2518403
Description
Flashcards by Anna Walker, updated more than 1 year ago
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Created by Anna Walker
over 9 years ago
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| Question | Answer |
| What is the difference between normal anxiety and pathological anxiety? | Anxiety is a normal human fight or flight response. With most sources of anxiety there is a normal basis for the fear but if it greatly impacts their functioning, or if they become anxious at a minimal level of stimuli, it becomes a disorder. |
| What are normal fears aged 0-6 months? | Loud noises, loss of physical support, rapid position change, rapidly approaching other objects. |
| What are normal fears aged 7-12 months? | Strangers, looming objects, unexpected objects or unfamiliar people. |
| What are normal fears aged 1-5 years? | Strangers, storms, animals dark, separation from parents, machines, loud noises, the toilet. |
| What are normal fears aged 6-12 years? | The supernatural, bodily injury, disease, burglars, failure, criticism, punishment. |
| What are normal fears aged 12-18 years? | Performance in school, peer scrutiny, appearance. |
| What is the breakdown of anxiety disorders? (need to determine if constant or episodic anxiety) | |
| What is the epidemiology of anxiety? | Most prevalent psychiatric disorder - 11% in primary care populations. All phobias account for 8%, then PTSD at 3.6%, GAD 52.8%, OCD 2.3% and Panic Disorder at 1.7%. |
| What are the 5 areas of anxiety symptoms? | Psychological arousal, sleep disturbance, muscle tension, autonomic arousal and hyperventilation. |
| What are the psychological arousal symptoms of anxiety? | Worrying thoughts, irritability, sensitivity to noise, restlessness, fearful anticipation, poor concentration. |
| What are the sleep disturbance symptoms of anxiety? | Insomnia and night terrors. Do not confuse the problems these patients have with getting off to sleep with the early waking seen in depression. |
| What are the autonomic arousal symptoms of anxiety? | Dry mouth, diarrhoea, difficulty breathing, palpitations, chest discomfort, frequent and urgent micturition. |
| What is the "cycle of anxiety"? | Patients find it difficult to differentiate all these things. They will often describe their physical symptoms but will not mention their thought symptoms until specifically asked. |
| Describe the features of a panic attack. | A sudden crescendo of severe anxiety. Associated with intense awareness of threatening bodily sensations e.g. palpitations, choking, chest pain, dizziness. Feelings of unreality are common. Associated with catastrophic cognitions, e.g. dying, loss of control, going mad. Short lived - <10 minutes. Can also be recurrent or associated with other anxiety disorders. Situational vs spontaneous. |
| Describe the features of generalised anxiety disorder | Generalised and persistent anxiety (somatic and psychological) most days for several months. Anxiety symptoms usually involve elements of apprehension, motor tension and autonomic overactivity. |
| Describe the features of agoraphobia. | Marked fear or avoidance of crowds, public places, travelling alone, travelling away from home, etc. A common key feature of agoraphobic situations is the lack of an immediate exit. Symptoms restricted to fearful situations or contemplation of fearful situation. Avoidance present. Can occur with or without panic disorder. |
| What is social phobia? | Marked fear of being the focus of attention, of embarrassment or humiliation. Symptoms restricted to fearful situations or contemplation of feared situation. Common anxiety symptoms are blushing or shaking, fear of vomiting, urgency or fear of micturition. Avoidance present. |
| What are obsessions and compulsions? | Obsessions are thoughts, impulses or images. They are recurrent, unwanted and cause distress. Compulsions are acts or rituals. People with OCD use compulsions to try to make the obsessions go away and reduce the associated anxiety. This is called "magical thinking". |
| Describe the features of OCD | Symptoms are common in childhood (normal). M=F. Mean time between onset of symptoms to diagnosis = 9 years. Frequently coexists with other psychiatric disorders: schizophrenia, Tourette's syndrome, depression. Depression may be secondary to the compulsions not working. Differs to Anankastic PD - those with PD show less engagement in compulsions and are generally less distressed. |
| Describe the features of PTSD | Can only be diagnosed after significant trauma - e.g. car accident, childhood abuse. Flashbacks, reliving or nightmares. Hyperarousal and hypervigilance. Avoidance of stimuli related to stressor. |
| What other things must you screen for in your anxiety history? | Presence of depressive symptoms (either causing the anxiety or resulting from it). Drug/alcohol misuse (significantly complicates treatment). Personality disorders. Anxiety symptoms secondary to organic pathology. |
| What are some medical conditions that could give an anxious presentation? | ENDOCRINE: Thyroid dysfunction, adrenaline. DRUGS: Caffeine, cocaine. DRUG WITHDRAWAL: Alcohol, opiates. CARDIAC: Arrhythmia. HYPOXIA: CCF, angina, anaemia, COPD. METABOLIC: Acidosis, hyperthermia. NEURO: Seizures, vestibular dysfunction. |
| What are avoidance and safety behaviours? | An AVOIDANCE behaviour is the things you do or avoid doing in order to not feel anxious. A SAFETY behaviour is an action taken to manage anxiety and limit or control the experience. |
| What are the NICE guidelines for Step 1: All known and suspected presentations of anxiety? | Education and active monitoring. |
| What are the NICE guidelines for Step 2: No improvement after education and monitoring? | Guided self-help and low-intensity psychological interventions. |
| What are the NICE guidelines for Step 3: Inadequate response to Step 2 interventions or marked functional impairment? | High-intensity psychological intervention (CBT) or drug treatment. |
| What are the NICE guidelines for Step 4: Complex treatment-refractory anxiety. Very marked functional impairment or risk. | Complex drug or psychological treatment regimens; input from multi-agency teams. |
| Describe the pharmacological management of anxiety disorders. | Antidepressants: All are anxiolytics. Should warn patient about possible brief increase in anxiety. B-blockers. Benzodiazepines (short half-life - Lorazepam, longer half-life - Diazepam). Antipsychotics: Sedative and anxiolytic properties. |
| What are some psychological interventions available for treating anxiety disorders? | Psychoeducation. Guided self-help. Computerised CBT. Counselling. Anxiety management/relaxation. CBT. Systematic desensitisation. Graded exposure. Response prevention. Social skills training. CAT/dynamic psychotherapy. Eye Movement Desensitising Reprocessing (for PTSD). |
| What is graded exposure therapy? | The fear is identified. Treatment aims are set as a series of manageable steps. Start with situations causing milder anxiety. Requires repeated exposure to anxiety causing stimuli. |
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