What is the age of onset and sex ration (F:M) for panic disorder (+/- agoraphobia)?
1) Late adolescence to mid 30s
2) 2.5 : 1
What is the age of onset and sex ratio (F:M) for social phobia?
What is the age of onset and sex ratio (F:M) for specific phobia?
1) Childhood to adolescence
What is the age of onset and sex ratio (F:M) for PTSD?
1) Any age - after trauma 2) 2:1
What is the 1 year prevelance, age of onset and sex ratio (F:M) for OCD?
2) Adolescence to early adulthood
Which of the anxiety disorders (ADs) have a higher genetic component?
Panic disorder OCD
Which AD is associated with having alcoholic parents?
What is the neurotransmitter pathology associated with OCD?
It involves dopamine and serotonin supposedly
What do some psychiatrists believe is the aetiology of ADs is?
Psychological in origin and are a consequence of inappropriate thought processes and overestimations of danger (hence why CBT is an effective treatment).
Draw the diagram that depicts the cycle in which pts with ADs get perpetually stuck
Describe the course of GAD
Chronic, but fluctuating, and often worse in times of stress.
What is the prognosis of panic disorder?
1) 1/2 will be symptoms free in 3 years
2) 1/3 have chronic symptoms that are distressing enought to reduce quality of life
What is the relationship between panic attacks and agoraphobia?
1) Panic attacks are central to the development of agoraphobia
2) Agoraphobia usually occurs within 1 year after onset of recurrent panic attacks.
What is the prognosis for PTSD?
1) 50% of patients with PTSD will recover fully in 3 months
2) 1/3 of patients will have severe-moderate symptoms in the long term
What % of pts with OCD have impaired functioning due to the condition?
What are the two inter-related components of ADs?
1) Thoughts of being apprehensive, nervous or frightened
2) The awareness of a physical reaction to anxiety
What are the two specific types of pathological anxiety?
1) Generalised anxiety
2) Paroxysmal anxiety
Describe generalised anxiety.
1) It does not occur in discrete episodes but rather lasts for hours to days or longer
2) There is no association with a specific external threat or
situation but rather an
apprehension about normal life events.
What is paroxysmal anxiety and what is the severest form?
1) abrupt onset
2) occurs in discrete episodes
3 it is pretty severe
In the severest of forms it presents as panic attacks.
What are the common autonomic symptoms that occur with panic attacks?
which may lead the patient to think they are dying
How can panic attacks be sub-classified?
1) episodes without a stimulus (panic disorder)
2) episodes with an external threat (phobic disorders)
Name the phobic anxiety disorders?
2) Social phobia
3) Specific phobias
What % of agoraphobic patients have panic attacks?
The fear of public places or crowded spaces where escape is not easy, especially if concerned about having a panic attack.
What is social phobia?
The fear of situation where the patient may come under scrutiny by others leading to their humiliation or embarrassment.
What are specific phobias?
Fear of certain situations.
The following are the most common in order of decreasing prevalence – situational, natural environment, blood/medical, animals, others (choking, illness, AIDS etc)
What are the non-situational anxiety disorders?
2) Panic disorder
3) anxiety can occur 2ry to other psychiatric conditions
What is the diganostic criteria for generalised anxiety disorder?
1) excess worry about minor matters on most days for about 6 months
2) ICD-10 criteria suggests three keys elements – a) apprehension b) motor tension c) autonomic over activity.
What is panic disorder?
Panic attacks that occur at random and are not restricted to any particular situation.
These are so distressing that patients often develop a fear of having these attacks.
Between attacks patients are relatively free of anxiety.
Define what obsessions are (in OCD)?
Involuntary thoughts, images or impulses which are:
recurrent, intrusive (enter the mind against consciousness resistance), unpleasant and distressing.
And are recognised as being a produced of the patients own mind.
Define Compulsions (as in OCD)
Repetitive mental operations or physical acts
that the patient feels propelled to perform,
to reduce anxiety through the belief that something terrible will happen if they do not.
These are not realistically connected to the event or are ridiculously excessive.
They are experiences as unpleasant and serve no purpose except to decrease anxiety.
What are the ICD-10 criteria for OCD?
- Obsessions or compulsions must be present for at least 2 successive weeks and are a source of distress or interfere with the patient’s functioning.
- They are acknowledged as coming from the patient’s own mind
- The obsessions are unpleasantly repetitive
- At least one thought or act is resisted unsuccessfully (chronically the patient may no longer resist)
- A compulsive act is not in itself pleasurable (excluding relief of anxiety)
Which psychiatric conditions commonly has obsessions and comulsions and should be considered if patient is thought to have OCD? (and give figures)
should always be considered with obsessions or compulsions as over
20% of depression patient have these symptoms and which resolve with treatment.
Over 2/3 of patients experience a depressive episode in their lifetime.
Which medication is usually 1st line for ADs?
Which medication has proved efficacy in GAD?
What medication is 2nd line in ADs and why?
Less tolerable side effect profile than SSRIs
Which medication has proved efficacy in OCD?
Why should benzodiazepines not be used long term?
They are very addictive
What should you council pts with ADs for before starting them on SSRIs or TCAs?
Restlessness and an initial increase in anxiety may occur in the first few days
which can hamper compliance.
What is the psychological treatment of choice in AD pts?
CBT (is synergistic with medication)
Which benzodiazepines are used for IV administration?
Lorazepam and diazepam
Which benzodiazepines are used for IM administration?
Which benzodiazepines are used for PR administration?
How do benzodiazepines work?
Benzodiazepines potentiate the action of GABA (the main inhibitory neurotransmitter in the brain)
They bind to specific receptors on the GABA A receptor which results in an increased affinity of the complex for GABA.
This results in an increase of chloride ions (CL-) flowing into the neuron, thereby hyperpolarising the post-synaptic membrane.
What are the contradindications for benzodiazepines?
- Avoid driving or operating machinery --> due to drowsiness, ataxia and reduced coordination
- Use with caution in COPD as --> they depress respiration so
- Prolonged use as --> risk of dependence, use shorter acting formulations
Which benzodiazepines do not cause hangover and why?
z-drugs (zopiclone, zolpidem and zaleplon) do not cause hangover
This is because:
1) despite acting on the benzodiazepine receptor they are really just hypnotics
2) have a short half life
What is buspirone used for and what actually is it?
generalised anxiety disorder.
It is a 5-HT1A receptor agonist
response may take up to two weeks
What can be used for insomnia? (what is the problem with it though)
diphenhydramine (nytol) is available OTC for insomnia
it is a a first-generation antihistamine
(but their long duration can cause drowsiness the next day)
What are the s/e of benzodiazepines?
Increased seizures in epileptics
What roughly is the prevelance of individual anxiety disorders? (except which one)
4% (except OCD = 2%)
What are benzodiazepines used for?
alcohol withdrawal (especially Chlordiazepoxide)
acute mania/psychosis (sedation)