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Anxiety Disorders Flashcards

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1
Q

Describe generalised anxiety disorder

A

Generalised persistent excessive anxiety or worry about a number of events that the individual finds difficult to control lasting at least 3 weeks (ICD10) or six months (DSM5)

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2
Q

What are the symptoms of generalised anxiety disorder ?

A

Nervousness, trembling, palpitations, dizziness, muscle tensions, epigastric discomfort, sleep problems

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3
Q

What is the prevalence of GAD?

A

9%

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4
Q

When does GAD usually start?

A

20-40 years old

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5
Q

What percentage of patients with GAD have another psychiatric disorder?

A

90%

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6
Q

Describe panic disorder

A

Recurrent episodic panic attacks, unpredictable and not restricted to any particular situation

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7
Q

What is the prevalence of panic disorder?

A

2-3%

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8
Q

What percentage of people with panic disorder have agoraphobia?

A

Up to 67%

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9
Q

What can trigger a panic attack in susceptible individuals?

A

Lactate infusion

Re-breathing air

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10
Q

What are the symptoms of panic disorder?

A

Discrete periods of intense fear, impending doom or discomfort, palpitations, tachycardia, SOB, trembling, chest pain, nausea, dizziness, chills, hot flushes, fear of dying

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11
Q

What is agoraphobia?

A

Characterised by fear and avoidance of places or situations from which escape may be difficult or in which help may not be available in the event of having panic attack

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12
Q

What is agoraphobia often secondary to?

A

Panic disorder

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13
Q

What situations do people with agoraphobia tend to avoid?

A
  • crowds
  • public places
  • travelling away from home
  • travelling alone
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14
Q

How to people deal with agoraphobia?

A

Avoid situations
Online shopping
Alcohol

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15
Q

Describe specific phobias

A

Marked persistent fear that is excessive or unreasonable caused by the person of a specific object/situation

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16
Q

How are phobias treated?

A

Behavioural therapy - exposure and CBT

SSRIs/SNRIs

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17
Q

What is social anxiety?

A

Persistent fear of one or more social/performance situations in which the person is exposed or under scrutiny. Fear of being embarrassed or humiliated usually in small social settings

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18
Q

What are the symptoms of social anxiety?

A

Blushing/shaking, fear of vomiting, urgency or fear of micturition or defection

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19
Q

How is social anxiety treated?

A

CBT, self help, exposure, social skills training, SSRIs

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20
Q

What are obsessional thoughts?

A

Ideas, images or impulses entering the mind in a stereotyped way - recognised as the patients own thoughts but unpleasant resisted and ego dystonic

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21
Q

What are compulsive acts?

A

Repeated rituals or stereotyped behaviours, not enjoyable or functional. Recognised as pointless and resistance may diminish over time.

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22
Q

How long must symptoms be present for to diagnose OCD?

A

Present most days for at least 2 weeks and is a source of distress and interference with activities

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23
Q

What is the mean age of onset of OCD?

24
Q

What percentage of OCD patients experience a major depressive episode?

25
Describe the neurobiology of OCD
Abnormality of the portico-striatothalamic circuit which mediates social behaviour Inability to suppress inappropriate acts Abnormalities in the basal ganglia and frontal cortex
26
Where in the brain does fear originate?
Amygdala centred circuit
27
Where in the brain does worry originate?
Cortico-striatal-thalamic cortical circuit
28
Which part of the brain is responsible for affect of fear?
Anterior cingulate/orbitofrontal cortex
29
Where in the brain does avoidance come from?
Periaqueductal gray
30
Which parts of the brain cause the autonomic and endocrine reaction?
Hypothalamus - increases cortisol | Locus coeruleus - increases HR/BP
31
Which part of the brain is responsible for re-experiencing and memory?
Hippocampus
32
Describe the action of GABA
Main inhibitory transmitter that reduces the activity of neurons in the amygdala and CSTC
33
What is the effect of benzodiazepines on GABA?
Enhances GABA action
34
Which receptor do benzodiazepines act on?
GABA A
35
Describe the pharmacokinetic action of benzodiazepines
Bind to a separate site and increase affinity of receptor to GABA and enhances the effect - positive allosteric modulation allows more chloride to pass through (preventing depolarisation)
36
Name three benzodiazepines
Lorazepam Diazepam Chlordiazepam
37
What are the pharmacological effects of benzodiazepines?
Reduce anxiety, hypnosis/sedation, muscle relaxant, anti-convulsant, anterograde amnesia
38
State the clinical uses of benzodiazepines
Acute anxiety, hypnosis, alcohol withdrawal, mania, delirium, status epileptics, before minor surgeries
39
What are the side effects of benzodiazepines?
``` Tolerance Dependence Paradoxical aggression Anterograde amnesia and impaired coordination Respiratory depression ```
40
What can be used to treat respiratory depression caused by benzodiazepines?
Flumazenil
41
Describe benzodiazepine withdrawal
Marked anxiety, shakiness, abdominal cramps, perceptual disturbance, delusions, depression, restlessness, Extreme - hypertension, seizures, psychosis, tachycardia
42
Why does withdrawal from benzodiazepines occur?
Chronic treatment reduced response to GABA due to decrease density of benzodiazepine receptors
43
Describe the technique used to prevent withdrawal when someone is stopping benzodiazepines
1. Transfer patient to equivalent dose of diazepam/chlordiazepoxide 2. Reduce dose every 2-3 weeks by 2/2.5 mg and maintain until symptoms improve 3. Reduce dose further in smaller steps 4. Stop completely this can take 4 weeks to a year
44
Why can pregabalin be used to treat anxiety?
Calcium channel blocker and GABA enhancer used when unresponsive to other treatment
45
What is the use of beta blockers in anxiety?
Symptomatic relief
46
What is the treatment for GAD?
1. Psychoeducation/self help 2. CBT or SSRI (consider 2 week benzodiazepine) 3. SNRI (duloxetine, venlafaxine) 4. Pregabalin 5. Combination of CBT and drug treatment
47
How long do anti-depressants take to work?
12 weeks but if no response after 4 weeks then response is unlikely
48
How long should GAD treatment be continued for?
18 months
49
Describe the treatment for panic disorder
1. Self help 2. CBT or SSRI if no benefit from CBT 3. Tricyclics
50
What drugs should not be used in panic disorder?
Benzodiazepines Sedating anti-histamines Propranolol, buspirone, bupropion
51
How long should treatment of panic disorder be?
6 months
52
Describe the treatment for OCD
1. CBT or ERP 2. More intensive psychological therapy or SSRI 3. Consider dose increase after 4-6 weeks 4. SSRI plus CBT and ERP 5. Clomipramine 6. Antipsychotic or clomipramine plus citalopram
53
Which SSRIs should be used in OCD?
Fluoxetine Sertraline Citalopram Paroxetine
54
How long should effective OCD treatment be continued for?
1 year
55
Describe the treatment for social anxiety
1. Individual CBT 2. SSRI (escitalopram or sertraline) 3. SSRI and CBT 4. Alternative SSRI or SNRI (venlafaxine) 5. MAOI (moclobemide)
56
What alternative SSRIs can be used to treat social anxiety?
Fluvoxamine | Paroxetine
57
When should SSRI treatment be reviewed?
12 weeks

Psychiatry (18 decks)

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