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neurotic disorders Flashcards

1
Q

what parts of brain involved in normal anxiety?

A

hippocampus
amygdala
thalamus
frontal and temporal regions

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2
Q

NTs involved in normal anxiety

A

NA
serotonin
GABA-A

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3
Q

core symptoms of a disorder of anxiety?

A
  1. psychological and physical symptoms + avoidance
  2. symptoms consistent with DSM V/ICD 10
  3. not caused by organic disease or other psych disorder
  4. pervasive, distressing, disabling
  5. affecting function
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4
Q

prevalence?

A

women 30%

men 18%

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5
Q

place of living and anxiety?

A

urban>rural

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6
Q

physical symptoms to ask about in history?

A
  1. restless
  2. muscular tension
  3. fatigue
  4. SOB
  5. palpitations
  6. abdominal pain
  7. diarrhoea
  8. urinary frequency
  9. tingling of extremities
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7
Q

important adjuncts to ask in history?

A
  1. affective symptoms
  2. alcohol/substance use/withdrawal
  3. caffeine/meds
  4. premorbid
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8
Q

ICD 10 classification

A
  1. neurotic, stress related and somatoform disorders
  2. phobic - agoraphobia, social, specific
  3. other anxiety disorders - panic, GAD
  4. OCD
  5. reaction to severe stress and adjustment disorders - PTSD
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9
Q

important features of phobic anxiety disorders?

A
  1. evoked by certain well defined situations or objects which are not actually dangerous
  2. avoided or endured with dread
  3. anticipatory anxiety
  4. often co-exists with depression
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10
Q

important features of agoraphobia?

A
  1. lack of immediately available escape
  2. leaving home
  3. entering shops
  4. crowds
  5. public places
  6. public transport
  7. occurs with or without panic disorder
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11
Q

6 month prevalence of agoraphobia?

A

3-6%

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12
Q

gender in agoraphobia?

A

women - 75%

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13
Q

age of onset agoraphobia?

A

24yrs

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14
Q

course of agoraphobia/

A

chronic fluctuating

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15
Q

aetiology of agoraphobia?

A

life events, preceded by neurotic or dependent personality traits

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16
Q

what thoughts in agoraphobia?

A
  1. fear of death
  2. collapse
  3. no one would help if something happened
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17
Q

behaviour in agoraphobia?

A

avoid

may be subtle eg companion/trolley/pram

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18
Q

what to rule out in agoraphobia?

A

depression
substance abuse
psychosis

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19
Q

tx for agoraphobia?

A
  1. psychological - CBT

2. meds: SSRI

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20
Q

social phobia prevalence

A

6 month 1.7%

10-13% lifetime

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21
Q

gender in social phobia

A

equal

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22
Q

onset of social phobia?

A

teens/ early childhood

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23
Q

comorbidities in social phobia?

A

depression

substance misuse

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24
Q

cause of social phobia?

A

can be specific eg public speaking or generalised

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25
thoughts in social phobia?
1. negative perception by others 2. people will notice blushing, tremor 3. fear of vomiting, fainting, humiliation
26
behaviours in social phobia?
avoid | use safety behaviours
27
tx of social phobia?
1. tx comorbidity 2. ddx schizoid personality disorder 3. psych: CBT 4. meds: SSRI
28
age of onset simple phobias
any but common in kids
29
lifetime prevalence simple phobia
5-10%
30
female male ratio simple phobias
2.1 | except blood-injection type where same
31
tx of simple phobia
graded exposure therapy
32
what is panic disorder
1. recurrent discrete attacks of severe anxiety 2. last mins 3. anticipatory anxiety
33
features of panic attacks
1. ANS anxiety and fear of death/heart attack/suffocation 2. need several within one month minutes 3. not predictable 4. anticipatory
34
prevalence panic disorder
1.5%
35
gender panic disorder
women more slightly
36
genetics panic disorder
probs
37
somatic sx of panic attack
1. palpitations 2. chest pain 3 . SOB 4. choking 5. dizzy
38
thoughts in PD?
fear of dying fear of going mad fear of losing control
39
behaviours in panic disorder
escape | avoid
40
tx panic disorder
1. rule out physical cause 2. psychoeducate 3. CBT SSRI 4. benzos - very last resort
41
classic description of GAD?
free floating anxiety
42
prevalence GAD
lifetime 4-6%
43
course of GAD
chronic
44
gender GAD
women
45
cause of GAD?
1. related to stressors in predisposed personality | 2. genetics - prob linked to that of depressive illness
46
comorbid in GAD?
depressive | other anxiety disorders
47
thoughts in GAD
1. worry about random things for long time 2. can't control worry 3. feel as though worry is useful - if I think about it enough I'll be prepared
48
somatic features GAD?
1. muscle tension 2. fatigue 3. trembling 4. epigastric discomfort
49
tx GAD
1. difficult 2. treat any comorbidity 3. modify environmental factors. 4. relaxation techniques 5. avoid caffeine 6. CBT 7. meds: SSRI
50
benzos in GAD
nope
51
prevalence of OCD?
2-3%
52
gender OCD
pretty equal
53
pathology of OCD?
caudate nucleus and cingulate gyrus serotonin
54
what is an obsession?
1. ideas, images or impulses with are intrusive and pervasive 2. cause distress and are resisted 3. OWN thoughts
55
common themes in OCD?
``` cleanliness contamination doubt violence sex ```
56
what is a compulsion?
stereotyped repetitive act recognise as pointless reduce tension
57
features of OCD?
1. obsessions are ego dystonic 2. obsessions are indicative of personal defect, immorality or badness 3. thoughts resisted 4. compulsions are not pleasurable but relieve anxiety
58
violent obsessions worry in OCD?
nope acting on them is really rare, less than general population
59
comorbidity in OCD?
1. depression | 2. obsessional personality: ego-syntonic -
60
tx OCD
1. psych: psychoeducation, behavioural therapy eg exposure, response prevention; CBT 2. meds: SSRI high dose. 2nd line = clomipramine NB combo therapy optimal
61
what is PTSD?
1. delayed/protracted response to a stressful event or situation 2. event = exceptionally threatening/catastrophic 3. event = would cause distress in anyone
62
cause of PTSD?
1. personality traits 2. 80% previous psych prob 3. possible biological basis
63
course of PTSD?
fluctuating, most recover
64
brain regions in PTSD?
1. memory processing problems: hippocampus, amygdala, frontal cortex 2. heightened stress: thalamus, hypothalamus, locus coeruleus
65
onset of PTSD?
within 6 months of event
66
acute stress reaction?
onset and subsides in days after event
67
what groups of symptoms are seen in PTSD?
1. reliving- intrusive memories or dreams 2. arousal - ANS + hypervigilance, startle response and insomnia 3. avoidance and fear of cues which will remind of the event
68
outside the group of PTSD symptoms what else is seen?
1. numbness 2. detachment 3. dramatic outbursts of fear/violence 4. substance misuse
69
effects of PTSD on person
1. depression 2. suicidal ideation 3. ongoing effects of the event itself eg refugee 4. emotionally enduring personality change - chronic over many years
70
tx of PTSD?
1. MDT 2. CBT 3. behaviour therapy 4. refer to specialist agency eg rape crisis or refugee agency 5. SSRI
71
what two things have no evidence in PTSD?
1. critical incident debriefing | 2. eye movement desensitisation and recall
72
what is an acute stress reaction?
1. lasts hours or days 2. can be within 1hr after exceptional stress 3. stress usually severe / threat to security or physical integrity
73
things that may cause an acute stress reaction?
1. natural disaster 2. major accident 3. serious assauly 4. warfare 5. rape 6. multiple bereavement 7. fire
74
signs and symptoms ASR?
1. vary 2. initial daze 3. subsequent depression, anxious, angry 3. social withdrawal 4. disoriented, aggression, hopeless 5. overactivity 6. excessive grief
75
classification of ASR?
mild - no symptoms moderate- 2 symptoms severe - 4 of above or stupor
76
epidemiology ASR?
15-25% after stress
77
cause of ASR?
meh dunno
78
RFs for ASR?
1. exhaustion 2. medical illness 3. elderly
79
tx ASR?
none
80
px ASR?
resolves
81
what are adjustment disorders?
1. state of subjective stress 2. interferes with functioning 3. adapting to life change or consequences of a stressful event
82
what might an adjustment disorder be a sign of?
subthreshold | mood/anxiety/somatoform/conduct disorder
83
important features of an adjustment disorder
1. must be 1 month after stressor 2. don't go on longer than 6 months after stressor removed 3. must be a stressor!
84
comorbidity adjustment disorder
1. more alcohol abuse | 2. individual predisposition
85
prevalence of adjustment disorder
5% | can be up to 20% in general hosp setting
86
tx adjustment disorders?
1. supportive psychotherapy 2. coping mechanisms 3. practical support eg carers, child care, financial, OT, support groups 4. antidepressant/anxiolytic if symptoms persistent or if psych intervention is unsuccessful
87
px adjustment disorder?
70% recovery at 5yrs adolescents 40% major psych prob development in 20% - usually depression or alcohol related
88
what is a common adjustment disorder?
grief reaction
89
grief vs depression
controversial whether normal/abnormal grief is distinct from depression bereaved have depressive sx
90
what is normal grief
variable basically the feelings, thoughts and behaviours associated with bereavement
91
what is abnormal gruef
1. intense, prolonged, delayed, or absent 2. thoughts of worthlessness or death 3. slowed thoughts, movements 4. guilt 5. poor function 6. hallucinations that aren't the image or voice of the deceased

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