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Year 4 Psychiatry > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

(89 cards)

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1
Q

Define Neurosis

A

Psychiatric Disorders characterised by distress
Non Organic with discrete onset
Delusions and Hallucinations are absent

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2
Q

Define Anxiety

A

Unpleasant Emotional State of subjective fear and somatic symptoms

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3
Q

Define the Yerkes Dodson Law

A

Anxiety increases Optimum Performance up to a plateau, and then declines

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4
Q

Name the ICD10 classifications of Anxiety Disorders

A

1 - Phobic related disorders
2 - Other Anxiety Disorders (Panic, GAD)
3 - OCD
4 - Reaction to severe stress and adjustment disorder

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5
Q

Name 5 physical symptoms of Anxiety

A 
CVS - Palpitations
Resp - Chest Tightness
GI - Loose Stools
GU - Increased Micturition Frequency
NM - Tremor
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6
Q

Give 5 psychological symptoms of Anxiety

A 
Impending doom
Restlessness
Poor Concentration
Derealisation
Depersonalisation
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7
Q

Anxiety can be Paroxysmal or Continuous. Describe Paroxysmal Anxiety.

A

Situation Dependent - Phobic Anxiety

Situation Independent - Panic Disorder

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8
Q

Anxiety can be Paroxysmal or Continuous. Describe Continuous Anxiety.

A

GAD

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9
Q

Give 5 conditions related to Anxiety

A 
Hyperthyroid
Phaeochromocytoma
Cushings
Eating Disorders
Schizophrenia
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10
Q

Define Generalised Anxiety Disorder

A

Syndrome of ongoing, uncontrollable widespread worry about many thoughts or events that the patient recognised as excessive and inappropriate.
Symptoms present most days for at least 6 months

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11
Q

Describe the genetic aetiology of Anxiety

A

5 fold increase if GAD in first degree relative

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12
Q

Describe the neurophysiological causes of GAD

A

Autonomic Nervous System Dysfunction
Exaggerated activity of Amygdala and Hippocampus
Alterations of GABA/NA/Serotonin

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13
Q

Describe some social risk factors for GAD

A

Divorced
Single Parent
Low Socioeconomic Status
Domestic Violence

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14
Q

The clinical features of GAD can be remembered by the mnemonic ‘WATCHERS’. Define it

A

Worry, Autonomic hyperactivity, Tension in muscles, Concentration difficulty, Headache, Energy Loss, Restlessness, Startled easily

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15
Q

Describe the ICD10 diagnostic criteria for GAD

A

A - Period of at least 6 months of prominent tension, worry, feeling of apprehension
B - Four of the physical symptoms with atleast one being excess autonomic arousal

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16
Q

Describe the expected Appearance, Speech and Mood for a patient with GAD (MSE)

A

Appearance - worried face with burrowed brow, sweaty
Speech - trembling, slow rate
Mood - Anxious

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17
Q

Describe the expected Thought, Perception, Cognition and Insight for a patient with GAD (MSE)

A

Thought - Repetitive worrying thoughts
Perception - No Hallucinations
Cognition - Poor memory and reduced concentration
Insight - May or may not have insight

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18
Q

Give two organic differentials for GAD

A

Hyperthyroidism

Hypoglycaemia

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19
Q

Name 3 Questionnaires used for GAD

A

GAD7
Becks Depression Inventory
HAD Scale

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20
Q

What is the first line management for GAD?

A

Low Intensity Psychological interventions such as Psychoeducational Groups

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21
Q

What is the Second Line management for GAD?

A

Combination of CBT and SSRI (Sertraline - continued for atleast a year)

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22
Q

Name three other medications that can be used for GAD

A

SNRIs - Venlafaxine
Pregabalin
Benzodiazepines (Short Term)

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23
Q

Name three social interventions for Generalised Anxiety Disorder

A

Self Help Methods
Support Groups
Exercise Encouragement

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24
Q

Define Phobia

A

Intense/irrational fear of an object/situation/place that is recognised as excessive or unreasonable

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25
Define Agoraphobia
Fear of public places from which immediate escape in the case of a panic attack would be difficult
26
What is Social Phobia?
The fear of social situations as they are perceived to lead to humiliation/criticism/embarrassment
27
Describe the aetiology of Agoraphobia
Maintained by anxiety and avoidance which prevents deconditioning and sets up viscous cycle
28
Describe the aetiology of Social Phobia
Usually begins in late adolescence as people are concerned about the impression they make
29
Describe the aetiology of specific phobias
Conditioning early in life either from own frightening experience or learnt from parents
30
Describe two biological and two psychological features of specific phobias
Biological : Tachycardia, Vasovagal | Psychological: Inability to relax, fear of dying
31
Describe the ICD10 diagnosis of Agoraphobia
A - Marked fear and subsequent avoidance of two of crowds/public places/travelling alone B - Atleast two symptoms of anxiety in feared situations C- Significant emotional distress that is excessive or unreasonable D - Symptoms restricted to feared situation
32
Describe the ICD10 diagnosis of Social Phobias
A - marked fear of being focus of attention B - Atleast two symptoms of anxiety plus blushing/fear of vomit/urgency C - Significant emotional distress D - Symptoms are excessive/unreasonable E- Symptoms restricted to feared situation
33
Describe the ICD10 diagnosis of Specific Phobias
A - Marked fear/avoidance of situations B - Symptoms of Anxiety in feared situation C - Significant emotional distress that’s excessive or unreasonable D - symptoms restricted to feared situation
34
Describe the differences between phobic anxiety and GAD
PA occurs in specific situations PA has anticipatory anxiety PA has attempted avoidance
35
Name two potential questionnaires for patients with phobic disorder
Social Phobia Inventory | Liebowitz Social Anxiety Scale
36
Describe the general management of Phobic Disorders
Avoidance of Anxiety Inducing Substances (Alcohol, Caffeine) | Screen for Co Morbidities (Substance Misuse, Personality Disorder)
37
Name the two main psychological interventions for Specific Phobias
CBT | Graduated Exposure
38
What is the first line Pharmacological management of Phobic Disorders
SSRIs (Sertraline or Escitalopram) 2nd and 3rd line include SNRIs and Moclobamide
39
Define Panic Disorder
Recurrent, episodic severe panic attacks which are unpredictable and not related to a certain circumstance
40
Give three risk factors for Panic Disorder
Family History Major life events Female
41
How does a Panic Attack normally present
Peaks within 10 minutes and rarely persists longer than an hour
42
Describe the ICD10 diagnosis of Panic Disorder
A - Recurrent panic attacks not associated with specific situations/objects B - Discrete episode of intense fear, starts abruptly, Atleast one episode of autonomic arousal
43
Describe the pharmacological management of Panic Disorder
First line is SSRIs If no improvement after 12 weeks - TCAs (Imipramine etc)
44
Describe the non pharmacological management of Panic Disorder
CBT Self help methods (Bibliotherapy, Support Groups)
45
Define PTSD
Intense delayed prolonged reaction following exposure to an exceptionally traumatic event
46
Define Abnormal Bereavement
Delayed onset, more intense and prolonged (>6m)
47
Define Acute Stress Reaction
Abnormal reaction to a sudden stressful event
48
Define Adjustment Disorder
When adapting to new circumstances causes significant distress and impairment in social functioning
49
What are the 5 stages of grief
``` Denial Anger Bargaining Depression Acceptance ```
50
The aetiology of PTSD is thought to be a combination of a severe traumatic event and an element of pre existing vulnerability, describe the cognitive theory.
Failure to process emotionally charged events causes memories to persist in an unprocessed form
51
Give three Pre Trauma risk factors for PTSD
History of mental illness Low socioeconomic background Childhood abuse
52
PTSD must occur within 6 months of the event, describe the four categories
Reliving the situation Avoidance Hyperarousal Emotional Numbing
53
What happens in ‘Reliving the Situation’ in PTSD?
Flashbacks Vivid Memories Nightmares
54
What happens in ‘Avoidance’ in PTSD?
Avoiding reminders of trauma Excess rumination Inability to recall
55
What happens in ‘Hyperarousal’ in PTSD?
Irritability or outbursts Difficulty concentrating Difficulty sleeping
56
What happens in ‘Emotional Numbing’ in PTSD?
Negative thoughts about oneself | Detachment from others
57
Describe the ICD10 criteria for PTSD
A - Exposure to stressful event B - Persistent remembering C - Actual/Preferred avoidance of stimulus D - Inability to recall important aspects, increased psychological sensitivity and arousal
58
Describe the expected Appearance, Behaviour, Speech and Mood of someone with PTSD
A and B - Hypervigilant, Startled Response Speech - Slow and Trembling Mood - Anxious Thought - Pessimistic/Reliving event
59
Describe the expected Perception,Cognition and Insight of a PTSD patient
Perception - No hallucinations, may have illusions Cognition - Poor attention and Concentration Insight - Good
60
Describe two questionnaires to give a patient with suspected PTSD
Trauma Screening | Post Trauma Diagnostic Scale
61
Describe the management of PTSD where symptoms are present within THREE MONTHS of trauma
Watchful waiting Trauma focussed CBT Short term drugs for sleep management (eg Zopiclone)
62
Describe the management of PTSD where symptoms are present within THREE to SIX MONTHS of trauma
Trauma focussed psychological intervention (such as CBT or EMDR) Consider drug treatment such as Paroxetine or Mirtazepine if little benefit to psych therapy/patient doesn’t want to engage/comorbid depression
63
Define OCD
Recurrent obsessional thoughts or compulsive acts
64
Define Obsessions
Unwanted intrusive thoughts or urges that repeatedly enter the patients mind
65
Define Compulsions
Repetitive stereotyped behaviours or mental acts that a person feels driven to perform
66
Describe three biological theories behind OCD
Reduced serotonin and abnormalities of frontal cortex and basal ganglia Genetic Element PANDAS (Childhood Group A Beta Haemolytic Strep Disorder)
67
Describe a Psychoanalytic and Behavioural theory behind OCD
Filling the mind with obsessional thoughts in order to prevent undesirable ideas from entering Operant Conditioning
68
Describe the ICD10 Criteria for Diagnosis of OCD
A - Obsessions and Compulsions present most days for two weeks B - Obsessions being contamination/excess fear of harm/excess concern of order and Compulsions being Checking/Cleaning/Counting C - Cause distress and interfere with social/individual functioning
69
Describe the four clinical features of OCD
- Failure to resist - Originate from patients own mind - Repetitive and Distressing - Carrying out the obsession/compulsion is not enjoyable but reduces anxiety
70
What questionnaire could be used for OCD patients?
Yale Brown Obsessive Compulsive Scale
71
Describe the non pharmacological management of OCD
CBT and ERP Patients are exposed to the stimulus causing the anxiety and prevented from performing the action
72
Name two pharmacological managements for OCD
SSRIs (Fluoxetine, Sertraline) | Clomipramine
73
Define Somatoform Disorders
Symptoms are suggestive of a physical disorder but in the absence of a physiciological illness Repeatedly seek medical attention when it has failed to benefit them
74
Define Dissociative Disorder
Unpleasant/stressful events are converted to symptoms
75
Describe the Social Aetiology(I.e. benefits of sick role behaviour) for patients with Somatoform Disorders
Primary Gain - Relief from stressful interpersonal expectations Secondary Gain - Attention/Care/Financial Reward from others
76
Describe the Biological and Psychological Aetiology for patients with Somatoform Disorders
Biological - Possible implication of Neuroendocrine Genes Psychological - High association with PTSD/Physical and Sexual Abuse
77
Describe the two processes occurring in Dissociate Disorder
Dissociation - Separating off certain memories from normal consciousness Conversion - Distressing events transformed into physical symptoms
78
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Amnesia
Partial or complete memory loss for recent traumatic/stressful event
79
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Fugue
Unusual physical journey away from surroundings followed by amnesia for this period
80
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Stupor
Reduction/Absence of voluntary movements/speech with normal tone
81
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Movement Disorder
Unable to perform movements under voluntary control
82
There are many different ICD10 categories of Dissociative Disorder. Define Dissociative Convulsions
Sudden unexpected spasmodic movements resembling epilepsy without LOC
83
Describe the ICD10 criteria of Somatisation (Briquets) Disorder
A - Two years of unexplainable physical symptoms B - Preoccupation with symptoms causing physical distress and constantly seeking medical attention C - Continuous refusal to accept reassurance D - 6 or more physical symptoms
84
Define Hyperchondriacal Disorder
Misinterprets normal bodily sensations which leads to non delusional preoccupation that they have a serious disease
85
Define Dysmorphophobia
Excess preoccupation with barely noticeable/imagined defects
86
Define Somatoform Autonomic Dysfunction
Symptoms are related to autonomic nervous system Resp - Psychogenic Ventilation GI - IBS CVS - Da Costa’s Syndrome
87
Any Somatoform disorder is likely a diagnosis of exclusion, however give three factors that may point towards this diagnosis
Previous Mental Health Issues Symptoms in Multiple Body Systems Vague Symptoms
88
Give two differential diagnoses for Somatoform Disorders
Malingering (Patient seeks advantageous consequences of being diagnosed with medical condition) Munchausen’s (Individual wishes to adopt sick role for emotional gain
89
Describe the management of Somatoform Disorder
Antidepressants and Physical Exercise CBT Coping Strategies

Year 4 Psychiatry (12 decks)

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