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

Anxiety disorders: clinical picture Flashcards

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

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

A

Five fold increase in 1st degree relatives

Monozygotic = dizygotic

Shared heritability for GAD and mood disorders

22
Q

Aetiology of GAD neurobiological mechanisms

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

A

Several studies found association with stressful/ traumatic life events

24
Q

GAD: parenting

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
Q

Psychic picture

A

Fear of losing control

Going mad

Fainting

Dying

Derealisation

Depersonalisation

26
Q

Somatic picture

A

Palpitations

Tachycardia

Sweating

Trembling

Dyspnoea

Choking

Chest pain

Nausea

Butterflies

Urgency

Dizziness

Faintness

Paraesthesia

27
Q

Endocrine diagnosis of panic

A

Hypoglycaemia

Phaeocromocytoma

Carcinoid

28
Q

Cardiovascular diagnosis of panc

A

Arrhythmia

29
Q

Respiratory diagnosis of panic

A

Asthma

30
Q

Neurological diagnosis of panic

A

Seizures

Vestibular

31
Q

Clinical picture of agoraphobia

A

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
Q

Epidemiology of panic

A

Panic attacks: 7-9% of the population

Panic disorder: 1.5-2.5% lifetime prevalence

Onset has two peaks: 15-24, 45-54

33
Q

Panic risk factors

A

Widowed, divorced or separated individuals in cities

Limited education, early parental loss and physical/ sexual abuse

Females > males

34
Q

Genetic predisposition of panic

A

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
Q

Environmental factors of panic

A

Separation/ loss

Relationship difficulties

New responsibilities

Early parental separation

Traumatic childhood event

Early sexual abuse

36
Q

Biological models of panic

A

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
Q

Clinical picture of specific phobias

A

Inappropriate anxiety in the presence of one of more particular objects or situations

Characterised by adding name of stimulus

38
Q

Specific phobias- subtypes

A

Blood, injections, injury

Animals and insects

Aspects of high nature

Situational

39
Q

Blood/ injection/ injury phobia response

A

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
Q

Psychological theories of specific phobias

A

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
Q

Clinical picture of social phobia

A

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
Q

Symptoms of social phobia

A

Anticipatory anxiety

Feeling anxious

Blushing

Trembling (observed writing is a problem)

Relieved by alcohol (potential for abuse)

43
Q

Clinical picture of OCD

A

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
Q

OCD symptoms

A

Contamination- washing

Doubts- checking

45
Q

Clinical picture of OCD 2

A

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
Q

Epidemiology of OCD

A

Lifetime prevalence of 2-3%

Men = women

During adolescence, boys > girls

Mean age onset ~ 20 years

47
Q

OCD co-morbidity

A

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
Q

Aetiology of OCD: neurotransmitters

A

Serotonin dysregulation

Dopamine dysfunction

49
Q

Aetiology of OCD: genetics

A

Monozygotic&raquo_space; 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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