Anxiety Flashcards
What is the NICE definition of anxiety?
Excessive worry about a number of different events associated with heightened tension
What are non-psychiatric causes of anxiety?
- Hyperthyroidism
- Cardiac disease
- Medications → salbutamol / theophylline / steroids / antidepressants / caffeine
What is the step-wise approach to GAD?
- Education about GAD + active monitoring
- Low-intensity psych interventions (self-help, groups)
- High-intensity psych interventions (CBT, applied relaxation) OR drug treatment
- Highly specialist input (eg. multiagency teams)
What is the drug treatment for GAD?
- First-line → sertraline
- Second-line → duloxetine or venlaflaxine
- Third-line → pregabalin
For pts < 30 yrs, warn pt sof inc risk of suicidal thinking + self-harm (weekly follow up recommended for first month)
What is the step-wise approach for panic disorder?
- Recognition + diagnosis
- Treatment in primary care
- Review + consideration of alternative treatments
- Review + referral to specialist services
- Care in specialist mental health services
What is the treatment in primary care for panic disorder?
- CBT or drug treatment
- SSRIs first-line (if CI or 12wks no response → imipramine or clomipramine)
What are features of PTSD?
Symptoms have to be present for > 1 month
- Re-rexperiencing: flashbacks, nightmares, repetitive + distressive intrusive images
- Avoidance: avoiding ppl, situations or circumstances resembling or associated w/ event
- Hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability + difficulty concentrating
- Emotional numbing: lack of ability to experience feelings, feeling detached
To others - depression, drug or alcohol misuse, anger + unexplained physical symptoms
What is the management of PTSD?
- Following a traumatic event, single-session interventions (debriefing) are not recommended
- Watchful waiting may be used for mild symptoms lasting < 4 wks
- Military personnel have access to treatment provided by armed forces
- Trauma-focused CBT or eye movement desensitisation (EMDR) may be used in more severe cases
- Drugs not first line, but can try venlaflaxine or sertraline - in severe cases use risperidone
What is an obsession?
Unwanted intrusive thought, image or urge that repeatedly enters the person’s mind
What is a compulsion?
- Repetitive behaviours or mental acts that the person feels driven to perform
- Can either be overt + observable by others, such as checking door is locked OR covert mental act that cannot be observed, such as repeating a certain phrase in one’s mind
What is OCD?
- Characterised by the presence of either obsessions or compulsions, but commonly both
- The symptoms can cause significant functional impairment and/or distress
- Multifactorial → genetic / psychological trauma / PANDAS
What are associations of OCD?
- Depression (30%)
- Schizophrenia (3%)
- Sydenham’s chorea
- Tourette’s syndrome
- Anorexia nervosa
What is the management of OCD?
- Mild → low intensity psych treatments: CBT incl exposure + response prevention
- Mod → SSRI (fluoxetine for body dysmorphic disorder) or intensive CBT (incl ERP)
- Severe → combine SSRI + CBT (incl ERP)
What is ERP?
- Exposure Response Prevention
- Psych method involving exposing pt to anxiety provoking situation
- then stopping them engaging in their usual safety behaviour
- Eg. for someone with OCD, having dirty hands and stopping them washing their hands
- This helps them confront their anxiety and habituation leads to eventual extinction of response
