Psych Flashcards
Generalised anxiety disorder - Definition & Presentations
Excessive worrying for >6 months about everyday issues in a manner that’s disproportionate to any inherent risk.
The Anxiety is not caused (obviously) only by other mental health issues, as a result of substance misuse or only relating to a physical health problem
Presentations:
–> At least 3 of the following should be present most of the time:
- Restlessness/nervousness
- easily fatigued
- poor concentration
- irritability
- muscle tension
- sleep disturbance
- Anxieties are hard to control
–> In children at least one Key symptom should be present most of the time
Other common presentations:
- sweating
- light-headedness/dizziness
- palpitations
- epigastric discomfort
- Anxieties may be ‘free floating’, in that they don’t necessarily correspond to particular environmental stressers
Examples of fears patients may have: Patient or their family members will soon get ill.
Generalised anxiety disorder - Aetiology & Risk Factors
No one cause for GAD.
Combination of: Increased no. of minor life stressers, physical/emotional trauma & genetic factors
Childhood risk factors:
- Maltreatment
- Parental Mental Health Problems/Substance use
- Family disruption (i.e. divorce)
- Exposure to overly harsh/over-protective parenting
Generalised anxiety disorder - Epidemiology
GAD is more common in high-income countries
- differences in no. could be due to cultural difference around mental health & diagnosis criteria between countries
GAD usually starts in adulthood and persists over time
2/3 of those with GAD are female
Higher prevalence of GAD during pregnancy and shortly after birth
GAD commonly occurs w/ or precedes other mental health disorders
Higher chance in those with chronic physical health conditions
Many don’t try to get diagnosed
Generalised anxiety disorder - Differentials
1) Panic Disorder –> characterised by recurrent unexpected panic attacks for >1 month, patients are often very concerned about having more panic attacks and may change their habits to try and avoid it.
- Panic attacks aren’t exclusive to Panic Disorder and can occur in GAD too
2) Social Anxiety Disorder –> Anxiety is limited to social situations
3) OCD –> anxiety directly related to compulsions or obsessions
4) PTSD –> anxiety directly related to reminders of past trauma
5) Depression –> inability to feel pleasure, overall sad/irritable moods, often also accompanied by anxiety symptoms
6) Substance/Drug-induced anxiety disorder
7) Situational anxiety (non-pathological) –> Anxiety is more controllable, and limited to certain environments/situations
Restlessness, fatigue and other physical symptoms are rarely present
Generalised anxiety disorder - Investigations
1st line:
- Thorough history and examination should be performed
Following criteria must be met:
–> at least 6 months of excessive anxiety and worry about a number of events or activities, causing distress or impairment
–> The worry is not confined to features of another mental health disorder or a result of substance misuse or a general physical health condition
–> At least three of the following symptoms are present most of the time in adults (only one item is required in children):
-restlessness or nervousness
-being easily fatigued
-poor concentration
-irritability
-muscle tension
-sleep disturbance
Investigations to consider:
- Thyroid function tests -> If there’s also signs of thyroid disfunction
- Urine drug screen test -> If there is a strong suspicion of substance misuse
- 24-hour urine for catecholamines, metanephrines, normetanephrines & creatinine -> If there is severe hypertension and/or tachycardia
- Pulmonary function tests -> If SOB (unlikely)
- ECG -> If abnormal cardiac auscultation, risk factors/FHx for cardiac diseases, syncope
Generalised anxiety disorder - Management
1st line: CBT
For non-pregnant adults:
First line Pharmacotherapy –> SSRI (selective serotonin-reuptake inhibitor)
–> sertraline: 25 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day
- Seems to be more effective for those w/ sever GAD.
- Considerations should be made: Has CBT not worked? Do the benefits out way the side effect? Is there a depression comorbidity?
- Usually mild anxiety is treated w/ SSRIs, & severe anxiety will be treated w/ a combination of SSRIs and CBT
In Pregnant adults and children, Pharmacotherapy is 2nd line treatment and the choice of drug must be chosen carefully for pregnancies
Generalised anxiety disorder - Prognosis & Complications
With proper treatment, around 50% gain remission - decreases in symptoms & improved psychosocial functioning
Pharmacotherapy should be given for at least 12 weeks to determine the efficacy, and if effective should be continued for at least 12 months, at which point discussions of slowly reducing dosage can be had.
Psychotherapy should be given at least 6-8 sessions. Improved from this has been seen to last up to 24 months
GAD may reoccur under emotional/physical stress
Complications:
- Co-morbid Depression = high chance –> Occurs in around 50% of cases, increases risk of suicide
- Inappropriate utilisation of healthcare resources = high chance
–> If they go to the doctor for something due to the anxiety and the doctor does not pick up on their anxiety, costly tests may be used on them for no reason - Comorbid anxiety disorder = high chance
- Comorbid substance misuse/dependence = medium chance
- Behavioural & mental health problems in offspring = low chance
–> Anxiety in pregnant women has been associated with long-term behavioural issues and mental health problems, w/ some evidence of an altering of the child’s brain structure
Alcoholic Hepatitis - Definition & Presentation
Alcoholic hepatitis is a condition characterized by inflammation of the liver caused by excessive and prolonged alcohol consumption
Alcoholic hepatitis can be acute, with sudden onset and specific symptoms, or chronic, developing over time due to long-term alcohol abuse
Presentations:
- Jaundice
- RUQ Abdominal pain
- Nausea and vomiting
- Loss of appetite + weight loss
- Fatigue
- Fever
- Swelling in the abdomen due to fluid accumulation (ascites)
- Confusion and disorientation (in severe cases)
Alcoholic Hepatitis - Aetiology
Alcoholic hepatitis is primarily caused by the toxic effects of alcohol on the liver.
When alcohol is consumed, the liver metabolizes it into harmful substances that can damage liver cells. Over time, this damage leads to inflammation and scarring (fibrosis) of the liver tissue, impairing its function.
Risk Factors = Alcoholism and its risk factors
Alcoholic Hepatitis - Investigations
Exam:
- Hx of alcohol consumption
- Check for Jaundice, RUQ pain, hepatomegaly
Blood tests:
- LFT
- FBC -> Anaemia or other blood anomalies
- Prothrombin Time -> Assess ability for blood clotting, can be reduced in liver disease
Imagining:
- Ultrasound of Liver -> Check cirrhosis (scarring) or ascites (fluid accumulation)
- CT/MRI
Liver Biopsy -> Rule out other things
Alcoholic Hepatitis - Treatment
Most important = stop alcohol consumption entirely
Abstinence from alcohol can prevent further liver damage and may allow the liver to heal to some extent
Acute:
- Supportive care is often provided, including proper nutrition, vitamin supplements (especially B-complex vitamins), and management of complications such as ascites or hepatic encephalopathy
- In severe cases, hospitalization may be necessary, and treatments like corticosteroids or pentoxifylline might be prescribed to reduce liver inflammation
- Liver transplantation may be considered for individuals with end-stage liver disease due to alcoholic hepatitis
Long term:
- Support groups/programs for alcoholism
