Anxiety disorder- clinical picture Flashcards Preview

202: Theme 3, Modulatory systems in psychiatry > Anxiety disorder- clinical picture > Flashcards

Flashcards in Anxiety disorder- clinical picture Deck (27)
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1

Normal response to a stressor

1. Amygdala detects sensory information indicating danger---> stimulates the hypothalamus

2. Hypothalamus stimulates the sympathetic NS---> stimulates release of NA from the adrenal medulla

3. NA--> Tachycardia, hypertension, bronchial dilation, sweating, hyperventilation

2

GAD
- Clinical presentation

Persistent features that are not restricted or strongly presenting before certain circumstances

- Worry
- Headache
- Motor tension
- Autonomic hyperactivity [sweating, dry mouth etc]

3

Psychological GAD symptoms

Fearful anticipation of things

Irritability

Sensitivity to noise

Restlessness

Poor concentration

Thoughts of worry

4

GI symptoms of GAD

Dry mouth

Difficultly swallowing

Epigastric discomfort

Frequent wind

5

Respiratory symptoms of GAD

Hyperventilation

Tight chest

Difficulty inhaling

6

Cardiovascular symptoms of GAD

Chest pain

Palpitations

Feeling of 'missed beats'

7

Genitourinary symptoms of GAD

Urinary urgency/ frequency

Dysmenorrhea

Amenorrhea

Erectile failure

8

Neuromuscular symptoms of GAD

Tremors

Trembling

Paraesthesia

Tinnitus

Dizziness

Headaches

9

GAD presentation in primary care

Presents a lot more than in general population
- Lifetime prevalence [8-9%]
- 3x more in GP

Also contains very high co-morbidity
- 70%

10

Genetics of GAD

5x increase in 1st degree relatives

Genetic factors have a modest role
- Monozygotic twins show no difference with dizygotic twins

11

Neurobiological mechanism of GAD

No clear studies related to humans

Abnormal APA axis

Possible role of serotonin--> Benefits from SSRIs

GABA agonists are effect--> Possible GABA mechanism

NA pathways possibly implicated

12

Psychological etiology of GAD

Stressful and traumatic life events= increases risk of developing GAD

Just one very negative event= 3x risk

13

Parenting effects on GAD

Disruption in early attachment--> anxious apprehension and dependency
- Withdrawal and depression can occur when disruption is severe

Overprotection + lack of warmth and responsiveness
- Can lead to anxiety

14

Endocrine differential diagnosis of panic disorders

Hypoglycaemia

Phaeocromocytoma--> neuroendocrine tumor of adrenal medulla

Carcinoid--> slow growing neuroendocrine tumour

15

Cardiovascular differential diagnosis of panic disorders

Arrhythmias

16

Respiratory differential diagnosis of panic disorders

Asthma

17

Neurological differential diagnosis of panic disorders

Seizures

18

Agoraphobia
- Clinical presentations

Fear and avoidances of places that may induce panic
- Specific context
- Example: in crowds, away from the house

Can present with panic attacks and general anxiety

19

Panic epidemiology

Panic attacks
- 7-9% of population

Panic disorder
- 1.5-2.5% lifetime prevalence

Peak onsets:
15-25, 45-54

Risks
- Living in city
- Broke relationship
- Less educated
- Previous abuse
- Being female

20

Panic genetic predisposition

Increase risk in first degree relatives
- 7x

Moderate inheritability

21

Biological model
- Panic

Panic attack triggered by activation of locus coeruleus--> Release of NA

SSRI are effective [though SRT studies are contradictory]

GABA agonists are effective

Pentagastrin and CCK seen to cause panic attacks

22

Specific phobias

Inappropriate anxiety in the presence of one or more particular objects/ situations

23

Aetiology of phobia

1. Biological preparedness
- Objects that historically threatened the survival of an organism is feared.

2. Previous unresolved unconscious conflict

3. Classical condition--> Fear is learned in association with negative symptoms

24

Autonomic response to blood/injury phobia

Vasovagal syncope:

1. Sigh of blood/ needles= initial tachycardia and hypertension

2. Then blood pressure and heart rate drops--> Decrease cerebral artery blood flow

25

Social phobias

Inappropriate anxiety when a person is observed or scrutinised

26

Epidemiology of social phobia
- Lifetime risk
- GP presentation
- Co-morbidity
- Onset
- Sex

Lifetime risk
- 2.4-13.3

GP
- Can be as high as 7%

Co-morbidity
- 81% meet another psychiatric disorder at one point

Peaks
- before 5
- 11-15
- Unusual after 30

Sex
- Women more than men

27

Aetiology of social phobia

Genetic and environmental
- Monozygotic> dizygotic twins