Anxiety

Question 1

PHYSICAL SIGNS OF ANXIETY:

Answer 1

1. Tachycardia
2. Palpitations
3. Hypertension
4. Dyspnoea/rapid breathing
5. Chest pain/discomfort
6. Dizziness, light-headedness, syncope
7. Choking sensation
8. Tremors, shaking
9. Muscle tension
10. Dry mouth
11. Sweating
12. Cold skin
13. Nausea/vomiting
14. Diarhoea
15. Abdominal discomfort
16. Mydriasis
17. Paraesthesia

Question 2

GENERALIZED ANXIETY VS PANIC ATTACKS

*Both can coexist

Answer 2

1. Slow onset vs acute onset
2. Mild-moderate severity vs intense severity
3. Long duration(hours/days or longer) vs shorter duration(usually <1h)

Question 3

PHOBIC DISORDERS:

a) Agoraphobia
b) Social phobia
c) Specific phobias

Answer 3

• Definition: Intense, irrational fear of an object, activity or situation.
  a) - fear of entering crowded spaces where difficult to escape in the event of panic attack. 95% have past/current diagnosis of panic disorder.
  b) Fear of social situations where might be exposed to humiliation and embarrassment
  c) Involve very specific objects and situations(not covered under agoraphobia/social phobia)

Question 4

DIAGNOSTIC ALGORITHM:

Answer 4

1. Organic cause or substanced-induced? Yes mean organic anxiety disorder/substance induced anxiety disorder. If No,
2. Secondary to other psychiatric conditions?

For onset after life event:

1. Event stressful but not traumatic => adjustment disorder. If traumatic,
2. Symptoms resolve ≤3d => acute stress reaction. If no,
3. Meet PTSD criteria => PTSD. If No, Adjustment Disorder.

Onset unrelated to life event:

1. Unpredictable or clear trigger? If unpredictable:
   a) Lengthy, mild-moderate periods of anxiety >6/12 => GAD
   b) Short, intense periods of anxiety => Panic disorder
2. If clear trigger:
   a) External event or situation => Phobia
   b) Intrusive thoughts => OCD

Question 5

NON-SITUATIONAL ANXIETY DISORDERS:

a) GAD
b) Panic disorder

Answer 5

a) - long-standing, free-floating anxiety, present for most days for about 6/12. ICD-10: Apprehension, Motor tension, Autonomic overactivity.
b) - unpredictable panic attacks and relatively anxiety-free in between. Can develop anticipatory anxiety

Question 6

SIDE-EFFECTS OF PRESCRIBED DRUGS ASSOCIATED WITH ANXIETY:

Answer 6

1. Antidepressants(SSRIs and tricyclics in first 2 weeks)
2. Corticosteroids
3. Antipsychotics(akathisia)
4. Thyroid hormones
5. Caffeine containing analgesics
6. Sympathomimetics
7. Anticholinergics