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Y5 Psych > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

% of EDs that are men / boys

A

15 to 20

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2
Q

BMI of bulaemia

A

normal / above normal

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3
Q

BMI of binge eating disorder

A

above normal

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4
Q

BMI of anorexia

A

low

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5
Q

what common belief do eating disorders have

A

individuals judge their self worth in terms of their shape / weight / eating / ability to control these features

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6
Q

EDs have highest rate of mortality of any mental illness. true or false?

A

TRUE - pre pandemic for sure but likely now

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7
Q

ED with the highest mortality rate

A

anorexia

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8
Q

why does anorexia have the highest mortality rate

A

physical decline & suicide

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9
Q

sex ratio of AN

A

1:10 F:M

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10
Q

age on onset for AN usually

A

16 to 17

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11
Q

diagnostic for AN

A

15% below expected or BMI under 17.5

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12
Q

behaviours of AN

A

self induced weight loss
avoidance ofcertain foods / resitriction
vomitting / purging / xs exercise / appetite suppresants / laxatives

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13
Q

thoughts of AN

A

body image distortion
dread of fatness
overvalued ideas
imposed low weight threshold

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14
Q

endocrine disorders of AN

A

HPA axis
amonorhoea
reduced libido / impotence
raised GH levels
altered TFTs
abnormal insulin secretion
delayed / arrested puberty

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15
Q

causes of EDs

A

genetics, personality, cultural enviroment, reaction to traumatic life event

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16
Q

physiological risk factors

A

lack of adaptive coping strategies
easily anxious / shy
personality traits: perfectionist / rigidity / impulsive
low self esteem
feelings of inadequacy / lack of control in life
depression, anxiety, anger, lonely

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17
Q

overlap of AN with other mental health disorders

A

depression - Sx of depression are Sx of starvation too
anxiety / OCD / social phobia - obsessions / compulsions related to food / exercise / weight

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18
Q

maintaining factors of AN

A

starvation –> difficulty concentrating / infelxible thinking / low mood / bloating makes ppl feel they lose control / guilt and denial
affected loved ones –> unhelpful, conflict, anger, carers can be lulled in false sense of security, intelligence masks it, splitting of family

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19
Q

how can you think of ED

A

like a food phobia

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20
Q

dental and renal consequences of ED

A

dental caries

renal calculi

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21
Q

blood issues of AN

A

anaemia, leucopaenia, thrombocytopaenia

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22
Q

neuro signs of AN

A

peripheral neuropathy, loss of brain volume

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23
Q

reproductive issues of AN

A

infertility, low birth weight infant

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24
Q

endocrine issues of AN

A

low K/Na/sugar/Ca/body temp
amenorrhoea, osteoporosis, high cortisol

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25
Q

russels sign?

A

callused skin over interpharangeal joints due to xs vomitting

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26
Q

hypercaratonaemia?

A

orange tint to skin like jaundice but spares sclera

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27
Q

heart and tummy issues of AN

A

low BP, porlonged QT, arrhytmias, cardiomyopathy
delayed gastric emptyingd

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28
Q

derm issues of AN

A

dry scal skin, brittle hair, lanugo hair

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29
Q

screening questionaire of AN

A

SCOFF

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30
Q

what is included in SCOFF Qs

A

do you make yourself sick when you feel full
*****

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31
Q

other features to look for in AN

A

overvalued ideas about shape / weight
body image disturbance
hormonal disturbance - no periods etc
emotionally labile
hide behaviours

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32
Q

Ix of AN

A

full psych history
SCOFF questionnaire to screen
current ED Sx - vomiting, laxatives, exercise, periods
bio/ psycho / social factors
collateral history from family - also to see fmaily dynamics

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33
Q

blood tests for AN

A

FBC - high HB in dehydration
ESR - organic cause
U&Es - urea/creaitnine/K/Pi/Mg - low
CK - raised in exercising
Amylase - raised = vomitting
glucose
LFTs - elevated
TFT
albumin
cholesterol - elevated
hypercortisolaemia, raised GH, low LH/FSH, low E/P

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34
Q

why would Na be low in AN

A

ppl drink lots and lots of water to gain weight for weigh ins

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35
Q

why check Mg/Pi

A

refeeding syndrome

36
Q

Mx of AN

A

early referral to EDU
rest, food, warmth
CBT / family intervention
dietician gives nutritional education
?MHA assessment if needed / refusing –> contact seniors

37
Q

what drug may be used in AN

A

olanzapine - will cause them to gain weight too

38
Q

key difficulty in Mx of AN

A

how to introduce food whilst maintaining the relationship with patient

39
Q

guidelines for Mx of acute physical deterioration of AN

A

marzipan guidelines

40
Q

how to assess the physically unwell AN patient

A

marzipan guidelines
looks at BMI, vital signs, clinical signs, blood tests
inpatient may be necessary

41
Q

reasons for inpatient admission for AN

A

rapid weight loss
severe electrolute imbalnace
marked chaneg in mental state
psychosis / suicide
failure of outpatient Tx
physiological complications - bradycardia, low BP

42
Q

refeeding diet content & why

A

low fibre, phosphate rich diet (milk)
- reduce refeeding syndrome

43
Q

process of refeeding syndrome

A

in starvation, main source from carbs –> fatty acids / amino acids so reduced insulin secretion
refeeding = insulin secretion resumes, so increased glycogen, fat, protein synthesis - uses up Mg/K
–> cardiac abnormalities

44
Q

what should happen if the patient deteriorates

A

consents –> use MCA to check if they can consent
not consent –> MHA and can give food under this

45
Q

bulaemia nervosa diagnostic criteria

A

preoccupation with eating
craving for food
binges
attempts to counyer the fattening effects of food by vomitting / laxatives

46
Q

co-morbidities of BN

A

anxiety / mood disorder
cutting / overdose

47
Q

Tx of BN

A

fluoxetine
CBT / family therapy

48
Q

key features of how to talk to patient with ED

A

collaborative approach - agree a care plan with them
avoid conflict / anxiety
facilitate their motivation to change
compassion and understanding - EDs are lonely
support family
MDT approach

49
Q

what is anxiety

A

fight or flight respons due to adrenal hypothalamocortical axis is overran in an unhelpful well
perception of threat / reaction is unnecessarily high

50
Q

psychological sx of anxiety

A

feeling worried
poor concentration
irritable
depersonalised / derealised
difficulty falling asleep

51
Q

physical sx of anxiety

A

fast heart rate / palpitations
chest discomfort
tremore
headache
restlessness
dry mouth
indigestion / farting
hyperventilating
dizziness
ED / increased urinary freq

52
Q

define phobia

A

fear out of proportion to the situation
can’t be reasoned away
not rationalised
beyond voluntary control
avoidance of fear

53
Q

epidemiology of phobias

A

lifetime prevalance 5-10%

54
Q

sex distribution of phobia

A

F>M 2:1

55
Q

age peak of phobias

A

presents age 5-9

56
Q

signs of phobias

A

avoidance, fear, disability

57
Q

aetiology of phobias

A

3/4 have 1st degree relative with same phobia
phobias develop through modelling or conditioning

58
Q

what is agorophobia

A

a fear of being in situations where escape might be difficult or that help wouldn’t be avilable if things go wrong eg open/confined spaces

59
Q

sex distribution of agorophobia
social phobia?

A

f>m 4:1
f>m 3:2

60
Q

what is social phobia

A

marked fear of being the focus of attention, or fear of behaving in a way that will be embarrassing / humiliating

61
Q

Mx for phobias

A

CBT with exposure therapy
meds used would be SSRI / venlafaxine, beta blockers

62
Q

drugs of choice for social phobia

A

SSRI

63
Q

what drug should be avoided in phobias

A

benzodiazepine

64
Q

define panic disorder

A

intermittent intense anxiety NOT triggered by a specific stimulus
unpredictable

65
Q

are panic attacks panic disorder?

A

NO - they have a specific stimulus so they are more a phobia

66
Q

sx of panic disorder

A

the panic attack sx
fear of dying
hyperventiliating
sweating, dizziness
palpitations
chest discomfort
desire to flee

67
Q

Mx for panic disorder

A

CBT / relaxation techniques
SSRIs
not benzos

68
Q

what is GAD

A

generalised anxiety disorder
excessive and uncontrolled anxiety, NOT triggered by a specific stimulus
continuous (most days over 6 months)

69
Q

sx of GAD

A

motor tension, restlessness, irritability, somatic Sx
comorbid depression / OCD / panic disorder

70
Q

are all anxiety disorders more common in women

A

all except OCD, which is even

71
Q

risk factors of GAD

A

history of trauma
low socioeconomic status
substance abuse
chronic illness

72
Q

Ix and Mx for GAD

A

rating scales eg GAD-7
Mx
1 = educate and monitor
2 = CBT
3 = high intensitiy CBT +/- drugs
4 = speciialist intervention

73
Q

meds for GAD

A

SSRIs, SNRI, pregabalin

74
Q

define OCD

A

obsessions are recurrent, unwanted and intrusive thoughts/images/impulses in ones mind, despite attempts to resit
compulsions are repeated and seemingly purposeful rituals that are carried out

75
Q

diagnostic for OCD

A

Sx present on most days for at least 2 successive weeks and be the source of distress or interference with activities

76
Q

most common OCD types

A

checking compulsions 63%
washing 50%
fears of contamination 45%
obsessive doubts 42%

77
Q

aetiology of OCD

A

FHx - 35% of 1st degree relative
tics 20%
anakastic personality
stress
basal ganglia defects

78
Q

Mx of OCD

A

CBT - ERP
SSRIs - high dose or clomipramine (TCA)

79
Q

prognosis of OCD

A

70% respond to Tx but can be chronic
better if mild sx / short prognosis

80
Q

what is in the GAD 7

A
81
Q

define PTSD

A

an event of exceptionally threatening or catastrophic nature likely to cause pervasive distress in anyone

82
Q

3 key sx of PTSD

A

reliving trauma - flashbacks, recurrent nightmares
hyperarousal / vigilance
avoidance due to perceived fear of re-exposure

83
Q

prevalence of PTSD

A

lifetime = 6.8%

84
Q

aetiology of PTSD

A

10% of people who have experienced severe trauma
predisposing traits = neuroticism, FHx of psych, child abuse, poor early attachment, survivor guilt

85
Q

mx of PTSD

A

psychological - CBT (trauma focused) or EMDR (eye movement desenistisation and reprocessing)
pharmacological - mirtazipine / SSRI / venlafaxine
MDMA - 80% cure rate at 12 weeks

86
Q

prognosis of PTSD

A

majority recover
chronic cases can change personality
sx precipitated by anniversaries of trauma

Y5 Psych (10 decks)

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