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Theme 3: Modulatory systems in psychiatry > Anxiety disorders: clinical picture > Flashcards

Anxiety disorders: clinical picture Flashcards

(49 cards)

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1
Q

Anxiety disorders

A

Panic disorder without agoraphobia

Panic disorder with agoraphobia

Agoraphobia without history of panic disorder

Specific phobia

Social phobia

Obsessive compulsive disorder

PTSD

Acute stress disorder

Generalised anxiety disorder

Secondary anxiety disorder

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2
Q

Clinical picture of acute stress reaction

A

Acute stress reaction lasts hours to 3 days

Response to exceptionally stressful events

Initial daze

Mixed and usually changing picture

Individual vulnerability

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3
Q

Typical symptoms of acute stress

A

Feelings of being numb or dazed

Insomnia

Restlessness

Poor concentration

Autonomic arousal

Anger/ anxiety/ depression

Withdrawal

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4
Q

Adjustment disorder

A

Wide range of emotional or behavioural symptoms

Stressor not necessarily life threatening

Out of proportion to stressor

Lasts up to 6 months

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5
Q

PTSD

A

Response to exceptionally threatening or catastrophic event

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6
Q

PTSD symptoms

A

Re-experiencing flashback/ nightmares

Numbness/ detachment

Avoidance

Hyperviligance/ startle

Insomnia

Anxiety/ depression

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7
Q

PTSD course

A

Usually immediate onset

Most recover within 1 year

Rape victims

  • 94% at 2 weeks
  • 65% at 1 month
  • 42% at 6 months
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8
Q

Aetiology of stress: psychological models

A

Working through the trauma memory

Understanding the meaning of the event

Distinguishing which of the stimuli present at the time of the trauma are dangerous and which are innocuous

Readjusting basic beliefs about the self and the world

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9
Q

Aetiology of stress: biological models

A

Extreme stress affects neurons, resulting in functional changes

Speculation concerning the neurotransmitters involved

  • catecholamines
  • glucocorticoids
  • serotonin
  • endogenous opiods
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10
Q

Clinical picture of GAD

A

Symptoms are persistent

Not restricted to or strongly predominating in any particular set of circumstances

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11
Q

Characteristic features of GAD

A

Worry and apprehension

Headache and motor tension

Autonomic hypersensitivity

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12
Q

Psychological symptoms of GAD

A

Fearful anticipation

Irritability

Sensitivity to noise

Restlessness

Poor concentration

Worrying thoughts

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13
Q

Physical symptoms of GAD

A

Gastrointestinal

Respiratory

Cardiovascular

Genitourinary

Neuromuscular

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14
Q

Gastro symptoms of GAD

A

Dry mouth

Difficulty swallowing

Epigastric discomfort

Excessive wind

Frequent/ loose motions

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15
Q

Respiratory symptoms of GAD

A

Tight chest

Difficulty inhaling

Hyperventilation

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16
Q

Cardio symptoms of GAD

A

Palpitations

Chest pain

Missed beats

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17
Q

Genitourinary symptoms of GAD

A

Frequent/ urgent micturition

Erectile failure

Dysmenorrhoea

Amenorrhoea

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18
Q

Neuromuscular symptoms of GAD

A

Tremor

Paraesthesia

Tinnitus

Dizziness

Headaches

Muscular aches and pain

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19
Q

Additional symptoms of GAD

A

Sleep disturbances (insomnia, night terrors)

Sadness

Depersonalisation

Fixation with details

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20
Q

Epidemiology of GAD

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A

Lifetime prevalence: 8.9%

Women > men

3 x higher in patients in primary care clinics

High level of co-morbidity

21
Q

Genetic predisposition of GAD

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A

Five fold increase in 1st degree relatives

Monozygotic = dizygotic

Shared heritability for GAD and mood disorders

22
Q

Aetiology of GAD neurobiological mechanisms

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A

Most evidence comes from animal studies

Effects of stress apparently mediated through cortisol- some evidence exists for abnormalities in HPA axis

Benefit from SSRIs and venlafaxine suggests role for serotonin

Noradrenergic pathways associated with fear, arousal and stress

GABA has a role and benzodiazapine type agonists are effective

23
Q

GAD: association with life events

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A

Several studies found association with stressful/ traumatic life events

24
Q

GAD: parenting

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A

Lack of warmth and encouragement leads to general perception of personal inefficacy

Overprotection coupled with lack of warmth and responsiveness can lead to anxiety

Mothers of anxious preschool children more critical and intrusive and less responsive

25
Psychic picture
Fear of losing control Going mad Fainting Dying Derealisation Depersonalisation
26
Somatic picture
Palpitations Tachycardia Sweating Trembling Dyspnoea Choking Chest pain Nausea Butterflies Urgency Dizziness Faintness Paraesthesia
27
Endocrine diagnosis of panic
Hypoglycaemia Phaeocromocytoma Carcinoid
28
Cardiovascular diagnosis of panc
Arrhythmia
29
Respiratory diagnosis of panic
Asthma
30
Neurological diagnosis of panic
Seizures Vestibular
31
Clinical picture of agoraphobia
Anxiety in specific context - away from home - in crowds - in situations they cannot easily leave Presents with anxiety symptoms and panic attacks Anxious cognition about fainting and loss of control are common Avoidance is common
32
Epidemiology of panic
Panic attacks: 7-9% of the population Panic disorder: 1.5-2.5% lifetime prevalence Onset has two peaks: 15-24, 45-54
33
Panic risk factors
Widowed, divorced or separated individuals in cities Limited education, early parental loss and physical/ sexual abuse Females > males
34
Genetic predisposition of panic
Increased risk in 1st degree relative 7 fold Increased concordance in all but one monozygotic twin study Modest inheritability suggested by family and twin studies At least 50% environmental influences
35
Environmental factors of panic
Separation/ loss Relationship difficulties New responsibilities Early parental separation Traumatic childhood event Early sexual abuse
36
Biological models of panic
Panic attacks may be triggered in locus coeruleus Noradrenergic agents stimulate attacks in sufferers SSRIs are effective but contradictory findings regarding the role of serotonin GABA has a role Cholecystokinin causes panic attacks in animals and pentagastrin causes attacks in panic disorder patients
37
Clinical picture of specific phobias
Inappropriate anxiety in the presence of one of more particular objects or situations Characterised by adding name of stimulus
38
Specific phobias- subtypes
Blood, injections, injury Animals and insects Aspects of high nature Situational
39
Blood/ injection/ injury phobia response
Initial short lived parasympathetic arousal Followed by parasympathetic arousal May result in vasovagal syncope Subjective experience tends to disgust and repulsion rather than pure apprehension
40
Psychological theories of specific phobias
Symptoms related to unresolved unconscious conflict Phobias learned through association of negative experience with object or situation Large number of studies suggest phobias may be acquired via observational learning
41
Clinical picture of social phobia
Inappropriate anxiety in - situations where the person is observed - situations where there is potential for criticism Leads to avoidance of trigger situations - eating in public - dinner parties - committees, seminars, public speaking
42
Symptoms of social phobia
Anticipatory anxiety Feeling anxious Blushing Trembling (observed writing is a problem) Relieved by alcohol (potential for abuse)
43
Clinical picture of OCD
Obsessional thoughts/ images - words, ideas, beliefs and/ or images - recognised as own - intrude forcibly into the mind - they are resisted Compulsions reduce anxiety Cleaning/ checking Precision
44
OCD symptoms
Contamination- washing Doubts- checking
45
Clinical picture of OCD 2
Obsessional impulses - urges to perform acts Obsessional rituals - magic words or numbers - desire to complete acts Compulsions- the need to act on the obsessions
46
Epidemiology of OCD
Lifetime prevalence of 2-3% Men = women During adolescence, boys > girls Mean age onset ~ 20 years
47
OCD co-morbidity
Mejor depressive episode Increased risk for - alcohol disorders - social phobia - specific phobia - panic disorder - eating disorder - schizophrenia - tic disorder Increased prevalence of tourette's in relatives
48
Aetiology of OCD: neurotransmitters
Serotonin dysregulation Dopamine dysfunction
49
Aetiology of OCD: genetics
Monozygotic >> dizygotic First degree relatives of patients with childhood onset OCD have higher than expected incidence of OCD

Theme 3: Modulatory systems in psychiatry (8 decks)

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