Anxiety Disorders Flashcards
(24 cards)
What are medical conditions commonly associated with anxiety?
Hyperthyroidism, anaemia, hypoglycaemia, phaeochromocytoma, Cushing’s, COPD, CCF, malignancies
What is generalised anxiety disorder GAD?
A syndrome of ongoing, uncontrollable, widespread worry that the patient recognises as excessive and inappropriate. Symptoms must be present on most days for at least 6 months
What is the biological and environmental aetiological factors of GAD?
Genetic, ANS dysfunction, neurotransmitter alterations, exaggerated responses in amygdala and hippocampus.
Environmental: adverse events (child abuse, relationship problems, illness, employment), substance dependence
What are common features of a presentation of GAD that fit with the mnemonic ‘WATCHERS’?
W- worry
A- autonomic hyperactivity
T-tension in muscles/ tremor
C- concentration difficulty/ chronic aches
H-hyperventilation/ headaches
E- energy loss
R- restlessness
S- startled easily/ sleep disturbance (hard getting to sleep, intermittent waking and nightmares)
What is the diagnostic criteria for GAD in ICD-10?
Over 6 months of prominent tension, worry and feelings of apprehension
At least 4 symptoms of anxiety and at least 1 symptom of autonomic arousal
What are psychological symptoms of anxiety?
Anticipatory fear of impending doom, worrying thoughts, exaggerated startle response, restlessness, poor concentration and attention, irritability, depersonalisation/derealisation
What are cardiovascular symptoms of anxiety?
Palpitations, chest pain
What are respiratory symptoms of anxiety?
Hyperventilation, cough, chest tightness
What are gastrointestinal symptoms of anxiety?
Abdominal pain (butterflies), loose stools, N+V, dysphagia, dry mouth
What are genitourinary symptoms of anxiety?
Increased frequency of micturition, failure of erection, menstrual discomfort
What are neuromuscular symptoms of anxiety?
Tremor, myalgia, headache, paraesthesia, tinnitus
Are depressive symptoms seen in neurosis?
Yes depressive symptoms are actually common in neuroses
What are some key questions to ask about anxiety symptoms?
Rate of onset, duration, severity, do they arise spontaneously or in response to certain situations
What are some medical conditions associated with anxiety?
Hyperthyroidism, hypoglycaemia, anaemia, phaeochromocytoma, Cushing’s, COPD, CCF, malignancies
What are three features that separate phobic anxiety from GAD?
- Anxiety occurs in a specific situation
- There is anticipatory anxiety when thinking they will encounter the feared situation
- There is attempted avoidance of the circumstances that make them anxious
What does the Yerkes-Dodson curve represent?
The relationship between anxiety and performance. It shows that a little anxiety can help improve our performance, but too much can be disruptive
What are physiological responses to anxiety which lead to anxiety symptoms?
Decreased blood flow to the gut
Smooth muscle contraction in the gut
Increased blood flow to skeletal muscle
Increased muscle tension
Pupil dilation
Nausea
Increased heart rate and BP
What is psychoeducation in anxiety?
Explaining the anxiety symptoms and why they occur to comfort patients, it can help them make sense of strange physical symptoms.
What are some examples of specific types of anxiety?
GAD, separation anxiety, social anxiety, agoraphobia, specific phobia, PTSD, OCD and panic disorder
Diagnosis of GAD requires three of which symptoms?
Restlessness, fatigue, irritability, poor concentration, sleep disturbance, muscle tension
How does you assess the severity of GAD?
Ask about the impact it has on the patients daily functioning
Use a diagnostic questionnaire
What are some organic differentials for GAD?
Hyperthyroidism, drug/alcohol withdrawal, hypoglycaemia, tachyarrhythmias, B12 deficiency, phaeochromocytoma
Other than medication, how can we manage GAD?
Psychoeducation
Avoid exacerbating lifestyle factors e.g caffeine, nicotine, alcohol
Encourage exercise
Stress reduction/management: mindfulness
CBT
Breathing techniques
What is carpopedal spasm and why do we occasionally see this in panic attacks?
Involuntary muscle contraction in hands and feet.
Results from hyperventilation due to the low CO2 levels leading to alkalosis, which is corrected by H+ from plasma proteins. The excess protein anions take up calcium resulting in a hypocalcaemic tetany
