3 - PSY - Anxiety Disorders

Question 1

Which four features distinguish pathological anxiety from normal anxiety

Answer 1

autonomy - no/min env trigger
intensity - exceeds pt capacity to deal with discomfort
Duration = Sx are persistent
Behaviour - impairs function +/or results in disabling behaviours

Question 2

2 classifications of anxiety disorders?

Answer 2

constant - GAD

episodic - Phobias, panic, PTSD, OCD

Question 3

Psych arousal Sx

Answer 3

worrying thoughts
irritable
noise sensitive
restless
fearful anticipation
poor concentration

Question 4

Sleep disturbance Sx

Answer 4

insomnia

night terrors

Question 5

Muscle tension Sx

Answer 5

tremors

aches

Question 6

Autonomic arousal Sx

Answer 6

dry mouth
diarrhoea
difficulty breathing
palpitations
chest discomfort
frequent and urgent urination

Question 7

4 components of the cycle of anxiety?

Answer 7

thoughts
behaviour
emotions
bodily responses

Question 8

Generalised Anxiety Disorder - criteria

Answer 8

neither situational or episodic
Sx involve elements of - Apprehension, Motor tension, Autonomic over activity
general and persistent psych and somatic anxiety Sx on most days for at least several weeks

Question 9

Panic disorder - ICD 10 criteria

Answer 9

• several attacks within one month
• circumstances with no objective danger
• not confined to known or predictable situations
• relatively free from anxiety Sx between attacks

Question 10

Panic disorder - Sx

Answer 10

unpredictable panic attacks
sudden crescendo of severe anxiety
catastrophic cognition (im dying)
Short lived (<10 mins normally)

Question 11

Agoraphobia - icd criteria

Answer 11

psych and auto Sx primarily from anxiety and not secondary to other Sx
Anxiety restricted to at least two of following - crowds, public places, travelling alone, travelling away from home
avoidance of phobic situation = prominent feature

Question 12

Social phobia - Sx

Answer 12

fear of being focus of attention
Sx restricted to situation/thinking about situation
Common Sx - blushing, shaking, fear of vomiting, urgency/frequency
Avoidance

Question 13

Characteristics of OCD

Answer 13

obsessive Sx (thoughts, impulses, images) +/or compulsive acts or rituals - causing distress + interferes with activities

Question 14

What do OCD Sx frequently co exist with

Answer 14

schizophrenia
tourette’s
depression

Question 15

Obsessions - describe

Answer 15

• thoughts ideas images
• repetitive
• excessive/unreasonable
• unpleasant (no pleasure)
• originate in mind of patient

Question 16

Compulsions - describe

Answer 16

• physical act
• excessive/unreasonable
• repetitive
• resisted by patient
• unpleasant (may relieve tension/anxiety)
• originates in mind of pt

Question 17

rule these out as causes of anxiety before reaching a psych diagnosis

Answer 17

drugs 
drug withdrawal
cardiac arrhythmias
neuro (seizures)
hypoxia (CHF, COPD, angina, anaemia)
Metabolic (acidosis, hyper/hypo thermia)
endocrine (thyroid)

Question 18

How do patients manage their own anxiety?

Answer 18

Avoidance and Safety behaviours

Question 19

NICE step care approach - 4 steps

Answer 19

1 - psychoeducation and active monitoring
2 - guided self help and low intensity psych interventions
3 - high intensity psych Tx (CBT) or drug Tx
4 - referral to secondary care - MDT approach

Question 20

CBT methods for phobias and OCD

Answer 20

OCD - exposure and response prevention

Phobias - systematic desensitisation or graded exposure

Question 21

4 types of meds used to Tx anxiety

Answer 21

Antidepressants
Beta Blockers
Benzos
Antipsychotics (beneficial in severe cases)

Question 22

Antidepressants use in anxiety + counselling

Answer 22

all are anxiolytic

warn pt of possible increase in anxiety in initial period

Question 23

Benzos - short and long half life examples - use - beware of…?

Answer 23

short half life - lorazepam
long half life - diazepam

use in short term acute management (<4 weeks) as can be addictive

can reduce psych Tx efficacy

Question 24

Acute stress reaction - describe briefly

Answer 24

brief response to severely stressful events

Question 25

acute stress reaction Sx

Answer 25

anxiety/depression pts may already use coping strategies (denial, avoidance) alcohol excess common (numbness, detachment, derealisation, insomnia, restless, nger etc)

Question 26

Management of Acute stress reaction

Answer 26

``` reduce emotional response by talking about it encouraging but not forcing recall learn coping skills anxiolytic if severe anxiety hypnotics if severe sleep disturbance ```

Question 27

Adjustment disorder - describe briefly

Answer 27

psych reaction to new circumstance related to and in proportion to stressful event most lasts a few months

Question 28

Adjustment disorder - Sx

Answer 28

``` anxiety/depression/irritable autonomic arousal Sx occasional outbursts Alcohol/drug abuse common impaired social Fx more gradual onset than acute stress reaction ```

Question 29

Adjustment disorder - mgmt

Answer 29

help resolve change prevent avoidance and denial relieve anxiety through talk consider talking therapy referral

Question 30

Sx indicating abnormal reaction to loss (abnormal grief)

Answer 30

- guilt about things other than actions at time of death - 'im better off dead/i shouldve died with them' - morbid preoccupation with worthlessness - psychomotor retardation - prolonged + serious Fx impairment - hallucinations beyond hearing/seeing deceased person transiently

Question 31

PTSD core triad of Sx

Answer 31

hyperarousal re-experiencing avoidance

Question 32

Other Sx of PTSD

Answer 32

depressive + guilt substance use for coping Sx may begin quickly after, rarely >6months after

Question 33

PTSD management

Answer 33

Psych Tx - education, CBT, Eye movement desensitisation and reprocessing bio - antidepressants social - avoid substances, educate family, reintegration to society