Anxiety - Clinical Picture

Question 1

EPIDEMIOLOGY

i) is it more or less common than bipolar?
ii) does it affect female or males more?
iii) what is the age of onset?

Answer 1

i) more common
ii) females > males
iii) has a broad age of onset

Question 2

ACUTE STRESS REACTION

i) what is it in response to?
ii) in what time frame does this normally last?
iii) what does it depend on?
iv) give five symptoms

Answer 2

i) in response to an exceptionally stressful event
ii) lasts from hours to three days
iii) deoends on the individual vulnerability
iv) numb, dazed, insomnia, restless, poor conc, anger, withdrawal

Question 3

ADJUSTMENT DISORDER

i) is the response proportional to the stressor?
ii) how long may it last?

Answer 3

i) reaction that is disproportionate to the stressor
ii) may last up to 6 months

Question 4

PTSD

i) what is it?
ii) what must the stress reponse involve?
iii) give five symptoms
iv) how quick is onset and recovery?

Answer 4

i) response to an exceptionally threatening or catastrophic event
ii) response must involve fear, helplessness, horror
iii) flashbacks, nightmares, numbness, detachment, hypervigillance, insomnia
iv) usually has immediate onset and usually recover within one year

Question 5

GENERALISED ANXIETY DISORDER

i) what is the key feature?
ii) give five symptoms
iii) does this involve physical symptoms? give some examples
iv) does it affect women or men more?

Answer 5

i) worry is they key feature
ii) fearful anticipation, irritability, sensitive to noise, poor conc, sadness, depersonalisation, fixation with detail
iii) yes - headaches, stomach pains, butterflies, palpitations
iv) women > men

Question 6

AETIOLOGY OF GAD

i) is there increased risk in first degree relatives? by how much?
ii) is there much difference between mono and dizygotic twins?
iii) disruption of which key event can lead to GAD?
iv) give two ways in which a parent may help foster a sense of control over events and therefore reduce GAD in child?
v) overprotection + what has been associated with anxiety?
vi) how do anxious parents predispose their children to be anxious? what does this show?

Answer 6

i) yes 5x risk in first degree relatives
ii) not much difference between mono and dizygotic twins
iii) disruption of caregiving can lead to withdrawal and depression
iv) responsiveness to child and encouragement for them to explore their environment
v) overprotection coupled with lack of warmth and responsiveness can lead to anxiety
vi) anxious parents may create an environment that prediposes a child to be anxious - this shows it is not just genetic

Question 7

PANIC DISORDER & AGORAPHOBIA

i) what two components does the clinical picture involve? give 5 symptoms of each
ii) what drug can be given to reduce some of these symptoms?
iii) give five system differential diagnoses
iv) what is agoraphobia? how may it present?

Answer 7

i) psychic - fear of losing comtrol, going mad, fainting, dying, depersonalisation

somatic - palpitations, tachycardia, sweating, chest pain, faintness

ii) beta blockers
iii) endocrine (hypoglycaemia), CV (arrhythmia), resp (asthma), drugs (caffeiene), neurological (seizure) or a PE
iv) agoraphobia is fear of being in a situation where escape might be difficult
- may present with a panic attack

Question 8

EPIDEMIOLOGY & AETIOLOGY OF PANIC

i) approx what % of the population suffer with panic attacks? do all of these amount to panic disorder?
ii) what are the two peaks of onset?
iii) what is the increased risk in first degree relatives of sufferes?
iv) what is the minimum enviro influence?
v) name three things that may contribute

Answer 8

i) 8% of population but not all amount to panic disorder
ii) peaks of onset are 15-24 and 45-54
iii) 7x increased risk in first degree relatives
iv) approx 50% enviro influence
v) adverse life events, trauma in early life, sexual abuse

Question 9

BIOLOGICAL MODELS OF PANIC

i) which brain area may panic attacks be triggered in? what gas can cause increased firing here?
ii) events due to which NT can stimulate an attack?
iii) what effect to benzo agonists and antagonists have on an attack? which NT is this mediated through?
iv) name a molecule that can cause panic attacks in animals

Answer 9

i) locus coruleus - co2 can cause increased firing
ii) noradrenergic agents can stimulate attacks

iii) benzo agonist - prevent an attack and benzo antag can aggravate an attack
- mediated through GABA

iv) cholecytokinin causes panic attacks in animals

Question 10

SPECFIC PHOBIAS

i) what is it?
ii) explain the biphasic reaction
iii) what do twin studies suggest? what % of first degree relatives are affected?
iv) what are the two potential mechanisms underlying these? explain each one
v) according to studies what may phobias be attributed to?

Answer 10

i) inappropriate anxiety in the presence of one or more objects or situations

ii) biphasic reaction is
- initial sympathetic (short lived)
- followed by parasympathetic (can result in vasovagal syncope)

iii) twin suggest suggest both genetic and environmental components
- 31% of first degree relatives affected

iv) two potential mechs are
1) psychoanalytic approach - symptoms are related to unresolved unconcious conflicts
2) classical conditioning - phobias learnt through associated of negative experience with an object/situation

v) phobias may be attributable to observational learning

Question 11

SOCIAL PHOBIA

i) what is it?
ii) what does it lead to? give two examples
iii) what are the symptoms (4)
iv) what may relieve the symptoms?
v) how do genetics play a role? what is seen in twin studies?

Answer 11

i) inappropriate anxiety in situations where the person is observed or where there is potential for criticism
ii) leads to avoidance of trigger situations such as eating in public or public speaking
iii) symptoms are anticipatory anxiety, general anxiety, blushing, trembling
iv) beta blockers or alcohol may relieve the symptoms

v) genetics and environment play a role (genetics around 1/3)
- monozygotic > dizygotic

Question 12

OCD

i) is it a primary anxiety disorder?
ii) what type of thoughts does it involve? are these recognised as own?
iii) what do compulsions do? give an example
iv) give examples of three associated behaviours
v) who is affected more - men or women? is this the same in adolescence?
vi) what is the mean age of onset?
vii) what do twin studies show?
viii) first degree relatives of which kind of patients have a higher than expected incidence?

Answer 12

i) not a primary anxiety disorder but anxiety is a big contributor
ii) involves obsessional thoughts and these are recognised as own
iii) compulsions may relieve the anxiety such as hand washing
iv) associated behaviours = checking, cleaning, precision
v) men and women are affected equally but in adolescence boys > girls
vi) mean age of onset is 20 yrs
vii) twin studies show strong inheritance (mono >> dizygotic)
viii) first degree relatives of patients with childhood onset OCD have higher than expected incidence

Question 13

EPIDEMIOLOGY OF OCD

i) who is affected more - men or women? is this the same in adolescence?
ii) what is the mean age of onset?
iii) what do twin studies show?
iv) first degree relatives of which kind of patients have a higher than expected incidence?
v) name five commonly associated comorbidities
vi) there is increased prevalence of which condition in relatives? what does this suggest?
vii) what % of schizophrenic patients will have an OCD disorder?

Answer 13

i) men and women are affected equally but in adolescence boys > girls
ii) mean age of onset is 20 yrs
iii) twin studies show strong inheritance (mono >> dizygotic)
iv) first degree relatives of patients with childhood onset OCD have higher than expected incidence
v) major depressive disorder, alcohol, social phobia, panic disorder, eating disorder, schz
vi) increased prevalence of tourettes in relatives which suggests some underlying neurpsychological aspects
vii) 25% of schizo patients will have OCD