Anxiety Disorders Flashcards
(41 cards)
Describe the areas of the brain that are involved in anxiety
- Amygdala: fight or flight response
- Hypothalamus: HPA axis activation, cortisol response
- Limbic system: emotions
- Cerebral cortex: thoughts, behaviours
Describe some of the symptoms of anxiety
- Psychological: worry, hyperarousal, irritability, difficulty concentrating, sleep disturbance
- Cardiopulmonary: ^ HR, RR, BP, palpitations
- GI: indigestion, diarrhoea
- Muscle: tension, headache, tremor
Define GAD, phobia, and panic disorder
- GAD: feelings of worry/fear that are present most of the time and not triggered by specific events, lasting for >6 months
- Phobias: episodes of intense fear triggered by a specific, ordinary situation
- Panic disorder: episodes of intense fear not triggered by any specific situation
Describe the presentation of phobias
- Episodes of anxiety + fear triggered by a specific but ordinary situation eg. social, heights, crowds
- May lead to avoidance behaviours
- Causes significant impairment
- Often present for long time
What are some examples of phobias? Explain them
- Agoraphobia: fear of being in situations where escape is difficult eg. crowds, public places, travelling
- Social phobia: fear of being the focus of attention/behaving in a way that will cause embarrassment or criticism
Which conditions commonly occur with agoraphobia?
Depression
Panic disorder eg. panic disorder when outside fuels the agoraphobia because they are now scared of leaving the house and provoking another panic attack
What are some differential diagnoses for agoraphobia?
Schizophrenia Personality disorder Social anxiety OCD Depression: social withdrawal
How can you differentiate agoraphobia vs social phobia?
What specifically are they afraid of when going outside? eg is it people looking at them or is it not being able to get away?
Does the place matter? eg small groups, large crowds
What are some differential diagnoses for social phobia?
Shyness Agoraphobia Avoidant PD Autism Schizophrenia
What can be used for assessing social phobia?
SPIN (social phobia inventory) or LSAS
How would you counsel someone that has been diagnosed with social phobia?
- Explain the diagnosis and check understanding
- Management: CBT, SSRIs in severe cases
- Advise to avoid using alcohol or drugs to cope, signpost for services
- Advise TCI if feeling worse, feeling very low in mood, etc
What is the management of social phobia?
- Bio: SSRIs second line
- Psych: CBT in Clark and Wells or Heimburg model. Self-guided if declined CBT.
What is the management of agoraphobia?
CBT with exposure and response prevention
SSRIs second line
Describe exposure and response prevention
A type of talking therapy where the patient is taught strategies to cope with fear and anxiety, then they are exposed to increasingly fear-inducing situations in order to cause habituation to the stimulus.
eg. fear of spiders: think about a spider, look at a picture of a spider, watch a video of a spider, etc.
What are some symptoms of panic attacks
- Intense fear/dread
- Chest constriction, difficulty breathing
- Hyperventilation
- Numbness and tingling in the fingers, mouth
- Sweating, dizziness
How is panic disorder diagnosed?
Recurrent panic attacks
What are some ways of assessing anxiety disorders?
GAD-7
Beck anxiety inventory
HADS
Specific eg. SPIN and LSAS for social phobia
What investigations would you do for someone with anxiety?
Usually only if GAD or panic disorder. Phobias have specific trigger
- Physical examination eg. pulse, heart
- Observations
- ECG
- Bloods: FBC, CRP, U+Es, TFTs
- Urine drug screen
Describe the management of GAD
Biopsychosocial
Mild-mod: individual guided self-help
2nd line or Mod-severe GAD: CBT or SSRI (12 week course)
When would you refer a patient with GAD to secondary care?
Treatment failure eg. trial of medications + CBT
High risk of suicide/self-harm
Self neglect
What is the management of panic disorder?
Biopsychosocial
Mild: individual self-help
Mod-sev: CBT -> SSRIs (12 week course) -> TCA (imipramine)
How should you follow-up someone newly prescribed Sertraline?
See within 2 weeks unless if <30 years, then see in 1 week to monitor for suicidal thinking
Define obsessions and compulsions
Obsessions: recurrent unwanted and intrusive thoughts, images, impulses
Compulsions: repeated and purposeful behaviours that the person feels compelled to do
How is OCD diagnosed?
Presence of obsessions and/or compulsions present for most days over 2+ weeks
Significant enough to cause distress
