Anxiety Disorders

Question 1

Three models of stress

Answer 1

Biomechanical Engineering
Medicophysiological
Psychological

Question 2

Psychological (transactional) model of stress

Answer 2

An individuals reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope. It tends to be problem or emotionally focussed.

Question 3

Problem focussed coping

Answer 3

When efforts are directed toward modifying stressor. Preparation, studying or interview practice are some examples.

Question 4

Emotion focussed coping

Answer 4

Modify emotional reaction. Mental defence mechanisms (denial), taking a sedative drug.

Question 5

Symptom groups of anxiety disorder due to flight or fight response

Answer 5

Psychological arousal

Autonomic Arousal

Muscle Tension

Hyperventilation

Sleep Disturbance

Question 6

Psychological arousal

Answer 6

Fearful anticipation
Irritability 
Sensitivity to noise
Poor concentration 
Worrying thoughts

Question 7

GI autonomical arousal symptoms

Answer 7

Dry mouth
Swallowing difficulties
Dyspepsia, nausea and wind
Frequent loose motions

Question 8

Respiratory autonomic arousal symptoms

Answer 8

Tight chest, difficulty inhaling

Question 9

CVS autonomical arousal symptoms

Answer 9

Palpitations, chest pain

Question 10

Urinary autonomic arousal symptoms

Answer 10

Increased frequency and urgency
Amenorrhoea/dysmenorrhoea
Erectile failure

Question 11

CNS autonimic arousal symptoms

Answer 11

Dizziness and sweating

Question 12

Muscle tension symptoms

Answer 12

Tremor, headache, muscle pain

Question 13

Hyperventilation symptoms

Answer 13

Causing CO2 deficit hypocapnia
Numbness tingling in the extremities may lead to carpopedal spasm
Breatlessness

Question 14

Sleep disturbance symptoms

Answer 14

Initial insomnia
Frequent waking
Nightmares and night terrors

Question 15

Generalise anxiety disorder

Answer 15

Persistent symptoms not confined to a situation or object. The symptoms can incur all of the symptom groups of anxiety.

Question 16

Psychiatric differential diagnosis of anxiety disorders

Answer 16

Depression, schizophrenia, dementia, substance misuse

Question 17

Physical conditions differential diagnosis of anxiety disorders

Answer 17

Thyrotoxicosis
Phaeochromoctoma
Hypoglycaemia
Asthma and or Arrhythmias

Question 18

Epidemiology of Generalised anxiety disroder

Answer 18

One year prevalence of 4.4% and tends to affect more women than men

Question 19

Cause of generalised anxiety disorders

Answer 19

Stressor acting on a personality predisposed to the disorder by a combination of genetic factors and environmental influences in childhood.

Question 20

Management of generalised anxiety disorders

Answer 20

Counselling, relaxation training, medication (sedatives or antidepressants), CBT

Question 21

CBT generalised anxiety disorder

Answer 21

Identifying errors, reprocessing and reassessing responsibility are the key elements.

Question 22

Key features of phobic anxiety disorders

Answer 22

Same symptoms as generalised anxiety disorder but it only occurs in specific circumstances. The patient will behave in a way that avoids these circumstances (phobic avoidance). The sufferer also experiences anxiety if there is a perceived threat of encountering the feared object or situation

Question 23

Specific phobias

Answer 23

When symptoms of anxiety are produced by an object or a situation the patient is frightened of

Question 24

Social phobia

Answer 24

Inappropriate anxiety in a situation where a person feels observed or could be criticised (rests, shops, public speaking). Symptoms are of any of the anxiety clusters mentioned but blushing and tremor can predominate.

Question 25

Management of social phobia

Answer 25

CBT addressing the groundless fear of criticism, education and advice, SSRI antidepressants

Question 26

Core features of Obsessive Compulsive Disorder

Answer 26

Experience of recurrent obsessional thoughts or complusive acts.

Question 27

Obsessive thoughts

Answer 27

Ideas, images or impulses Occurring repeatedly not willed Unpleasant and distressing (often the antithesis of personality type) Obscene Violent or senseless Recognised as the individual’s own thoughts Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist

Question 28

Compulsive Acts or Rituals

Answer 28

These are stereotypical behaviours repeated again and again. They are often viewed by the sufferer as preventing some harm to self or others. Viewed as pointless and resisted but key anxiety symptoms arise when resistance occurs.

Question 29

Epidemiology of OCD

Answer 29

yearly prevalence is 2%

Question 30

Aetiological theory of OCD

Answer 30

Genetic (gene coding for 5HT receptors), 5HT function abnormalities

Question 31

Management of OCD

Answer 31

Education and explanation, SSRI (fluoxetine), clomipramine, CBT (exposure and response prevention), psychosurgery

Question 32

Post Traumatic Stress Disorder

Answer 32

Delayed and or protracted reaction to a stressor of exceptional severity.

Question 33

Three key elements to reaction in PTSD

Answer 33

Hyperarousal, re-experiencing phenomena and avoidance of all reminders

Question 34

Hyperarousal

Answer 34

Persistent anxiety Irritability Insomnia Poor concentration

Question 35

Re-experiencing phenomena

Answer 35

Flashbacks when awake | Nightmares during sleep

Question 36

Avoidance

Answer 36

Emotional numbness Cue avoidance Recall difficulties Diminishes interests

Question 37

Epidemiology of PTSD

Answer 37

1-4% prevelance women suffer 2:1

Question 38

Vulnerability factors for PTSD

Answer 38

Mood disorder Previous trauma especially as child Lack of social support Female

Question 39

Management of PTSD

Answer 39

Survivors of disasters screened at one month Mild symptoms “watchful waiting” and review further month Trauma-focused CBT if more severe symptoms Eye Movement Desensitisation and Reprocessing Risk of dependence with any sedatives but patient may prefer medication SSRI or TCA