Anxiety Disorders

Question 1

What is a simple explanation of anxiety and why it happens?

Answer 1

most likely pathological fear associated with things that should otherwise be pleasant resulting in avoidant/ fearful behaviour and/or thinking

Question 2

What are some examples of symptoms of anxiety?

Answer 2

• psychological arousal e.g. panic, fearful anticipation, irritability, poor concentration, worrying thoughts
• muscle tension (may present as tremor, headache or muscle pain)
• hyperventilation, breathlessness
• sleep disturbance-initial insomnia, frequent waking, nightmares and night terrors
• autonomic arousal e.g. not being able to keep calm, still, nausea, heart palpitations, dry mouth, cold, sweaty, numb or tingling hands and feet, frequency/urgency of micturition, amenorrhoea, dysmenorrhoea, erectile failure

Question 3

Why are phobic anxiety disorders and general anxiety disorder separate diagnosis and how do they differ?

Answer 3

have same core anxiety symptoms but they either occur in particular circumstances e.g. agoraphobia, social phobia (phobic anxiety disorders) OR occur persistently (generalised anxiety disorder)

Question 4

What would be included in a differential diagnosis of anxiety disorders?

Answer 4

• depression
• schizophrenia
• dementia
• substance misuse
• thyrotoxicosis
• phaechromocytoma
• hypoglycaemia
• asthma and or arrhythmias

Question 5

How are generalised anxiety disorders (Including panic disorder) managed?

Answer 5

• counselling
• relaxation training
• medication e.g. SSRI fluoxetine or TCA
• CBT

Question 6

What are the core features of obsessive compulsive disorder?

Answer 6

recurrent obsessional thoughts and/or compulsive acts

Question 7

How is OCD managed?

Answer 7

• good history and MSE to exclude treatable depressive illness
• education and explanation
• involvement of family/partner
• serotenergic drugs e.g. SSR fluoxetine or clomipamine
• CBT
• psychosurgery

Question 8

What is Post Traumatic Stress Disorder (PTSD)?

Answer 8

delayed and/or protracted reaction to a stressor of exceptional severity e.g. combat, rape, assault, torture etc

Question 9

What are three key elements to reaction in PTSD?

Answer 9

• hyperarousal
• re-experiencing phenomena e.g. flashbacks or nightmares
• avoidance of reminders (emotional numbness, cue avoidance, recall difficulties, diminishes interests)

Question 10

What are symptoms of hyperarousal in PTSD?

Answer 10

• persistent anxiety
• irritability
• insomnia
• poor concentration

Question 11

How can PTSD be managed?

Answer 11

• mild symptoms ‘‘watchful waiting’’
• trauma focussed CBT if more severe symptoms
• eye movement desensitisation
• antidepressant medications SSRI or TCA