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Yr4 - Psych > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Define neurosis

A

Functional illness
- not psychotic - patients are distressed but no delusions or hallucinations
Synonymous with anxiety disorders

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2
Q

Pathology of anxiety disorders

A

When danger perceive or anticipated brain activates autonomic nervous system
- sympathetic response primes body for action - release of adrenaline and nor-adrenaline
Brain unable to distinguish between physical and psychological threat - responds to false alarm

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3
Q

Define specific phobias

A

Marked fear of specific object or situation

  • > marked avoidance of such object or situation
  • dogs, spiders, thunder, balloons, snakes, flying
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4
Q

Define panic disorder

A

Fear of you own physiological and psychological reactions
Bodily changes viewed as signs of impending collapse, insanity or death
Agoraphobia - Accompanying avoidance of situations that may trigger these reactions

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5
Q

Cognitive model of panic disorder

A

Internal/external trigger

  • > perceived threat
  • > anxiety
  • > physical/cognitive symptoms
  • > misinterpretation
  • > further anxiety and avoidance/safety behaviours
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6
Q

Define generalised anxiety disorder

A

Worry problem
- specific content of (type 1) worries changes/varies
- includes worries about worries (type 2 worries)
Usually accompanied by low level physical symptoms
- insomnia, muscle tension, GI problems, headache
Often maintained by belief that worry is useful - positive worry beliefs
- motivates, shows responsibility etc

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7
Q

Social anxiety disorder

A

Fear of negative evaluation of others
-> avoidance of feared situations, use of safety behaviours, anticipatory anxiety and unhelpful post-mortems following social encounters

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8
Q

Define OCD

A

Obsessive Compulsive Disorder
Obsessions = unwanted recurring distressing intrusive thoughts or images
Compulsions = manage distress caused by intrusion the patient conducts neutralising behaviours

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9
Q

Examples of obsessions

A

Contamination
Doubting
Aggression or horrific impulses
Sexual imagery

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10
Q

Examples of compulsions

A 
Overt - seen
- washing
- checking
- ordering/aligning
Covert - within head
- praying
- counting
- repeating words
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11
Q

Cognitive behavioural model of OCD

A

Trigger

  • > intrusive thought
  • > interpretation and appraisal
  • > emotion
  • > neutralisation
  • > consequences
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12
Q

Define body dysmorphic disorder

A

Characterised by a preoccupation with an imagined defect in appearance
- leads to time consuming behaviours - mirror gazing, comparing features to others, excessive camouflaging tactics, skin picking and seeking reassurance

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13
Q

Define PTSD

A 
Post Traumatic Stress Disorder
Caused by exposure to event or situation of exceptionally threatening or catastrophic nature which would be likely to cause pervasive distress in almost anyone
3 main features
- re-experiencing
- avoidance
- hyperarousal
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14
Q

Problems associated with anxiety disorders

A 
Increased autonomic arousal 
Avoidance
Time consuming anxiety reducing behaviours
Worry 
Procrastination/inability to make decisions
Reduced concentration
Impact on functioning
Impaired sleep patterned
Alcohol and drug dependence
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15
Q

Differential diagnosis of anxiety disorders

A 
Adjustment disorders or bereavement
Other functional psychiatric illness
Organic disorders
- endocrine - hyperthyroidism
- neurological - dementia, MS, lupus
- drug induced - steroids, antihypert
- alcohol and illicit drug misuse and withdrawal
- miscellaneous - infection, anaemia
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16
Q

Define neurosis

A

Collective term for psychiatric disorders characterised by distress

  • non-organic
  • discrete onset
  • delusions and hallucinations absent
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17
Q

Define anxiety

A

Unpleasant emotional state involving subjective fear

- normal human experience but can become excessive or inappropriate

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18
Q

Types of anxiety disorders

A 
Specific phobia
Social phobia
Generalised anxiety disorder
Agoraphobia
Panic disorder
OCD
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19
Q

Common symptoms of neurosis

A

Pscyhological
- anticipatory fear of impending doom, worrying thoughts, restlessness, poor concentration and attention, irritability, depersonalisation and derealisation
CVS
- palpitations, chest pain
Resp
- hyperventilation, cough, chest tightness
GI
- abdo pain, loose stools, N+V, dry mouth
GU
- increased frequency, failure of erection, menstrual discomfort
Neuromuscular
- tremor, myalgia, headache, paraesthesia, tinnitus

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20
Q

Classification of neurosis

A 
Paroxysmal anxiety
- situation dependent
   - phobic anxiety disorder
       - specific phobia
       - agoraphobia
       - social phobia
- situation independent
   - panic disorder
Continuous anxiety
- generalised anxiety disorder
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21
Q

Generalised vs espisodic anxiety

A 
Generalised
- present most of the time
- excessive or inappropriate worry about normal life event
- longer duration
Episodic 
- abrupt onset
- discrete episodes
- severe with strong autonomic symptoms
- short lived
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22
Q

Differential diagnosis of anxiety

A 
Medical
- hyperthyroid, hypoglycaemia, anaemia, phaeochromocytoma, Cushing’s disease, COPD, congestive cardiac failure (CCF), malignancies
Substance related
- Intoxication
- Withdrawal
- Side effects
Psychiatric
- eating disorders, depression, schizophrenia, OCD, PTSD
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23
Q

Define GAD

A

Generalised Anxiety Disorder
Syndrome of ongoing, uncontrollable, widespread worry about many events or thoughts that the patient recognises as excessive and inappropriate
- symptoms present most days for at least 6 months

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24
Q

Pathophysiology of GAD

A 
Biological
- genetic
- neurophysiological - alterations in GABA, serotonin and noradrenaline
Environmental
- stressful life events
- substance dependence
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25
Q

Risk factors of GAD

A

Predisposing
- genetics, childhood upbringing, personality type and demands for high achievement, divorced, living alone, low socioeconomic status
Precipitating
- stressful life events, unemployment, relationship problems, personal illness
Maintaining
- continuing stressful events, marital status, living alone, ways of thinking which perpetuate anxiety

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26
Q

Clinical features of GAD

A 
Worry - excessive, uncontrollable
Autonomic hyperactivity - sweating, increased pupil size, increased HR
Tension in muscles
Tremor
Concentration difficulty
Chronic aches
Headache
Hyperventilation
Energy loss
Restlessness
Startled easily
Sleep disturbance
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27
Q

ICD-10 criteria for GAD

A

A period of at least 6 months with prominent tension, worry and feelings of apprehension about everyday events and problems
At least four of the following symptoms with at least one symptom of autonomic arousal
- symptoms of autonomic arousal, palpitations, sweating, shaking/tremor, dry mouth

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28
Q

Differential diagnosis of GAD

A

Other neurotic disorder - panic, specific phobias, OCD, PTSD
Depression
Schizophrenia
Personality disorder
Excessive caffeine or alcohol consumption
Withdrawal from drugs
Organic - anaemia, hyperthyroidism, phaeochromocytoma, hypoglycaemia

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29
Q

Management of GAD

A 
Biological 
- SSRIs - sertraline - 1st line
- SNRIs and pregabalin
- benzodiazepines only for short term due to dependence
Psychological
- psychoeducational groups - low intensity
- CBT - high intensity
- applied relaxation
Social
- self help - writing down thoughts
- support groups
- exercise
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30
Q

Step care model for management of GAD

A 
Step 1
- identification and assessment
- psychoeducation 
- monitoring
Step 2
 - low intensity psychological interventions
Step 3
- high intensity psychological interventions 
- drug treatment
Step 4
- highly specialised input
- combination of drug and psychological therapies
- crisis team
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31
Q

Define phobia

A

Intense, irrational fear of an object, situation, place or person that is recognised as excessive or unreasonalbe

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32
Q

Define agoraphobia

A

Fear of public spaces or entering a public space from which immediate escape would be difficult in the event of a panic attack

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33
Q

Define social phobia

A

Fear of social situations which may lead to humiliation, criticism or embarrassment

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34
Q

Risk factors for phobias

A 
Adverse experiences
Stress and negative life events
Other anxiety disorders
Mood disorders
Substance misuse disorders
Family history
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35
Q

Clinical features of phobias

A 
Biological
- tachycardia 
     - vasovagal response (bradycardia) in need and blood phobias -> syncope
Psychological
- anticipatory anxiety
- inability to relax
- urge to avoid situation
- fear of dying
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36
Q

ICD-10 criteria for agoraphobia

A

Marked and consistently manifest fear in or avoidance of at least two of the following
- crowds
- public spaces
- travelling alone
- travelling away from home
Symptoms of anxiety in the feared situation with at least two symptoms present together
- at least one symptom of autonomic arousal
Significant emotional distress due to the avoidance or anxiety
- recognised as excessive or unreasonable
Symptoms restricted to feared situation

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37
Q

ICD-10 criteria for social phobia

A

Marked fear or marked avoidance of being the focus of attention or fear of acting in a way that will be embarrassing or humiliating
At least two symptoms of anxiety in the feared situation
- blushing
- fear of vomiting
- urgency or fear of micturition/defecation
Significant emotional distress due to the avoidance or anxiety
- recognised as excessive or unreasonable
Symptoms restricted to feared situation

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38
Q

ICD-10 criteria for specific phobia

A

Marked fear or avoidance of specific object or situation that is not agoraphobia or social phobia
Symptoms of anxiety in the feared situation
Significant emotional distress due to the avoidance or anxiety
- recognised as excessive or unreasonable
Symptoms restricted to feared situation

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39
Q

General management of phobias

A

Establish good rapport with patient
Avoidance of anxiety-inducing substances - caffeine
Screen for co-morbidities - substance misuse and personality disorders
Refer to specialist if there is a risk of self-harm, suicide, self-neglect or significant co-morbidity

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40
Q

Management of agoraphobia

A

CBT - graduated exposure

SSRIs

41
Q

Management of social phobia

A 
CBT
Graduated exposure
Pharmacological 
- SSRIs - sertraline
- SNRIs - venlafaxine
- MAOI - moclobemide
Psychodynamic psychotherapy for those who decline CBT or medication
42
Q

Management of specific phobia

A

Exposure using self-help or formally CBT

Benzodiazepines - short term

43
Q

Define panic disorder

A

Recurrent, episodic, severe panic attacks which are unpredictable and not restricted to any particular situation of circumstance

44
Q

Aetiology of panic disorders

A 
Biological
- genetic
- neurochemical - post-synaptic hypersensitivity to serotonin and adrenaline
- sympathetic NS - fear or worry stimulates SNS increases CO increases anxiety
Cognitive
- misinterpretation of somatic symptoms
Environmental
- presence of life stressors
45
Q

Risk factors for panic disorders

A 
Family history
Major life events
Age 20-30
Recent trauma
Females
Other mental disorders
White ethnicity
Asthma
Cigarette smoking
Medication - benzodiazepine withdrawal
46
Q

Clinical features for panic disorders

A

Peak within 10 minutes and rarely persist beyond an hour
Panic attacks
- intense fear/discomfort
- autonomic arousal

47
Q

ICD-10 criteria for panic disorder

A

Recurrent panic attacks that are not consistently associated with specific situation or object - often occur spontaneously
Characterised by
- discrete episode of intense fear of discomfort
- starts abruptly
- reaches crescendo within a few minutes and lasts a few minutes
- at least one symptom of autonomic arousal - palpitations, sweating, shaking, dry mouth
- other symptoms of anxiety

48
Q

GAD vs panic disorder vs phobic anxiety

A 
GAD
- persistent
- a/w agitation
- constant worry
- a/w depression
Panic disorder
- episodic
- a/w escape
- fear of symptoms
- a/w depression, agoraphobia, substance misuse
Phobic anxiety
- situational
- a/w avoidance
- fear of situation
- a/w substance misuse
49
Q

Management of panic disorder

A

SSRIs - 1st line
- if not improvement after 12 weeks then TCA - imipramine or clomipramine
CBT
Self help methods - bibliotherapy, support groups, encouraging exercise

50
Q

Step care approach to management of panic disorders

A 
Recognition and diagnosis
Treatment in primary care
Review and consider alternative treatments
Specialist referral
Care in mental health services
51
Q

Define post-traumatic stress disorder

A

Intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event

52
Q

Define abnormal bereavement

A

Delayed onset, more intense and prolonged (>6 months)

Impact of loss overwhelms individuals coping capacity

53
Q

Define acute stress reaction

A

Abnormal reaction to sudden stressful events

54
Q

Define adjustment disorder

A

Significant distress accompanied by an impairment in social functioning

55
Q

Aetiology of PTSD

A

Exceptionally stressful event

  • severe assault
  • major natural disaster
  • serious RTC
  • observer/survivor of civilian disaster
  • involvement in wars
  • freak occurrences
  • physical torture
  • pow or hostage
  • unexpected injury or violent death of family member/friend
56
Q

Risk factors for PTSD

A

Exposure to traumatic event
- armed forces, police, fire service, journalists, doctors
- refugees, asylum seekers
Pre-trauma
- previous trauma, history of mental illness, females, low socioeconomic backgrounds, childhood abuse
Peri-trauma
- severity of trauma, perceived threat to life, adverse emotional reaction
Post-trauma
- concurrent life stressors, absence of social support

57
Q

Clinical features of PTSD

A

Occur within 6 months of event
Relieving situation
- flashbacks, vivid memories, nightmares, distress when exposed to similar situations
Avoidance
- locations or associated people, excessive rumination, inability to recall aspects
Hyperarousal
- irritability, difficultly with concentration and sleep, hypervigilance, exaggerated startle response
Emotional numbing
- negative thoughts, difficulty experiencing emotions, feelings of detachment from others, giving up previously enjoyed activities

58
Q

ICD-10 criteria for PTSD

A

Exposure to a stressful event or situation - likely to cause distress in anyone
Persistent remembering/reliving
Actual or preferred avoidance of similar situations
Inability to recall some important information about period of exposure or persistent symptoms of increased psychological sensitivity and arousal
All occur within 6 months of stressful event

59
Q

Stages of grief

A 
Denial
Anger
Bargaining
Depression
Acceptance
60
Q

ICD-10 criteria for acute stress reaction

A

Exposure to an exceptional physical or mental stressor followed by an immediate onset of symptoms (within 1 hour)
Divided into mild, moderate and severe

61
Q

Clinical features of acute stress reaction

A 
Anxiety symptoms
Narrowing of attention
Apparent disorientation
Anger or verbal aggression
Despair or hopelessness
Uncontrollable or excessive grief
62
Q

ICD-10 criteria for adjustment disorder

A

Identifiable psychosocial stressor within one month of onset
Symptoms not severe enough to be classed as a specific psychiatric disorder
Present for less than 6 months

63
Q

Management of PTSD

A

< 3 months
- watchful waiting for mild symptoms < 4 weeks
- military personal access to treatment provided by armed forces
- trauma-focused CBT
- short-term drug treatment for actue sleep disturbance - zopiclone
- risk assessment for neglect of suicide
> 3 months
- trauma-focused psychological intervention
- CBT
- eye movement desensitisation and reprocessing (EMDR)
- drug treatment
- paroxetine
- mirtazapine
- amitriptyline
- phenelzine

64
Q

Define OCD

A

Obsessive-compulsive disorder

Recurrent obsessional thoughts or compulsive acts

65
Q

Define obsessions

A

Unwanted intrusive thoughts, images or urges that repeatedly enter the individuals mind

  • distressing for individual who attempts to resist them and recognises them as absurd
  • product of their own mind
66
Q

Define compulsions

A

Repetitive, stereotyped behaviours or mental acts that a person feels driven into performing

  • overt - observable by others
  • covert - mental acts not observable
67
Q

Aetiology of OCD

A

Biological
- reduced serotonin
- abnormalities of the frontal cortex and basal ganglia
Psychoanalytical
- filling mind with obsessional thoughts in order to prevent undesirable ideas from entering consciousness
Behavioural
- compulsive behaviour learned and maintained by operant conditioning

68
Q

Risk factors for OCD

A

Relative with OCD
Carrying out compulsive act exacerbates obsessions - maintaining factor
Developmental factors
- neglect, abuse, bullying and social isolation

69
Q

ICD-10 criteria for OCD

A

Either obsessions or compulsions present on most days for a period of 2 weeks of less
Obsessions share a number of features all which must be present
Obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning usually by wasting time

70
Q

ICD-10 specifications of OCD

A

Predominately obsessional thoughts or ruminations
Predominately compulsive acts
Mixed obsessional thoughts and acts

71
Q

Examples of obsessions

A 
Contamination
- dirt, viruses, germs, bodily fluids
Fear of harm
- door locks not safe
Excessive concern with order or symmetry
Sex
Violence
Blasphemy
Doubt
72
Q

Examples of compulsions

A 
Checking
- gas or water taps, doors
Cleaning or washing
Repeating acts
- counting, arranging objects
Mental compulsions
- special words repeated in a set manner
Hoarding
73
Q

Features of obsessions or compulsions

A 
Failure to resist
Originate from patient's mind
Repetitive
Distressing
Carrying out the obsessive thought is not itself pleasurable
74
Q

OCD cycle

A

Obsession
Anxiety
Compulsion
Relief

75
Q

Differential diagnosis for OCD

A 
Obsessions and compulsions
- eating disorders
- anankastic personality disorder
- body dysmorphic disorder
Primarily obsessions
- anxiety disorders
- depressive disorders
- hypochondriacal disorder
- schizophrenia
Primarily compulsions
- Tourette's syndrome
- kleptomania
Organic
- dementia
- epilepsy
- head injury
76
Q

Management of OCD

A 
CBT
- ERP - exposure and response prevention involved repeated exposure to situation and prevention of performing repetitive actions
Pharmacological 
- SSRIs
     - fluoxetine
     - fluvoxamine
     - paroxetine
     - sertraline
     - citalopram
Psychoeducation, distracting techniques and self-help books can be used
77
Q

Management stages of OCD

A

Mild
- low intensity psychological intervention - < 10 hours per patient
Moderate
- SSRI or high intensity psychological intervention
Severe
- combined SSRI and CBT (with ERP)

78
Q

Define somatoform disorders

A

Group of disorders whose symptoms are suggestive of or take the form of a physical disorder

  • in the absence of a physiological illness leading to the presumption that they are causes by psychological factors
  • sufferers repeatedly seek medical attention despite it consistently failed to benefit them
79
Q

Define dissociative (conversion) disorders

A

Characterised by symptoms which cannot be explained by a medical disorder
- convincing associations in time between symptoms and stressful events, problems or needs

80
Q

Pathophysiology of somatoform disorders

A

Biological
- possible implication of neuroendocrine genes
- genetic component
Psychological
- high proportion of those with PTSD suffer from somatoform disorders
- association with physical or sexual abuse
Social
- adopting sick role to gain relief from stress

81
Q

Pathophysiology of dissociative disorders

A

Must be causally linked to stressful like events

  • dissociation - process of separating off certain memories from normal consciousness - psychological defence mechanism used to cope with emotional conflict
  • conversion - distressing life events transformed into physical symptoms
82
Q

Sequence of events in dissociative disorders

A 
Distressing event
- tragic death of loved one
Emotional distress
- anxiety and distress
Dissociation
- separating distressing event from normal consciousness
Conversion
- emotional distress to physical symptoms
Gain
- primary = stress relief
- secondary = financial rewards
83
Q

Risk factors for somatoform and dissociative disorders

A 
Childhood abuse
Reinforcement of illness behaviours
Anxiety disorders
Mood disorders
Personality disorders
Social stressors
84
Q

ICD-10 criteria for dissociative amnesia

A

Amnesia, partial or complete for recent events of problems that were traumatic or stressful
Too extensive and persistent to be explained by ordinary forgetfullness

85
Q

ICD-10 criteria for dissociative fugue

A

An unexpected physical journey away from usual surroundings followed by amnesia for the journey
- self care is maintained

86
Q

ICD-10 criteria for dissociative stupor

A

Profound reduction in or absence of voluntary movements, speech and normal responses to stimuli
- normal muscle tone

87
Q

ICD-10 criteria for trance and possession disorders

A

Trance - temporary alternation in state of consciousness

Possession - absolute conviction by the patient that they have been taken over by a spirit, power or person

88
Q

ICD-10 criteria for dissociative motor disorders

A

Loss of the ability to perform movements that are under voluntary control or ataxia

89
Q

ICD-10 criteria for dissociative convulsions

A

Sudden, unexpected spasmodic movements that resemble epilepsy but without loss of consciousness

90
Q

ICD-10 criteria for dissociative anaesthesia and sensory loss

A

Partial or complete loss of cutaneous sensation, vision, hearing or smell

91
Q

ICD-10 categories of somatoform disorders

A 
Persistent somatoform pain disorder
Undifferentiated somatoform disorder
Somatisation disorder
Hypochondriacal disorder
Somatoform autonomic dysfunction
92
Q

ICD-10 criteria for somatisation disorder

A

At least 2 years duration of physical symptoms that cannot be explained by any detectable physical disorder
Preoccupation with symptoms causes physical distress which leads to them seeking repeated medical consultations and requesting investigations
Continuous refusal by patients to accept reassurance from doctors that there is no physical cause for their symptoms
Total of 6 or more symptoms

93
Q

Common symptoms in somatisation disorder

A 
GI
- abdo pain, N+V, bloating, regurgitation, loos bowel movements, swallowing difficulty
CVS
- chest pain, breathlessness at rest, palpitations
GUM
- dysuria, frequency, incontinence, vaginal discharge, menstrual problems
Others
- discolouration or itching of skin
- arthralgia
- paraesthesia in limbs
- headaches
- visual disturbance
94
Q

Features of hypochondriacal disorder

A

Patient misinterprets normal bodily sensations which leads to non-delusional pre-occupation that they have a serious physical disease
Refuse to accept reassurances from doctors

95
Q

Features of dysmorphophobia

A

Excessive preoccupation with barely noticeable or imagined defects in physical appearance
- causes significant distress

96
Q

Features of somatoform autonomic dysfunction

A

Symptoms related to autonomic nervous system
- palpitations, tremor, sweating, dry mouth, flushing, hyperventilation
Attributed by patients to a physical disorder

97
Q

Features of persistent somatoform pain disorder

A

Persistent (6 months +) and severe pain that cannot be fully explained by a physical disorder

  • result of psychosocial stressors and emotional difficulties
  • differs from somatisation disorder in that pain is primary feature and multiple symptoms from different systems not present
98
Q

Malingering and factitious disorders

A

Physical of psychological symptoms intentionally produced
Malingering - patient seeks advantageous consequences of being diagnosed with a medical condition
Factitious (Munchausen’s) - individual wishes to adopt the sick role in order to receive the care of a patient for internal emotional gain

99
Q

Management of somatoform and dissociative disorders

A 
Biological
- antidepressants - SSRIs for underlying mood disorder
- physical exercise enhances self-esteem
Psychological 
- CBT
- coping strategies
Social
- encourage pleasurable private time
- involve family where appropriate

Yr4 - Psych (13 decks)

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