Anxiety related disorders

Question 1

Give 5 symptoms of anxiety

Answer 1

• Rumination
• fatigue, irritable
• restlessness, inner tension and worry
• Derealisation and depersonalisation
• Physical symptoms - palpatations, sweating, shaking, hot flushes, hyperventilation, numbness, choking, chest pain

Question 2

What does stress do to our body?

Answer 2

• HPA axis - cortisol
• direct sympathetics
• Pro-inflammatory (cytokines)
• Reduced neurotrophin (BDNF) - small hippocampus, reduced neurogenesis

Question 3

What history do we take for anxiety disorders?

Answer 3

• predisposing factors
• describe anxiety symptoms
• what triggered the episode?
• what was the response to the episode?
• has it affected: sleep, social functioning, alcohol intake

Question 4

What is generalised anxiety disorder?

Answer 4

• freefloating anxiety disorder - not necessarily triggered by things
• excessive anxiety and worry occurring more days than not, for 6 months
• associated with restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance.

Question 5

How does the DSM-IV define specific phobias?

Answer 5

• excessive unreasonable fear, by presence or anticipation of a specific object or situation
• exposure provokes anxiety attacks
• interferes with life

Question 6

What is agoraphobia?

Answer 6

• fear of open or public places

- places where escape is difficult

Question 7

What is social anxiety disorder?

Answer 7

• fear of scruitny or criticism by others
• avoidance of social situations
• may present with blushing, hand tremor, nausea
• low self-esteem
• may progress to panic attacks

Question 8

What is the SAD triad?

Answer 8

• fear of focus of attention
• fear of behaving in embarrassing or humiliating manner
• avoidance

Question 9

What is OCD?

Answer 9

• obsessions - unwanted, disturbing and intrusive thoughts/images/impulses - excessive or irrational
• compulsions - repetitive behaviours and mental acts - neutralise obsessions and reduce emotional distress
• find a trick that allows you to instantly stop feeling anxious

Question 10

What do NICE guidelines say the process of treatment should be?

Answer 10

Identification and assessment -> low intensity psych interventions -> high intensity or drug treatment -> highly specialist treatment

Question 11

What treatments are there?

Answer 11

• Antidepressants - SSRIs, MAOIs
• Sedatives - promethazine, Z-drugs, BZDs
• Propanolol
• CBT
• Sustained exposure
• Systematic desensitisation