Anxiety disorders

Question 1

OVERVIEW

i) how are anxiety disorders categorised by frequency? name two types in each category

ii) what is it likely to be if the triggers are:
a) there all the time
b) cant tell - it just happens
c) something specific
d) public speaking
e) trapped or unable to escape
f) obsessions or compulsions
g) excessive worry about body

Answer 1

i) continous (always there) - GAD and PTSD
episodic (happen at spec time) - panic, spec phobia, social phobia, agoraphobia, OCD, acute stress reaction

a) GAD
b) panic disorder
c) specific phobia
d) social phobia
e) agoraphobia
f) OCD
g) body dysmorphia

Question 2

FEATURES OF ANXIETY

i) what is the key feature of most anxiety disorders? why is this bad?
ii) name four organic causes of anx
iii) name two medications that can cause it

Answer 2

i) avoidance - can reinforce the anxiety and be debilitating
ii) PCT, hyperthyroid, hypoparathyroid, caffiene, substance misuse,

iii) asthma drugs eg salbutamol, theophylline
steroids

Question 3

GENERALISED ANXIETY DISORDER

i) how is it characterised? is it associated with something in particular?
ii) how frequent is it present for?
iii) name three things there are elements of

Answer 3

i) generalised and persistent
- not assoc with anything in particular

ii) present for most days for at least severeal weeks at a time

iii) elements of apprehension (worry about future and feel on edge), motor tension (restless, figit, cant relax)
autonomic overactivity

Question 4

PANIC DISORDER

i) how is it charac?
ii) how quickly do symptoms come on? how may a sufferer feel when it happens?
iii) which two medical conds can it be mistaken for? how long does it usually last

Answer 4

i) charac by recurrent unpredictable severe panic attacks
ii) comes on suddenely and mau feel like they are goingt o die

iii) mistaken for MI or asthma attack
- usually lasts for mins

Question 5

SPECIFIC PHOBIA

i) what is it? what does it lead to?
ii) name three examples

Answer 5

i) marked and excessive anx occurs on exposure or anticipation to object or situation
- leads to signif distress and impairment in function

ii) animals, flying, heights, blood

Question 6

SOCIAL PHOBIA

i) when does it often begin? what is it a fear of?
ii) what is avoided? how may the person appear?

AGORAPHOBIA

i) what is it? give an example
ii) what can it lead to

Answer 6

i) begins in adolescence - fear of scrutiny or criticism

ii) avoid social situations
- blushing, sweating, tremor, stutter

i) fear of a situation where escape may be difficult
eg entering shops or using public transport

ii) can lead to housebound and social isolation

Question 7

OCD

i) what is an obsession?
ii) what is a compulsion?
iii) name three characs of obsessional thoughts? are they recognised as own?
iv) name three characs of compulsive acts

Answer 7

i) obsession - unwanted and unpleasant thought, image or urge that enters mind causing feelings of anx, disgust or unease
- can be religious, sexual, violent, hygiene

ii) compulsion is a repeititive behaviour or mental act that needs to be done to temp relieve the unpleasant feelings from an obsessive thought
- cleaning, checking, rituals eg handwashing or closing doors

iii) obsessional thoughts - recog as own, intrusive and source of disrtress, pt tries to resist them unsucessfully
iv) compulsive acts - may interfere with acitiity, doing them doesnt bring permanent relief and acting on them isnt pleasureable

Question 8

BODY DYSMORPHIC DISORDER

i) what is it?
ii) what does the person enagage in?

Answer 8

i) persistent pre occupation with one or more percoeved defects or flaws in appearance
ii) engage in repetitive behacs eg checking, examining appearnce, covering up

Question 9

ACUTE STRESS REACTION

i) what is it?
ii) how quick to symptoms appear? how quick do they go away?

Answer 9

i) transient disorder of significant severity in response to an exceptional physical or mental stress

ii) symps appear within mins of the stressor and resolve rapidly (hours or days)
- no one type of symptom predominates for long

Question 10

PTSD

i) what is it? what happens during it?
ii) name three symptoms?
iii) what characterises state of hyperarousal? how is sleep affected?
iv) what is the initial treatment? why?
v) what can worsen outcomes

Answer 10

i) delayed response to an exceptionally stressful event
_ repeated relieving tratma - flashbacks, intrusive memories or nightmares

ii) numb, emotional blunting, remisinicing trauma

iii) hypervigilance and exaggerated startle response
- get insomnia

iv) resolves over time so intiial tx is watch and wait
- evidence that debrief straight after intial trauma is harmful and worsens outcomes

Question 11

TREATMENT

i) what pharma tx is first line for pTSD ? what is it most effective with?
ii) what is second line? what care needs to be taken with benzos
iii) what are all psychotherapy techniques based on? what is initially given?
iv) name a psychological approach that can be taken in phobia, PTSD and OCD
v) name three social interventions for anx

Answer 11

i) SSRI with psychotherapy
ii) SNRI, then imipramine, pregabalin, clomipramine - equally efficacious but less well tol than SSRIs
iii) based on CBT - intiialy give counselling, self help, relax techniques

iv) phobia - exposure therapy
trauma focused CBT - PTSD
expsure and response prevention - OCD

can also do EMDR in PTSD

v) sleep hygiene, diet, exercise, breathing, mindfulness, distraction techniques, peer support