Anxiety disorders

Question 1

DSM 5 of GAD

Answer 1

• not proportionate to the situation or event
• more days than note for > 6 months
• RE: a number of events or activites

1. restlessness, ‘on edge’
2. easily fatigued
3. difficulty concentrating/ ‘mind goes blank’
4. irritability
5. muscle tension
6. sleep disturbance (difficulty falling asleep, staying asleep or restless, unsatisfied sleep)

Question 2

Outline the Mx of GAD

Answer 2

1. RISK ASSESSMENT - always consider dx co-morbid depression
2. Every patient requires
   - monitoring
   - education
   - lifestyle review
   - supportive counselling
3. PSYCHOEDUCATION - for pt and significant others
   • outline nature of illness
   • supports and community resources
   • treatment options
4. Lifestyle review
   - review of relationships, stress levels, work, sleep, diet, caffeine + EtOH use
   - avoiding stimulants e.g.: caffeine, nicotine
   - encourage good hygiene, nutrition, exercise
   - alternative coping strategies to EtOH/substance use
   - self-help: meditation, relaxation, breathing techniques, distraction techniques
5. PSYCHOTHERAPY
   - CBT: challenging negative thought patterns, structured problem solving, mindfulness, cognitive reframing and graded exposure
   - relaxation therapy/mindfulness
   - activity scheduling
   - graded exposure therapy

5. Consider DRUG THERAPY
• SSRI: escitalopram, fluoxetine, fluvoxamine,(normally lower doses than fro depression)
• SNRI: duloxetine
- 12 weeks for response
• beta blockers for physical symptoms

6. Consider benzo for acute exacerbations

Question 3

When are BENZODIAZEPINES indicated for Mx of anxiety disorders?

Answer 3

• limited to short term use for ACUTE EXACERBATIONS of GAD who have not responded to psychological Tx or anti-depressants
• because of their high addictive potential, shouldn’t be prescribed to pt w Hx of EtOH or other substance addiction
• reduce gradually to avoid discontinuation reaction

Question 4

Adverse effects and drug interactions when using BENZOS

Answer 4

• dependence/tolerance
• sedation
• withdrawal syndrome
• interaction w EtOH/other drugs
• depression
• confusion in the elderly
• overdose

Question 5

DSM 5 OCD

Answer 5

[A] Presence of obsessions, compulsions or both:

OBSESSIONS

• recurrent + persistent thoughts, urges or images
• intrusive, unwanted (causes marked anxiety or distressed in most)
• individual attempts to ignore or suppress with another thought or action i.e.: by performing a compulsion

COMPULSIONS

• repetitive & intentional behaviours or mental acts performed in response to obsessions or according to certain rule the must be applied rigidly
• behaviours/mental acts aimed at:
  1) neutralise or reduce pt anxiety/distress
  2) prevent dreaded event/situation
• rituals not connected in a realistic way with what they are designed to neutralise or prevent OR are clearly excessive

eg: GAD, body dysmorphia, hoarding disorder, trichotillomania, illness anxiety disorder etc