Anxiety

Question 1

What is anxiety

Answer 1

A feeling of worry, nervousness, or unease about something with an uncertain outcome; nervous disorder marked by excessive uneasiness and apprehension

Question 2

Epidemiology

Answer 2

Common, 25% lifetime risk

30% of MH seen in GP

Question 3

When does anxiety become a problem

Answer 3

when it interferes with daily life

out of proportion to threat, occurs without threat

physiological response

Question 4

What physiological response can happen with anxiety

Answer 4

tachycardia

HTN

tachypnoea

nausea

Question 5

What is anhedonia

Answer 5

Inability to feel pleasure in normally pleasurable activities

Question 6

Psychological symptoms of anxiety

Answer 6

“free floating anxiety”

worry, apprehension

fear

persistent nervousness

poor concentration

irritability

Question 7

Arousal symptoms of anxiety

Answer 7

hypervigilance

restlessness

increased startle response

Question 8

Fear symptoms of anxiety

Answer 8

fear of losing control
impending danger

unrealistic ideas of danger

negative thoughts

feeling they can’t cope

fear of dying

Question 9

Motor symptoms of anxiety

Answer 9

muscle tension

headaches

trembling

purposeless activity

weakness

Question 10

Autonomic symptoms of anxiety

Answer 10

CVS e.g. Palpitations, tightness, pains

Resp e.g. Over breathing, difficulty inhaling

GI e.g. dry mouth, loose stools, epigastric discomfort, butterflies, choking, dysphagia

GUS e.g. freq micturition

Neuro e.g. blurred vision, light headed, dizzy, nausea, numbness, tingling

Others : sweating, sleep disturbance (initial Insomnia), derealisation, depersonalisation, flushing, sweats

Question 11

Other symptoms of progressed anxiety

Answer 11

Panic attacks - Sudden overwhelming intense fear and anxiety, associated with physical symptoms, short duration (5-20 mins)

Obsessions
Repetitive intrusive involuntary anxiety provoking thoughts/images/ideas. Recognised by pt as own

Compulsions
Repeated stereotyped behaviours, associated with anxiety
Pt has insight. Will try to resist but if acts are resisted, anxiety gets worse
“to prevent some objectively unlikely event, often involving harm or danger to or caused by the patient, which they fear might otherwise occur” (ICD 10).

Question 12

Post-traumatic stress disorder (PTSD)

Answer 12

“flashbacks“ - episodes of repeated reliving of the trauma in intrusive memories dreams or nightmares

persisting background of a sense of “numbness”
emotional blunting

detachment from other people & surroundings

anhedonia

avoidance of activities and situations reminiscent of the trauma

Question 13

Differentials of anxiety

Answer 13

Physical disorder
Heart disease (IHD, AF, heart failure, PE)
Diabetes
Thyroid problems, such as hypothyroidism or hyperthyroidism
Asthma or COPD
Drug & alcohol abuse or withdrawal
Irritable bowel syndrome
Tumours e.g. phaeochromocytoma 

Depression – important not to miss
Psychosis
Another different anxiety disorder

Question 14

Treatment for anxiety

Answer 14

Bio-psycho-social:
MANAGE UNDERLYING PHYSICAL DISORDERS / ALCOHOL & DRUG MISUSE

Psychological→ “talking therapies”

IAPT in primary care

Relaxation*

mindfulness

problem focussed

counselling

guided self help

graded exposure

Cognitive Behavioural Therapy

Question 15

Medical Treatment for anxiety

Answer 15

Biological → Antidepressants

selective seratonin reuptake inhibitors SSRI e.g. fluoxetine, citalopram, sertraline

noradrenergic and specific serotonergic antidepressant NaSSA e.g. mirtazapine

selective norepinephrine reuptake inhibitor SNRI e.g. venlafaxine

Others: pregabalin, trazadone, buspirone

Benzodiazepines – PRN only

Question 16

Anxiety treatment donts

Answer 16

Benzodiazepinse, should not be prescribed for treatment of panic disorders or GAD in 1 or 2 care unless short term

Antipsychotics should not be prescribed for panic disorders or GAD in 1 care