Anxiety

Question 1

What is the management for generalised anxiety disorder (GAD)?

Answer 1

Step 1:
Eduction about GAD and active monitoring

Step 2:
Low intensity psychological interventions (individual guided self-help or psychoeducational groups)

Step 3:
High intensity psychological interventions (CBT or applied relaxation) or drug treatments

Step 4:
Highly specialist input

Drug treatment:
SSRI
SNRI
Pregablin
Buspirone
Beta-blocker

Avoid benzodiazepines due to highly addictive and tolerance-building effects. Only give for special occasions of anxiety

Question 2

What is the management for panic disorder?

Answer 2

Step 1:
Recognition and diagnosis

Step 2:
Either CBT or drug treatment
1st line = SSRIs
If no effect, try the TCAs imipramine or clomipramine

Step 3:
Review and consider alternative treatments

Step 4:
Review and refer to specialist MHS

Step 5:
Care in specialist MHS

Question 3

What is the management of OCD?

Answer 3

If functional impairment is mild:
Low intensity psychological treatment - CBT and exposure and response prevention (ERP)
If insufficient then offer SSRI or more intensive CBT + ERP

If moderate functional impairment:
Either any SSRI (give fluoxetine if body dysmorphic disorder) or more intensive CBT + ERP

If severe functional impairment:
Combined treatment with an SSRI and CBT + ERP

Question 4

What are the features of PTSD?

Answer 4

Mnemonic HARD:
Hyperarousal
Avoidance
Re-experiencing - flashbacks, nightmares
Distress

Question 5

What is the management for PTSD?

Answer 5

Mild symptoms lasting < 4 weeks:
Watchful waiting

Severe cases:
Trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR) therapy

Drug treatment not 1st line but can try venlafaxine or SSRIs (e.g. sertraline). In severe cases, can use risperidone