Anxiety Disorders

Question 1

name 3 models of stress

Answer 1

biomechanical engineering
medicophysiological
psychological (transactional)

Question 2

name two ways of coping with psychological stress

Answer 2

problem focussed

emotion focussed

Question 3

symptom groups of flight or fight response

Answer 3

psychological arousal
autonomic arousal
muscle tension
hyperventilation
sleep disturbance

Question 4

features psychological arousal stress response

Answer 4

fearful anticipation
irritability
sensitivity to noise
poor concentration
worrying thoughts

Question 5

features autonomic arousal stress response - GI

Answer 5

dry mouth, swallowing difficulties, dyspepsia, nausea, wind, frequent loose motions

Question 6

features autonomic arousal stress response - respiratory

Answer 6

tight chest

difficulty inhaling

Question 7

features autonomic arousal stress response - CV

Answer 7

palpitations/missed beats

chest pain

Question 8

features autonomic arousal stress response - GU

Answer 8

frequency
urgency
amenorrhoea/dysmenorrhoea
erectile failure

Question 9

features autonomic arousal stress response - CNS

Answer 9

dizziness and sweating

Question 10

features of muscle tension in a stress response

Answer 10

tremor
headache
muscle pain

Question 11

features of hyperventilation in a stress response

Answer 11

CO2 deficit hypocapnia
numbness and tingling in extremities may lead to carpopedal spasm
breathmessness

Question 12

features of sleep disturbance in a stress response

Answer 12

initial insomnia
frequent waking
nightmares and night terrors

Question 13

what is the difference between phobic anxiety disorders and GAD?

Answer 13

same core anxiety symptoms

occur in particular circumstances or persistently

Question 14

what is agoraphobia?

Answer 14

Agoraphobia is a type of anxiety disorder in which you fear and avoid places or situations that might
cause you to panic and make you feel trapped, helpless or embarrassed.

Question 15

what is social phobia?

Answer 15

This is inappropriate anxiety in a situation where a person feels observed or could be criticised e.g.
restaurants, shops, queues, public speaking. Symptoms are any of the anxiety cluster but blushing and
tremor predominate.

Question 16

define GAD

Answer 16

This is a persistent (several months) presence of symptoms that are not confined to a situation or
object. All the symptoms of human anxiety mentioned earlier can occur. Dominant sympoms are
variable but include tremor, palpitations, epigastric pain, worried thoughts, fear, trembling.

Question 17

list the psychiatric DDx for anxiety

Answer 17

depression
schizophrenia
dementia
substance misuse

Question 18

list the physical DDx for anxiety

Answer 18

thyrotoxicosis
pheochromocytoma
hypoglycaemia
asthma and or arrhythmias

Question 19

prevalence of GAD

Answer 19

4.4%

women > men

Question 20

management of GAD

Answer 20

counselling
relaxation training
medication
CBT

Question 21

counselling in GAD

Answer 21

clear plan of management
explanation and education
advice re caffeine, alcohol, exercise

Question 22

relaxation training in GAD

Answer 22

group or individual

DVDs, tapes or clinician led

Question 23

medication in GAD

Answer 23

SSRI or TCA

Question 24

define phobic anxiety disorders

Answer 24

Same core features as GAD but only in specific circumstances. The person behaves to avoid these
circumstances i.e. phobic avoidance. The sufferer also experiences anxiety if these is a perceived
threat of encountering the feared object or situation i.e. anticipatory anxiety.

Question 25

management of social phobia

Answer 25

CBT SSRI Education and advice

Question 26

what are the core features of OCD?

Answer 26

recurrent obsessional thoughts and or compulsive acts

Question 27

describe obsessional thoughts

Answer 27

ideas, images or impulses occurring repeatedly not willed unpleasant and distressing recognised as the individuals own thoughts usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist

Question 28

describe compulsive acts or rituals

Answer 28

sterotypical behaviours repeated again and a again not enjoyable not helpful often viewed by the sufferer as preventing some harm or pointless

Question 29

what is the prevalence of OCD?

Answer 29

2% | men=women

Question 30

name the theories of aetiology of OCD

Answer 30

abnormality in gene coding for 5HT receptors and 5HT function abnormalities

Question 31

management of OCD

Answer 31

education Serotonergic drugs - SSRI (fluoxetine), clomipramne CBT psychosurgery

Question 32

define PTSD

Answer 32

delayed and or protracted reaction to a stressor of exceptional severity i.e. would distress anyone

Question 33

to what events may people develop PTSD?

Answer 33

``` combat natural or human caused disaster rape assault tortue witnessing any ```

Question 34

3 key elements of PTSD

Answer 34

hyperarousal re-experiencing phenomena avoidance of reminders

Question 35

hyperarousal in PTSD

Answer 35

persistent anxiety irritability insomnia poor concentration

Question 36

re-experiencing phenomena in PTSD

Answer 36

intense intrusive images either flashbacks or nightmares

Question 37

avoidance of reminders in PTSD

Answer 37

emotional numbness cue avoidance recall difficulties diminishes interests

Question 38

M:F ratio in PTSD

Answer 38

M1:F2

Question 39

causes of PTSD

Answer 39

``` • Nature of stressor o Life threatening and degree of exposure generally confers greater risk however § Vulnerability factors • Mood disorder • Previous trauma especially as child • Lack of social support • Female § Protective factors • Higher education and social group • Good paternal relationship • Susceptibility is partly genetic ```

Question 40

management of PTSD

Answer 40

* NICE guidance ww.nice.org.uk * 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