1: Anxiety - generalised anxiety, panics and phobias

Question 1

What are some physical symptoms of anxiety?

Answer 1

Sweating; hot flushes; cold chills

Tremor

Sesnory disturbance e.g pararesthesia

Feeling faint

Dry mouth

Question 2

What are some cognitive symptoms of anxiety?

Answer 2

Fear of losing control

Feeling on edge

Difficulty concentrating

Hypervigilance

Meta-worry (worrying about worry)

Preference for order and routine

Question 3

What is derealisation?

Answer 3

A feeling that you’re not real

Question 4

What is hypervigilance?

Answer 4

Paying extreme attention to internal (e.g your heartbeat) or external (other people) factors

Question 5

What type of lifestyle do people with an anxiety disorder prefer?

Answer 5

Ordered

Routine

Question 6

What are some behavioural symptoms of anxiety?

Answer 6

Avoidance of certain situations

Exaggerated startle

Insomnia due to worrying

Excessive use of substances

Restlessness; inability to relax

Question 7

Which structure initially determines if a sensory stimulus requires a stress response?

Answer 7

Amygdala

Question 8

Which hormone regulates the stress response?

Which gland releases it?

Answer 8

Cortisol

Adrenal gland

Question 9

When is anxiety pathological?

Answer 9

Extreme symptoms

Context: anxiety is disproportionate to situation

Impairment of daily activities

Question 10

Which type of anxiety disorder has ever-present, non-specific symptoms?

What are some of these symptoms?

Answer 10

Generalised anxiety disorder

Sweating, tremor, feeling faint

Question 11

What are the symptoms of generalised anxiety disorder?

Answer 11

Nervousness

Tremor

Aches and pains

Sweating

Dizziness

Question 12

Generalised anxiety disorder presents as ___ worrying over no particular situation.

Answer 12

persistent

Question 13

What is an endocrine disease which causes anxiety?

Answer 13

Hyperthyroidism

Question 14

What are the criteria for diagnosing generalised anxiety disorder?

Answer 14

Long-lasting (most days for > 6 months)

Uncontrollable anxiety

Significant distress / impairment of function

Question 15

What percentage of the population will have generalised anxiety disorder?

Answer 15

10%

Question 16

Generalised anxiety disorder is more common in (men / women).

Answer 16

women

Question 17

Generalised anxiety disorder often presents with medically ___ symptoms.

Answer 17

medically unexplained symptoms

Question 18

90% of patients with GAD have other ___ disorders.

Answer 18

psychiatric

Question 19

How is GAD managed in the long term?

Answer 19

Cognitive behavioural therapy

SSRIs / SNRIs

Pregabalin

Question 20

Which class of drug can be used to control anxiety in the short term management of GAD?

Answer 20

Benzodiazepines

Question 21

What is panic?

Answer 21

Acute presentation of severe anxiety

Question 22

What is a panic disorder?

Answer 22

Recurrent, unpredictable episodes of panic

Question 23

Panic disorder is (predictable / unpredictable).

Answer 23

unpredictable

Question 24

What are some symptoms of panic disorder?

Answer 24

Palpitations

Chest pain

Derealisation

Dizziness

Question 25

What is **agoraphobia**?

Answer 25

**Fear of going outside or similar** - social situations, crowds etc.

Question 26

**GAD** and **panic disorder** can be caused by drugs or medical conditions like hyperthyroidism - true or false?

Answer 26

**False** **Unrelated to physiological effects of drugs / diseases**

Question 27

**Panic disorder** can only be diagnosed when symptoms **aren't** explained by an underlying disorder. What is an example of an underlying psychiatric disorder which may present as panic?

Answer 27

**Depression** **Bipolar disorder**

Question 28

What is the typical course of **GAD** and **panic disorder?**

Answer 28

**Chronic, fluctuating**

Question 29

What are a) psychological b) pharmacological methods of managing **panic disorder**?

Answer 29

**a) CBT** **b) SSRIs / SNRIs/ TCAs** or **benzodiazepines** for acute episodes

Question 30

What is a **phobia**?

Answer 30

**Irrational fear of something; avoidance behaviour and anxiety**

Question 31

What is the most common **phobia**?

Answer 31

**Agoraphobia** fear of going outside, travelling alone, crowds etc.

Question 32

Why do patients with **agoraphobia** tend to experience very little anxiety?

Answer 32

**Because they don't leave the house**

Question 33

**Agoraphobia** may be a primary disorder or secondary to other disorders such as?

Answer 33

**Depression** **Panic disorder**

Question 34

Patients with **agoraphobia** may misuse ___ to reduce their anxiety.

Answer 34

**drugs**

Question 35

**In specific phobias**, exposure to the phobic stimulus causes \_\_\_.

Answer 35

**anxiety**

Question 36

What are some examples of **specific phobias**?

Answer 36

**Flying** **Heights** **Injections** **Animals**

Question 37

Which **animals** do some patients have phobias for?

Answer 37

**Dogs** **Spiders**

Question 38

What psychological therapy is often recommended for **phobias**?

Answer 38

**Behavioural therapy** systematic desensitisation to phobic stimulus

Question 39

Which anxiety disorder presents as a **fear of scrutiny by others** and aversion to being **embarrassed or humiliated?**

Answer 39

**Social anxiety disorder**

Question 40

What are the common **symptoms** of **social anxiety disorder**?

Answer 40

**Blushing** **Fear of vomiting** **Fear of micturition; defaecation**

Question 41

Who tends to present with **social anxiety disorder**?

Answer 41

**School-aged children**

Question 42

How do patients with **social anxiety disorder** react to new situations?

Answer 42

**Avoidance** **Withdrawal**

Question 43

What are the two components of **obsessive compulsive disorder**?

Answer 43

**Obsessive thoughts** **Compulsive acts**

Question 44

**Obsessive thoughts** are often described as **ego-dystonic.** ## Footnote **What does this mean?**

Answer 44

**Unpleasant, doesn't match with ideal view of self or situation** Can see why this is horrible when patient cannot shift them

Question 45

What is a **compulsive act**?

Answer 45

**Repeated ritual or stereotypical behaviour**

Question 46

In **obsessive compulsive disorder**, patients often realse that their **thoughts** are ___ and their **behaviours** are \_\_\_.

Answer 46

**thoughts** - irrational **behaviours** - non-functional

Question 47

What is the difference between **obssessive acts** (seen in **OCD**) and **obsessive traits?**

Answer 47

**Obsessive acts** - non-functional, not enjoyable, recognised as pointless by the patient **Obsessive traits** - e.g enjoying things being tidy, perfect; behaviour brings **satisfaction** (and are often recognised as 'competent' or 'professional' by others)

Question 48

What are the **criteria** for **diagnosing OCD?**

Answer 48

**Symptoms present for \> 2 weeks** **Interfering with patient's life and daily activities** **Obsessions are patient's own thoughts** **Compulsive acts aren't enjoyable**

Question 49

**OCD** often exists co-morbidly with other ___ disorders.

Answer 49

**psychiatric**

Question 50

What is the main **psychological treatment** for **OCD?**

Answer 50

**CBT** response prevention, encourage patient to do/not do something to show them that thoughts or acts are irrational

Question 51

Which receptor do **benzodiazepines** act on? What general effect does this cause?

Answer 51

**Enhance action of GABA** (inhibitory neurotransmitter) **Inhibition** effective anxiolytic

Question 52

What are some **side effects** of benzodiazepines?

Answer 52

**Sedation** **Addictive drug**