Flashcards in Anxiety + Somatoform Disorders Deck (32)
What types of psychotherapy can be effective for GAD?
1. Education + active monitoring
2. Low intensity psychotherapy e.g. Self help / gp psycho education
3. High intensity psychotherapy e.g. CBT
What pharmacological treatment is effective in panic disorder and agoraphobia?
1st line: SSRIs
2nd line: TCA
What pharmacological treatment is effective in GAD
1st line: sertraline -> paroxetine -> venlafaxine
2nd line: imipramine
Treatment resistant: consider diazepam, hydroxyzine, buspirone
What psychotherapy is effective in panic disorder and agoraphobia?
Exposure therapy for agoraphobia
What pharmacological treatment is effective for social phobia?
1st line: paroxetine/sertraline/fluvoxamine
2nd line: phenelzine
Treatment resistant: clonazepam, venlafaxine, nefadozone, gabapentin
What psychotherapy is effective in social phobia?
Incl exposure therapy
What treatment is effective for specific phobias?
No pharmacological usually
Desensitisation, flooding, modelling
What pharmacological treatment is effective in OCD?
1st line: SSRIs
2nd line: clomipramine
Treatment resistant: anti psychotics, pindolol, clonazepam
What pharmacological treatment is effective for PTSD?
1st line: paroxetine (sertraline, fluoxetine)
2nd line: mirtazapine (amitriptyline, imipramine)
Treatment resistant: phenelzine, lamotrigine
What psychological treatment is effective in PTSD?
EMDR: eye movement desensitisation and processing therapy
What would you diagnose the following patient with?
> 6 months anxiety
Autonomic overactivity: tachycardia, sweating
Generalised anxiety disorder
What organic causes might you want to rule out in a patient seemingly presenting with GAD?
Excessive caffeine use
Thyrotoxicosis, parathyroid disease
Phaechromocytoma/ carcinoid syndrome
Cardiac dysrhythmias/ mitral valve disease
What would you call episodes where a patient suddenly experiences:
Chest pain, palpitations, SOB
Fear of dying, loss of control
Peak severity reached by 10 mins
What would you diagnose in a patient who:
Experiences unpredictable panic attacks
Is scared of further attacks
Is scared abut losing control
Is avoiding all activities she worries may trigger attacks
What organic causes might you want to rule out in a patient seemingly presenting with panic disorder?
Acute intoxication/withdrawal from any drugs
What would you diagnose in a patient who presents with:
Extreme persistent fear of social situations
Fear of humiliation/embarrassment
Experiences extreme anxiety in social situations
Fear is excessive/unreasonable
Avoids social situations
Experiences anxiety thinking about social situations
What might you diagnose is a patient who:
Has an extreme stress event - life threatening
Distress if re exposure -> avoidance of similar circumstances
Hyervigilance + hyperarousal
Psychogenic amnesia, insomnia, irritability, pessimistic mood
Post-traumatic stress disorder
What might increase the severity of PTSD?
Premorbid mental/ psychological problems
Repeated similar stress
What screening questions might you ask for OCD?
Do you wash or clean a lot?
Do you check things a lot?
Is there any thought that keeps bothering you, that you'd like to get rid of but can't?
Do your daily activities take a long time to finish?
Are you concerned about putting things in a special order or are you very upset by mess?
What is the aetiology behind anxiety disorders?
Heritable vulnerability but no specific genetic links identified
Childhood adversity predisposes
Threatening life events predispose
? Dysregulation of serotonin, noradrenaline and GABA
What are the behavioural and cognitive theories about anxiety disorders?
Classical conditioning: neutral stimulus paired with frightening stimulus
Negative reinforcement: anxiety relieving behaviours repeated preventing habituation, maintaining the fear response
Cognitive theories: worrying thoughts repeated in an automatic way that induces and maintains anxiety response
Attachment theory: insecurely attached children = anxious adults
What is agoraphobia?
Fear of being unable to escape easily to a safe place
Onset in 20s-30s
Fear of open spaces and confined spaces e.g.
Travelling on planes, trains, buses
Queuing, supermarkets, large crowds, parks, cinemas
What are the consequences of hyperventilation?
CO2 blown off -> low PCO2, raised pH, hypocalcaemia
Nerve conduction affected: paraesthesia
In extreme cases = carpopedal spasm
What investigations might you perform to rule out organic causes in apparent anxiety?
Urine drug screen
24 hour urine for VMA
What are the aims of CBT?
reduce patient's expectation of threat and the behaviours that maintain threat-related beliefs
> education re physiology of anxiety and techniques for managing arousal
> likelihood and impact of anticipated catastrophe discussed
> behavioural experiments set up to test beliefs
> gradually increase confidence, more adaptive coping strategies
What is exposure therapy?
Used when strong elements of avoidance and escape exist
In absence of actual harm body can only maintain anxiety response for a short period before habituation and drop in anxiety levels
Gradual desensitisation technique used in exposure therapy
Aim to stay in situation until anxiety has subsided
What is the prognosis in anxiety disorders?
1/3 recover completely
1/3 partial improvement
1/3 suffer considerable disability and poor quality of life
What is the aetiology of OCD?
Relatives at 3 x risk
Premorbid anankastic personality disorder
Illnesses which affect them increase risk of OCD incl
Sydenham's chorea, Tourette's, encephalitis lethargica
Anti basal ganglia antibodies in those who have developed OCD following strep throat infection
Also linked to deficit in frontal -lobe inhibition
What are the clinical features of OCD?
Recurrent unwanted intrusive thoughts
Despite attempts to resist and recognition that they are irrational
Contamination, aggression, infection, morality
Tension/discomfort neutralised by compulsion
Compulsions= repeated stereotyped and seemingly purposeful rituals
Compelled to carry out, irrational, may lack link to obsession