Anxiety

Question 1

biological symptoms of anxiety (that you wouldnt expect)

Answer 1

• muscle tension or aches and pains
• feeling of choking
• palpitations
• chest pain
• nause or abdominal distress

Question 2

derealization

Answer 2

• Psychosensory feelings of detachment or estrangement from surroundings
• Objects appear altered/unreal

Question 3

depersonalization

Answer 3

• Parts of the body experienced as being changed, unreal, remote, automatized
• feeling that the self is distant or not reall there

Question 4

what differentiates depersonalisation from psychosis

Answer 4

there is insight into the subjective nature

Question 5

what is meta worry

Answer 5

worry about everything, eg worrying about worrying

Question 6

what is there often a preference for in anxiety

Answer 6

order and routine

Question 7

what are 4 symptoms in children that are indicative of anxiety

Answer 7

thumb sucking

nail biting

bed wetting

food fads

Question 8

what is the first thing that the brain does when stimuli arrives

Answer 8

amygdala acts as the emotional filter to decide whether it needs a stress or fear response

later there is modification by a cortically processed signal

–> act first think later

Question 9

where is the amygdala located

Answer 9

set of neurons in the medial temporal lobe

Question 10

which system is the amygdala part of

Answer 10

the limbic (emotional system)

Question 11

what happens when teh amygdala perceives something as dangerous

Answer 11

• Stimulus information sent to amygdala – stress or fear??
• Yes - distress signal to hypothalamus, which communicates with the rest of the body (so you have the energy to fight or flee)
• Hypothalamus controls ANS, activates sympathetic nervous system via adrenal glands release of adrenaline (epinephrine) into blood stream
• Then the hypothalamus activates HPA axis (hypothalamus, pituitary gland and adrenal glands). This aims to suppress the sympathetic nervous system
• If the brain continues to perceive something as dangerous, the hypothalamus releases CRH… cortisol is released from adrenal cortex.

Question 12

what does acute stress do to cortisol levels then

Answer 12

raises them

Question 13

how much cortisol and catecholamines are released due to stress

Answer 13

dose dependent

Question 14

is release of exxcess cortisol harmful?

Answer 14

yes it is neurotoxic to some extent, damages the hippocampus

Question 15

what must be first eliminated in the presentation of anxiety

Answer 15

substance misuse, medication misuse, hyperthyroidism etc

Question 16

which group of symptoms are pertinent in GAD

Answer 16

physical symptoms! medically unexplained

Question 17

what are 3 severity criteria GAD must fulfil

Answer 17

long lasting, most days for at least 6 months

not controllable

causing significant distress or impairment in function

Question 18

is there a genetic predisposition for GAD

Answer 18

yes

Question 19

what type of things can trigger GAD

Answer 19

• Stress: work, noise, hostile home
• Events: divorce, death, moving house etc.

Question 20

are females or males more affected by GAD

Answer 20

females

Question 21

management of GAD

Answer 21

• Symptom control: listen and reason
• Regular (non-obsessive) exercise
• Mediation
• CBT and relaxation
• pharmacotherapy

Question 22

which pharmacological agents are used for GAD

Answer 22

SSRI/SNRI

pregabalin (anticonvulsant)

Question 23

do benzodiazpines have a role in the management of anxiety

Answer 23

short term use, they have no long term benefits

Question 24

what is the essential feature of panic disoder

Answer 24

recurrent attacks of severe anxiety, which are not restricted to any particular situation or set of circumstances and are therefore unpredictable

Question 25

what cues panic disorder attacks

Answer 25

they are not restricted to a particular set of circumstances and are unpredictable!

Question 26

which phobia is panic disorder often seen with

Answer 26

agoraphobia - 60%

Question 27

where do patients with panic disorder often present to

Answer 27

cardiology ward, present with palpitations, chest pain, dizziness etc

Question 28

what should be suspected if someone presents with panic/anxiety later in life

Answer 28

underlying depression

Question 29

are comobridities common with panic disorder

Answer 29

yes - drugs, depression, alcohol, other anxiety disorders

Question 30

what has been shown to trigger panic attacks in susceptible individuals

Answer 30

lactate build up and increased CO2 (re breathing air, hypoventilation)

Question 31

which area of the brain has a role in the triggering of panic attacks

Answer 31

parahippocampal gyrus

Question 32

management of panic attacks

Answer 32

CBT SSRIs, SNRIs, TCA

Question 33

when have most phobias presented by

Answer 33

20s - early onset

Question 34

what type of behaviour do phobias lead to

Answer 34

avoidance behaviour, they are only anxious in specific situations

Question 35

what happens to the person with a phobia if they expect to see what they are scared of

Answer 35

anticipatory anxiety

Question 36

do patients with phobias have insight into their fear being irrational?

Answer 36

yes

Question 37

what type of behaviour is typical of avoidance behaviour

Answer 37

alcohol use getting others to do stuff for them avodiing situation, eg online shoppingin agoraphobia

Question 38

what is agoraphobia

Answer 38

A fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes

Question 39

what is a specific phobia

Answer 39

This is a marked and persistent feat that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation.

Question 40

in specific phobia, does exposure to the phobic stimulus always provoke immediate anxiety response?

Answer 40

yes

Question 41

what is the mainstay of psychotherapy for specific phobia

Answer 41

behavioural therapy based on graded exposure/systematic desensitisation to phobia

Question 42

are people with social anxiety disorder scared of small or big groups

Answer 42

small groups - feat of being scrutinised/unfamiliar people often fine in large groups as can hide

Question 43

what is there a common fear of with social anxiety

Answer 43

micturition or defaecation vomiting often there is blushing or shaking

Question 44

what imapct can social anxiety disorder have on soemones life

Answer 44

poor school performance, poor employment history

Question 45

what is behavioural inhibition

Answer 45

a consistent tendency to react to novel situations with fear and withdrawal to safety

Question 46

what is behavioural inhibition a good predictor of if seen in children

Answer 46

anxiety disorders

Question 47

what is seen in the brain during phobia attack

Answer 47

increased bilateral activation of amygdala and increased rCBF to amygdala and other limbic areas

Question 48

OCD: what are obsessions

Answer 48

stereotyped, puposeles,s words ideas or phrases that come into the mind

Question 49

are the obsessions in OCD recognised as the patients own thoughts or someone elses

Answer 49

recognised as their own thoughts

Question 50

OCD: how do the obssessive thoughts seem to the patients

Answer 50

unpleasant, resisted and egodystonic

Question 51

OCD: what are compulsions

Answer 51

senseless, repeated rituals or sterotyped behaviours not enjoyable or functional !

Question 52

do patients believe there are consequences to not doing compulsions in OCD

Answer 52

often viewed as neutralizing - eg this wont happen if i do this

Question 53

do patients resist compulsions in OCD

Answer 53

often they do, but if they are longstanding the patients often give up on resisting

Question 54

how long must OCD symptoms be present for for diagnosis

Answer 54

minimum 2 weeks, this is more of a diagnosis of exclusion as they are normally present for much longer must be present for most days a week

Question 55

can obsessions be different things each time in OCD

Answer 55

they must be repetitive

Question 56

when is peak onset of OCD in males and females

Answer 56

males - 14 females - 24

Question 57

is depression associated with OCD

Answer 57

most patients experience at least one major depresive episode

Question 58

is there co morbidity in COD

Answer 58

significant co-morbidity with schizophrenia, tourettes and other tic disorders, body dysmorphic disorder (spend a lot of time worrying about flaws in appearance), eating disorders and trichotillomania (pulling out hair).

Question 59

management of OCD

Answer 59

CBT , response prevention SSRI clomipramine

Question 60

what dose of SSRI is required for CBT

Answer 60

a higher than normal dose