Anxiety

Question 1

What are the types of anxiety?

Answer 1

• Generalised Anxiety Disorder (GAD) – excessive anxiety & worries >6/12, wide range of possible triggers
• Panic Disorder (PD) – anticipatory anxiety of recurrent panic attacks
• Social Anxiety Disorder (SAD) – fear of being scrutinized or humiliated by others in public
• Obsessive Compulsive Disorder (OCD) – obsessional thoughts/impulses that causes anxiety, followed by compulsive behaviours to relieve that anxiety
• Post-Traumatic Stress Disorder (PTSD) – re-experiencing of trauma, persistent avoidance, increased arousal

Question 2

What are the medications that can induce anxiety?

Answer 2

• Sympathomimetics (pseudoephedrine)
• Stimulants
• Xanthines (theophylline, caffeine)
• Levothyroxine
• Antidepressants
• Dopamine agonists (levodopa) - Beta-adrenergic agonists (PO salbutamol)
• Anticonvulsants (CBZ)
• Antibiotics (quinolones, isoniazid)
• Herbals (Ma Huang, ginseng, ephedra)
• NSAIDs (ibuprofen)

Question 3

What are the symptoms of generalised anxiety disorder?

Answer 3

Excessive anxiety and worry, occurring more often than not for ≥6/12, about a number of events or activities (e.g. work, school performance)

The person finds it difficult to control

Anxiety and worry are associated w ≥3 or the following Sx
→ Restlessness or feeling keyed up or on edge
→ Being easily fatigued
→ Difficulty concentrating or mind going blank
→ Irritability
→ Muscle tension
→ Sleep disturbance (insomnia, restless unsatisfying sleep)

Focus of the anxiety/worry are not confined to the features of another mental disorder

Sx cause significant functional impairment

Sx are not due to another mental condition or direct physiological effects of a substance

Question 4

What are the symptoms of a panic attack?

Answer 4

A discrete period of intense fear/discomfort, in which ≥4 of the following Sx developed abruptly and reached a peak within 10 mins (usually lasts no longer than 20-30min)
→ Palpitations, pounding heart, ↑PR
→ Sweating
→ Trembling/Shaking
→ Sensations of shortness of breath
→ Feeling of choking
→ Chest pain/discomfort
→ Nausea or abdominal distress → Feeling dizzy, unsteady, lightheaded, faint
→ Derealization or depersonalisation
→ Fear of losing control or going crazy
→ Fear of dying
→ Paraesthesia (numbness or tingling sensations)
→ Chills or hot flushes

Question 5

What are the symptoms of panic disorder?

Answer 5

Recurrent unexpected panic attacks AND
≥1 of the panic attacks has been followed by ≥ 1/12 of ≥ 1 of the following
→ Persistent anticipatory anxiety of having additional panic attacks
→ Worry about implications of the panic attack
→ Significant change in behaviour related to the panic attack

Panic attacks are not due to direct physiological effects of a substance or a general medical condition

Panic attacks are not better accounted for by another mental disorder

Question 6

What are the symptoms of agoraphobia?

Answer 6

• Anxiety about being in places/situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having unexpected situationally predisposed panic attack or panic-like symptoms
• The situations are avoided (e.g. travel is restricted) or endured with marked distress or with anxiety about having a panic attack or panic-like Sx, or require presence of a companion
• Anxiety/phobic avoidance is not better accounted for by another mental disorder
• Two or more agoraphobia situations required for a diagnosis

Question 7

What are the symptoms of social anxiety disorder?

Answer 7

Marked & persistent fear of ≥1 social/performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others/peers
→ Exposure to the phobic stimulus almost invariably provokes an anxiety response (may be situationally bound/predisposed panic attack)
→ Duration >6/12

Feared situations are avoided or endured w intense anxiety/distress – significantly impairs functioning

Sx not due to another mental condition or direct physiological effects of a substance

Question 8

What are the symptoms of Obsessive Compulsive Disorder

Answer 8

Obsessions
→ Recurrent and persistent thoughts/impulses/images that are experienced at some time during the disturbance, as intrusive and inappropriate and caused marked anxiety/distress
→ Thoughts, impulses or images are not simply excessive worries about real life problems
→ Person attempts to ignore or suppress such thoughts/impulses/images or to neutralize them with some other action/thought
→ Person recognizes that the obsessional thoughts/images/impulses are a product of his own mind

Compulsions
→ Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession, or according to rigid rules
→ Behaviours or mental acts are aimed at preventing/reducing distress but not connected in a realistic way with what they are designed to neutralize/prevent or are clearly excessive

Either Obsessions or Compulsions and
→ At some point, the person recognised that the obsessions/compulsions are excessive/unreasonable
→ Obsessions/compulsions cause marked distress, are time-consuming (take ≥1h a day) or significantly impairs functioning
→ If another mental condition is present, content of the obsession/compulsions is not restricted to it
→ Sx are not due to another mental condition or direct physiological effects of a substance**

Question 9

What are the symptoms of PTSD?

Answer 9

• Person was exposed to a stressor (x1)
• Traumatic event is persistently re-experienced (x1)
• Persistent effortful avoidance of distressing trauma-related stimuli after the event (x1)
• Negative alterations in cognitions and mood that began or worsened after the traumatic event (x2)
• Trauma-related alterations in arousal & reactivity that began or worsened after the traumatic event (x2)
• Persistence of symptoms for >1 month – full diagnosis is not met until at least 6 months after trauma(s)
• Significant symptom-related distress or functional impairment
• Disturbance is not due to medication, substance use, or other illness