Anxiety disorders Flashcards
Psychological symptoms
Inner tension Agitation Fear of loss of control Dread Irritability Depersonalisation Derealisation
Physical symptoms
Cardiovascular - tachycardia, palpitations
Respiratory - dyspnoea, hyperventilation, chest tightness
GI - borborygmi, loose bowels/urge to defecate, dry mouth, epigastric sensation, nausea
Urinary - urinary urge
Motor - tremor
Autonomic - sweating
Hyperventilation syndrome
Important as can lead to false diagnosis with a physical disorder or can miss a physical disorder
Rapid shallow breathing → hypocapnia → respiratory alkalosis → physical symptoms such as paraesthesia, light-headedness, spasm, chest tightness etc → increased anxiety etc etc
Can treat with paper bag but not recommended. Better is encouraging slow breathing with complete exhalation. Long term management is behavioural
Generalised anxiety disorder
Pervasive anxiety symptoms
Not restricted to certain situations
May be associated with phobias, depression or substance misuse
May be caused by physical illness (eg thyroid) or in response to physical illness (eg MI)
Familial predisposition
Biological and psychological factors
M:F 2:3
GAD treatment
Pyschological: CBT, anxiety management, psychodynamic psychotherapy
Physical: TCAs or SSRIs, avoid sedative tranquillisers
Panic disorder
Recurrent attacks of panic
Occur unpredictably and without obvious precipitants
Commonly co-exists with GAD or agoraphobia
Severe anxiety and psychological and physical symptoms
Panic disorder treatment
Pyschological: CBT, anxiety management, hyperventilation management
Physical: TCAs or SSRIs, avoid sedative tranquillisers
Phobic disorders
Fear disproportionate to the situation that provokes it
Situational, predictable and preceded by anxiety and avoidance
Include animal phobias, blood, sharps, vertigo, agoraphobia and social phobias
Phobic disorder treatment
Psychological: behavioural therapy - graded exposure and desensitisation, anxiety management, CBT
Physical: anti-depressants only as an adjunct to psychological approaches, avoid sedative tranquillisers
OCD - obsessional thoughts
Come into mind against will
Unpleasant and often abhorrent
Recognised as being the subjects own
May be resisted → ↑ in anxiety
OCD - compulsive acts
Repetitive actions based on obsessional thoughts
Not directly pleasurable
Temporary relief of tension and anxiety created by provoking thoughts
May have symbolic quality
OCD treatment
Psychological: thought stopping (distraction used to interrupt obsessional thought), response prevention (patient resists ritual in response to stimulus), anxiety management/CBT
Physical: Clomipramine, SSRIs, lithium and tryptophan (most effective short term, length of efficacy increased when in conjunction with CBT), ECT, neurosurgery
Acute stress reaction
Onset within minutes, resolution hours - 3 days
Symptoms mixed and changing
Patient appears dazed and disorientated
Anxiety, anger and withdrawal
Adjustment reaction
Onset within one month of stressful event
Resolution within six months
Depression, anxiety, irritability, feeling unable to cope
PTSD
Onset weeks to months after stressor of exceptionally threatening or catastrophic nature
May persist for years
Flashbacks, nightmares, avoidance, autonomic hyperarousal with hypervigilance, anxiety, depression, guilt, emotional blunting
