Anxiety

Question 1

what are the components of anxiety

Answer 1

physical/biological
cognitive
behavioural

Question 2

list biological/physical symptoms of anxiety

Answer 2

tremor/shaking
difficulty breathing 
tight chest 
tingling/numbness 
muscle aches/tension 
headache
palpitations 
hyperventilation dizziness
dry mouth 
nausea 
sweating 
flushing 
globus hystericus

Question 3

list cognitive symptoms of anxiety

Answer 3

fear of losing control and feeling on edge 
meta worry 
difficulty concentrating 
depersonalisation 
derealisation 
hypervigilance
preference for order and routine 
racing thoughts hypochondriosis

Question 4

list behavioural symptoms of anxiety

Answer 4

avoidance
social isolation 
alcohol/drug misuse
checking behaviours exaggerated startle response
restlessness 
irritability 
seeking reassurance

Question 5

list the anxiety disorders

Answer 5

Generalised anxiety disorder GAD
Panic disorder
Agoraphobia 
Social phobia
Specific phobias 
Obsessive Compulsive Disorders OCD

Question 6

what is GAD

Answer 6

generalised and persistent anxiety
“free floating”
worried about lots of different things
not due to any substance misuse or any other medical condition

Question 7

epidemiology of GAD

Answer 7

onset 20-40 yo
chronic fluctuating course
F>M
a lot of comorbidity

Question 8

management of GAD

Answer 8

1st = CBT

SSRI/SNRI, pregabalin, BZD

Question 9

when can benzodiazepines be given for anxiety disorders

Answer 9

acutely only!

for symptomatic relief

Question 10

how severe should symptoms be for it to be classified as GAD

Answer 10

long lasting - most days for 6 months
not controllable
causes significant distress and impairment in function

Question 11

what is CBT based on

Answer 11

identifying an individual’s automatic thoughts, cognitive biases and schemas and helping to identify own thoughts, assumptions, misinterpretations which perpetuate the anxiety

Question 12

what is panic disorder

Answer 12

recurrent attacks of severe anxiety due to an unpredictable trigger

Question 13

in panic disorder there is often a secondary fear of dying, losing control or going mad, true or false

Answer 13

true

Question 14

epidemiology of panic disorder

Answer 14

onset late teens-30s
comorbidities
chronic

Question 15

management of panic disorder

Answer 15

1st = CBT
SSRI/SNRI/tricyclics
BZD short term

Question 16

when is the onset of phobias and in what order

Answer 16

early onset
social and specific phobias = really early
agoraphobia = early

Question 17

what is agoraphobia

Answer 17

fear of public spaces

Question 18

what is the main feature of agoraphobia

Answer 18

avoidance is prominent

Question 19

what is a specific phobia

Answer 19

marked persistent fear that is excessive and unreasonable from the presence of something specific

Question 20

what is the difference between a phobia and just being scared of something

Answer 20

someone with a phobia recognises their fear is irrational

Question 21

features of specific phobia

Answer 21

exposure to stimulus provokes anxiety response
person recognises fear is irrational
avoidance symptoms
impaired normal functioning

Question 22

management of specific phobias

Answer 22

1st = behavioural therapy + exposure
Graded exposure/systematic desensitisation
if needed: 
CBT
SSRI/SNRI

Question 23

what is social phobia/social anxiety disorder

Answer 23

fear of social scrutiny

fear of acting in a way that is embarrassing

Question 24

features of social phobia

Answer 24

blushing 
shaking 
fear of vomiting
fear of micturition/defaecation 
poor school/employment performance
avoid new situations

Question 25

management of social phobia

Answer 25

1st = CBT SSRI/SNRI BZD

Question 26

what is obsessive compulsive disorder OCD

Answer 26

recurrent obsessional thoughts +- compulsive acts

Question 27

features of obsessional thoughts in OCD

Answer 27

ego-dystonic ie cause discomfort thinking about them | recognised as the patient's own thoughts

Question 28

features of compulsive acts in OCD

Answer 28

repeated rituals or stereotyped behaviours not enjoyable or functional recognised as pointless "if I keep doing x, prevents something bad happening"

Question 29

what are some common obsessions in OCD

Answer 29

``` contamination + dirt harm order + symmetry health sexual thoughts hoarding violence ```

Question 30

what are some common compulsions in OCD

Answer 30

``` checking cleaning + washing repeating acts mental compulsions - words or prayers ordering + symmetry collecting counting ```

Question 31

comorbidities with OCD

Answer 31

``` Tourettes Schizophrenia tic disorders body dysmorphic disorder eating disorders trichtillomania ```

Question 32

Management of OCD

Answer 32

1st = CBT including response prevention | SSRIs / clomipramine

Question 33

criteria of OCD

Answer 33

present for most days for at least 2 weeks AND must be a source of distress obsessions must be own thoughts + repetitive resistance must be present rituals are NOT pleasant

Question 34

what class of drug are benzodiazepines and what is their mechanism fo action

Answer 34

anxiolytics GABA agonist (promote inhibitor effects of GABA) Also anticonvulsants

Question 35

agonising GABA results in influx of which ion

Answer 35

Cl- influx and hyperpolarisation

Question 36

Benzodiazepines can be used long term, true or false

Answer 36

FALSE | only short term/acutely

Question 37

side effects of benzodiazepines

Answer 37

``` addiction + abuse sedation psychomotor impairment alcohol interaction can worsen co-morbid depression ```

Question 38

heretibility is/is not significant in OCD

Answer 38

is significant

Question 39

what is a rumination and in which condition is it seen

Answer 39

repetition of same thought in your head over and over again | OCD