Anxiety

Question 1

what is pathological anxiety

Answer 1

when anxiety is more extreme than normal, or in situations that are not normally anxiety provoking

causes significant distress and impairment of social/occupational/other function

Question 2

what are the anxiety disorders

Answer 2

generalised anxiety disorder 
panic disorder 
agoraphobia 
social phobia 
specific phobia 
obsessive compulsive disorder

Question 3

what is generalised anxiety disorder

Answer 3

Generalised and perisistant but not restricted to any particular circumstances

persistent nervousness 
trembling 
muscular tensions 
sweating 
light headedness 
palpitations 
dizziness 
epigastric discomfort 
fears patient or relative will be come ill or have an accident

Question 4

criteria for GAD

Answer 4

long lasting (most days for at least 6 months) 
not controllable 
causing significant distress/impairment in function

Question 5

common physical symptoms of anxiety which present to the GP

Answer 5

diarrhoea 
constipation 
stomach pains 
unable to swallow 
lump in throat etc

Question 6

comorbidity with generalised anxiety disorders

Answer 6

depression
substance abuse
etc

Question 7

treatment of generalised anxiety disorders

Answer 7

Cognitive Behavioural Therapy
SSRIs/SNRIs
Pregabalin

Benzodiazepines (short term only)

Question 8

what is CBT

Answer 8

cognitive behavioural therapy

Evidence based on psychological treatment - help individual identifying thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety

Question 9

what is Panic Disorder

Answer 9

recurrent severe attacks of panic, unpredictable - could happy any time

dominant symptoms include:

• sudden onset palpitations
• chest pain
• choking sensations
• dizziness
• feelings of unreality

often secondary fear of dying, loosing control or going mad

Question 10

essential clinical features of panic disorder

Answer 10

typical onset is late adolescence to mid 30s
usual course is chronic
comorbid with other anxiety disorders, depression, drug and alcohol misuse

Question 11

how can panic attacks be triggered biologically

Answer 11

by infusions of lactate

or by rebreathing air - increased CO2

Question 12

how do you treat panic disorder

Answer 12

Cognitive behavioural therapy

SSRIs/SNRIs/Tricyclics

Benzodiazepines (short term only)

Question 13

what are the 3 phobias

Answer 13

Agoraphobia
Social phobia
Specific phobia

Question 14

what is agoraphobia

Answer 14

cluster of phobias embracing fears of leaving home, entering shops, crows and public places, travelling alone in trains, busses or planes.

Question 15

how do people deal with life if they have agoraphobia

Answer 15

others help - do shopping
drink to overcome fear
go shopping at 24hr store at night
internet shopping

Question 16

what is a specific phobia

Answer 16

marked persistent fear that is excessive or unreasonable - cured by presence or anticipation of specific object or situation. eg.

• flying
• heights
• animals/insects
• injections
• blood

Question 17

treatment of specific phobias

Answer 17

behavioural therapy - exposure

• graded exposure/systematic desensitisation
• add in CBT if necessary

SSRIs/SNRIs if needed

Question 18

what is social phobia/ social anxiety disorder

Answer 18

fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others

fear of embarrassing and humiliating themselves

Question 19

social anxiety symptoms

Answer 19

• blushing or shaking
• fear of vomiting
• urgency or fear of micturition or defecation

Question 20

when does social anxiety/phobia come on

Answer 20

childhood - leads to poor school performance, school refusal, poor employment history

Question 21

how do you treat social phobia

Answer 21

CBT
SSRIs/SNRIs

benzodizepeins (short term)

Question 22

what is OCD

Answer 22

Recurrent obsessional thoughts and/or compulsive acts

obsessional thoughts

• ideas, images, impulses entering the mind in a stereotyped way
• recognised as the patients own thoughts
• but unpleasant, resisted and ego-dystonic

compulsive acts

• repeated behaviours to make the thought go away
• not enjoyable or functional
• ‘magical’ thinking
• recognised as irrational and pointless

Question 23

OCD criteria

Answer 23

Obsessional symptoms or compulsive acts must be persistent for most days for at least 2 weeks and be a source of distress and interference with activities

• obsessions must be individuals own thoughts
• resistance must be present
• rituals are not pleasant
• obsessional thoughts/images/impulses must be competitive

Question 24

treatment of OCD

Answer 24

Cognitive behavioural therapy
-including response prevention

SSRIs/Clomiparmine

Question 25

benzodiazepines and anxiety

Answer 25

Benzodiazepines enhance the effect of GABA this slows down the firing of neurones? rapid action, well tolerates, efficacious but: - sedation and psychomotor impairment - discontinuation/withdrawal problems - dependency and abuse - alcohol interaction - can worsen co-morbid depression