pregabalin) 4. Specialist assessment
45
What are drugs given for GAD management=
SSRI SNRI Pregabalin
46
When is Benzo given in anxiety
As a LAST RESORT for <4 weeks | or AS A ONE OFF
47
What are criteria for agoraphobia diagnosis?
Minimum 2 of fear in the following: - crowds - public places - travelling away from home - travelling alone
48
What are signs/symptoms of agoraphobia?
House bound Panic attacks when outdoors / confined places Dependency on other
49
What are signs/symptoms of social phobia?
``` Social withdrawal Blushing Tremor Panic attack Alcohol abuse ```
50
What is a specific phobia?
Out of proportion fear to the demands of a situation, due to specific trigger Cannot be reasoned away as it is involuntary (stems from the deep brain aka amygdala)
51
How do specific phobias present?
Avoidance Fear Disability
52
How does a panic attack present?
``` Breathing difficulty, choking feeling Fear of suffocating/dying Hyperventilation > dizziness, parasthesia Palpitations Depersonalisation / derealisation Lasts <30 mins, self resolving ```
53
What differentials do you rule out for panic disorder?
Other anxiety disorders (GAD; agoraphobia) Depression Alcohol or drug withdrawal Organic causes (CV, respiratory, phaeo)
54
What is the difference in panic attack presentations in panic disorder vs other anxiety disorders?
in panic disorders, they have no obvious trigger | In other disorder (e.g. GAD), they occur with trigger and mark severity of the condition
55
Give examples of obsession categories that could occur in OCD
Contamination e.g. something getting dirty Infection e.g. getting HIV Aggression e.g. thought of harming others Morality (sex/religion) e.g. sacrilege - shout blasphemous things in a church e.g. thinking they might be a pedophile
56
What are examples of compulsion categories in OCD?
Cleaning Counting Checking Ordering objects
57
What is the triad of symptoms that occurs in PTSD?
Re-experiencing Avoidance Hyperaro\usal
58
What time frame do symptoms have to occur in to be qualified as PTSD
>4 weeks from event Usually present within first 6 months
59
Explain how CBT works for anziety disorders
Aims to reduce patients expectations to threat and the behaviours that maintain threat-related beliefs Structure: - explore likelihood and impact of anticipated catastrophe - Test feared situation using behavioutal experiment - This increases the patient's confidence in their capacity to cope with the feared situatio
60
Explain how exposure therapy works for anxiety
Expose person to perceived threat Exposure is achieved gradually, via desensitisation In the absence of actual harm, body can only remain anxious for 45minds before habituation occurs and aniety drops Anxiety decreases until extinction
61
How does EMDR work
Eye movement desensitisation and reprocessing Experience orignal trauma in as much detail as possible (ask patient to narrate) while they do this, they fix eye on therapists finger as it quickly passess from side to side eye movements. can be replaced by alternating left right stimulus this aids memory processing

Y5 Psych (17 decks)

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