Anxiety

Question 1

what is anxiety?

Answer 1

excessive worrying and nervousness around a situation that is not usually stressful

Question 2

what hormones does the stress response release?

Answer 2

catecholamines

cortisol

Question 3

physical symptoms of anxiety

Answer 3

sweating
trembling
dizzy, faint
dry mouth, choking sensation
chest pain
nausea
abdominal discomfort

Question 4

cognitive symptoms of anxiety

Answer 4

losing control
mentally tense
difficulty concentrating
derealisation
depersonalisation
racing thoughts
meta-worry
preference for order and routine

Question 5

behavioural symptoms of anxiety

Answer 5

avoidance
exaggerated startle response
difficulty sleeping
restlessness

Question 6

types of anxiety disorders

Answer 6

1. generalised anxiety disorder
2. panic disorder
3. phobias= agoraphobia, social phobia, specific phobia
4. obsessive compulsive disorder (OCD)

Question 7

define generalised anxiety disorder

Answer 7

persistent and generalised anxiety not restricted to any particular environment

Question 8

what do you need to rule out in generalised anxiety disorder?

Answer 8

substance misuse
medical conditions (hyperthyroidism)

Question 9

how often does generalised anxiety disorder need to happen?

Answer 9

most days for at least 6 months

Question 10

who gets generalised anxiety disorder?

Answer 10

2:1 females

20-40

Question 11

management of generalised anxiety disorder

Answer 11

CBT/ self-help/ psychoeducation
SSRIs/SNRIs
pregabalin
BZDs

Question 12

what is panic disorder?

Answer 12

recurrent attacks of severe panic not restricted to any setting or circumstance

Question 13

what can panic disorder occur with?

Answer 13

agoraphobia

Question 14

what needs to be ruled out in panic disorder?

Answer 14

substance misuse
medical conditions (caffeine intoxication, hyperthyroidism)

Question 15

commonest age for panic disorder?

Answer 15

mid-30s

Question 16

management of panic disorder

Answer 16

self-help/ CBT
SSRIs/ SNRIs/ tricyclics
BZDs (short-term only)

Question 17

what medications should be avoided in panic disorder

Answer 17

sedating antihistamines
BZDs
beta blockers
buspirone
bupropion

Question 18

describe phobias

Answer 18

early onset
recognise fear as irrational
typified by avoidance

Question 19

what is agoraphobia

Answer 19

fear of open spaces

Question 20

presentation of agoraphobia

Answer 20

avoidance is predominant with never leaving the house

Question 21

what is social phobia?

Answer 21

fear of social situations with the possibility for scrutiny by others

Question 22

what can social phobia result in?

Answer 22

poor school and employment performance

Question 23

management of social phobia

Answer 23

CBT
SSRIs/SNRIs
MAOI (moclobemide)
BZDs

Question 24

define a specific phobia

Answer 24

marked and persistent fear that is excessive to specific object or situation

Question 25

presentation of specific phobia

Answer 25

exposure promotes anxiety response | recognises fear is excessive and often avoid

Question 26

management of specific phobia

Answer 26

behavioural therapy with graded exposure, can include CBT | SSRIs/SNRIs if required

Question 27

what is OCD?

Answer 27

ideas and thoughts entering the head in a stereotyped way leading to repeated, unenjoyable rituals that are recognised as pointless

Question 28

presentation of OCD

Answer 28

symptoms must be present for at least 2 weeks | most experience 1 major depressive episode

Question 29

management of OCD

Answer 29

CBT, including response prevention SSRIs/ clomipramine augmentation with antipsychotic

Question 30

when are beta blockers used in anxiety?

Answer 30

somatic symptoms e.g. palpitations, tremor

Question 31

action of BZDs

Answer 31

target the GABA-A receptor making the channel more permeable to Cl- influx when GABA binds

Question 32

what does the Cl- influx in the GABA channel cause?

Answer 32

hyperpolarisation inhibiting AP

Question 33

problems with BZDs when used over 2 weeks

Answer 33

- sedation - withdrawal, dependency, abuse - alcohol interaction

Question 34

other binding sites of the GABA

Answer 34

barbiturate general anaesthetic BZD GABA site

Question 35

examples of BZDs

Answer 35

lorazepam diazepam chlordiazepoxide

Question 36

what do BZDs do?

Answer 36

reduce anxiety sedation muscle relaxation anticonvulsant effect

Question 37

risks in use of BZDs

Answer 37

paradoxical aggression anterograde amnesia dependence

Question 38

presentation of BZDs withdrawal

Answer 38

``` abdominal cramps panic attacks chest pain sweating blurred vision dizziness headaches N&V ```

Question 39

what causes withdrawal in use of BZDs?

Answer 39

rapid removal and neuroadaption of the GABA response

Question 40

define derealisation

Answer 40

world is not real around you

Question 41

define depersonalisation

Answer 41

detached from self