anxiety clinical

Question 1

what are the 5 types of anxiety disorders

Answer 1

GAD
OCD
PTSD
panic disorder
phobic anxiety disorders

Question 2

what is the epidemiology of anxiety

Answer 2

0.9-28%

Question 3

what are the general clinical features of anxiety

Answer 3

anticipation
irritability
palpitations
breathlessness
worrying
dry mouth
heavy chest
tremor
insomnia

Question 4

what are the treatments that can be used in anxiety

Answer 4

SSRI - 1st line for everything
benzos
pregabalin
TCAs - clomipramine
venlafaxine/duloxetine

Question 5

which medications are used in anxiety that are off license

Answer 5

busipurone - long titration
mirtazapine
beta blockers
antihistamines

Question 6

what are the non-pharmacological treatment options for anxiety

Answer 6

counselling
CBT
self-help
lifestyle
relaxation techniques

Question 7

how are SSRIs used in anxiety

Answer 7

1st line for all disorders
12 weeks to response
increased suicidal thoughts risk in those under 30

Question 8

what is GAD

Answer 8

anxiety lasting for more than 6m, worry out of proportion to risk

Question 9

what are the symptoms of GAD

Answer 9

all general anxiety symptoms plus
- sweating
- trembling
- dry mouth
- fear of losing control
- poor concentration
- thinking the worst
O/E
- strained face
- close to tears
- restless

Question 10

how is GAD diagnosed

Answer 10

DSM IV - 2x major symptoms on most days
- excessive worry
- not able to control worrying
3/6 of additional symptoms
- on edge/restless
- easily fatigues
- difficulty concentrating
- irritable
- muscle tension

Question 11

what are the differential diagnosis for GAD

Answer 11

schizophrenia
depression
substance abuse
physical illness - thyrotoxicosis, hypoglycaemia
dementia

Question 12

what are the steps in the GAD stepped care model

Answer 12

1. assessment - monitor
2. low intensity psychological interventions
3. high intensity psychological interventions +/ meds
4. specialist referral

Question 13

what is the pharmacological treatment for GAD

Answer 13

1. SSRI - fluox+sert - unlicensed but NICE, start at half doses and increase (12m)
2. venlafaxine - 8 weeks response
3. pregabalin

Question 14

what short term adjuncts can be used in GAD

Answer 14

benzos
busipirone
beta blockers
pregabalin
venlfaxine/mirtazapine
antihistamines
antipsychotics

Question 15

what is OCD

Answer 15

repeated, intrusive, obsessive thoughts, impulses or acts - that cause anxiety when restricted

Question 16

OCD epidemiology

Answer 16

2-3%, most common in adolescents and early adulthood

Question 17

what is the pharmacological treatment of OCD

Answer 17

1. SSRI or clomipramine
   - only central serotonin enhancers are effective - fluox, sert and clomipramine
   - high doses
   - max dose tolerated for 3m to assess, treatment 1-2 years to prevent relapse

Question 18

what is social anxiety

Answer 18

excessive anxiety evoked by a specific object or situation - high in alcohol dependency

Question 19

how is social anxiety treated

Answer 19

1. SSRI/venlafaxine - at least 12 weeks

Question 20

what are the symptoms of panic disorder

Answer 20

SOB, palpitations, chest discomfort, sweating, nausea, trembling

Question 21

how is panic disorder treated

Answer 21

self-help/CBT
mod-severe
1. SSRI - (es)citalopram, sertraline or paroxetine
2. clomipramine or imipramine if no SSRI response after 12 weeks

Question 22

anxiety pathophysiology

Answer 22

abnormal regulation of fear response
amygdala activated by fer - more activity in amygdala