Anxiety Disorders

Question 1

What does an individual’s response to stress depend on?

Answer 1

Cognitive processing of any perceived threat and perceived ability to cope with threat

Question 2

What are the two kinds of coping and how do they differ?

Answer 2

Problem focussed - dealing modifying with the stressor

Emotion focussed - modifying emotions towards the stressor, e.g. denial or relaxation therapy

Question 3

What are the groups of symptoms in anxiety disorders?

Answer 3

Muscle tension - MORE
Sleep disturbance - SAD 
Psychological arousal - PEOPLE
Hyperventilation - HAVE 
Autonomic arousal - ANXIETY

Question 4

What is the model describing that the right amount of stress is helpful?

Answer 4

Yerkes-Dodson Curve

Too little stress leads to sleep, low alertness etc., too much leads to anxiety and disorganisation

Question 5

What symptoms are included within the psychological arousal symptom group?

Answer 5

Irritability
Sensitivity to noise
Poor concentration 
Fearful anticipation 
Worrying thoughts

Question 6

What symptoms are included within the autonomic arousal symptom group?

Answer 6

GI - nausea/loose stools/wind/dyspepsia/dry mouth/difficulty swallowing
Resp - tight chest, difficulty inhaling
CV - palpitations/missed beats/chest pain
GU - urinary frequency/urgency/erectile dysfunction/a/dysmenorrhoea
CNS - dizziness, sweating

Question 7

What symptoms are included within the muscle tension symptom group?

Answer 7

Tremor
Muscle cramps
Headache

Question 8

What symptoms are included within the hyperventilation symptom group?

Answer 8

Hypocapnia
Tingling fingers (may lead to carpopedal spasm (intense muscle pain in hands/feet)
Breathlessness

Question 9

What symptoms are included within the sleep disturbance symptom group?

Answer 9

Initial insomnia
Frequent waking
Night terrors/nightmares

Question 10

What is the differences between phobic and generalised anxiety?

Answer 10

Same symptoms that occur but GAD occurs persistently and anxiety is not confined to a particular object/situation, whereas phobic anxiety is

Question 11

What are the three most clinically relevant phobic anxieties?

Answer 11

Agoraphobia
Social phobia
Specific phobias

Question 12

What is agoraphobia?

Answer 12

Fear of being in situations where escape/seeking help would be difficult

Question 13

What is social phobia?

Answer 13

Inappropriate anxiety in a situation where the person feels observed/criticised

Question 14

What are specific phobias?

Answer 14

Intense, persistent fear of a particular object/situation

Question 15

How do you diagnose GAD?

Answer 15

Persistent (>6m) anxiety symptoms not confined to a situation/object

Question 16

What are differential diagnoses for anxiety conditions?

Answer 16

Psychiatric - depression, schizophrenia, substance misuse, dementia
Physical - phaeochromocytoma, thyrotoxicosis, asthma/arrhythmias, hypoglycaemia

Question 17

What is the 1 year prevalence of GAD?

Answer 17

4.4%

Question 18

Which gender is most affected by GAD?

Answer 18

Woman

Question 19

What causes GAD?

Answer 19

Caused by a stressor acting on a personality predisposed to the disorder by genetic and environmental influences in childhood

Question 20

How do you manage GAD?

Answer 20

Counselling - advice (re caffeine, alcohol, exercise), education, planning management
Relaxation training
Medication - sedatives/SSRIs/TCAs
CBT

Question 21

What are the key features of phobic anxiety?

Answer 21

Same features as GAD but only in specific circumstances
Avoidance of these circumstances = phobic avoidance
Anxiety in perceived threat of encountering object/situation = anticipatory anxiety

Question 22

What are the main symptoms of social phobia?

Answer 22

Blushing and tremor

Question 23

How do you manage social phobia?

Answer 23

CBT addressing fear of criticism, challenging negative view of self, safety barriers, unrealistic exceptions, excessive self-monitoring
Education and advice
SSRIs

Question 24

What are the core features of OCD?

Answer 24

Recurrent obsessional thoughts and compulsive acts

Question 25

What are the obsessional thoughts in OCD?

Answer 25

Ideas, images, impulses Not willed, repeated Unpleasant/intrusive/violent/obscene RECOGNISED AS INDIVIDUALS OWN THOUGHTS

Question 26

What causes anxiety in OCD?

Answer 26

Distress of thoughts or attempting to resist compulsions

Question 27

What are the compulsions like in OCD?

Answer 27

Stereotypical behaviours repeated over and over | Not enjoyable/helpful

Question 28

How does the sufferer tend to view their compulsions in OCD?

Answer 28

As a way of preventing harm to self or others | As pointless and they get symptoms of anxiety when trying to resist them

Question 29

What is the prevalence of OCD?

Answer 29

2%

Question 30

Which gender is OCD affect more?

Answer 30

Equally

Question 31

What is the aetiology of OCD?

Answer 31

Genetic abnormality in gene coding from 5HT receptor --> 5HT function abnormality

Question 32

How do you manage OCD?

Answer 32

Rule out depression Education, advice, involve family Serotonergic drugs, e.g. fluoxetine, clomperamine CBT (graded exposure, response prevention, weakening convictions)

Question 33

What is PTSD?

Answer 33

Delayed/protracted reaction to stressor of exceptional severity

Question 34

What may be stressors causing PTSD?

Answer 34

``` Combat Assault Rape Natural/human caused disasters Torturing Witnessing the above ```

Question 35

What are the three key elements of PTSD?

Answer 35

Hyperarousal Avoidance of reminders Re-experiencing phenomena

Question 36

What is included in hyperarousal in PTSD?

Answer 36

Irritability Poor concentration Persistent anxiety Insomnia

Question 37

What is included in re-experiencing phenomena in PTSD?

Answer 37

Nightmares/flashbacks

Question 38

What is involved in avoidance of reminders in PTSD?

Answer 38

Emotional numbness Cue avoidance Difficulty recalling Diminished interests

Question 39

Which gender does PTSD affect more?

Answer 39

2x more woman

Question 40

What is the aetiology of PTSD?

Answer 40

Nature of stressor - more lifethreatening/more exposure --> greater risk (vulnerability/protective factors) Some genetic susceptibility

Question 41

What are the vulnerability factors for PTSD?

Answer 41

Mood disorder Prev trauma, esp in childhood Lack of social support Female

Question 42

What are the protective factors for PTSD?

Answer 42

Higher educational attainment/social group | Good paternal relationship

Question 43

How do you manage PTSD?

Answer 43

Trauma focused CBT Eye movement desensitisation and reprocessing SSRI/TCA

Question 44

How is it made sure that we catch PTSD in at risk populations?

Answer 44

Survivors of disasters screened monthly | If mild symptoms - watch and review next month