Neurotic disorders

Question 1

anxiety definiton

Answer 1

excessive worry about a number of different events associated with heightened tension

Question 2

Anxiety alternative diagnoses

Answer 2

hyperthyroidism, cardiac disease and medication-induced anxiety (NICE).
Medications that may trigger anxiety include salbutamol, theophylline, corticosteroids, antidepressants and caffeine

Question 3

Management of generalised anxiety disorder

Answer 3

NICE suggest a step-wise approach:
step 1: education about GAD + active monitoring

step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)

step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment.

step 4: highly specialist input e.g. Multi agency teams

Question 4

first line drug treatment in GAD plus other drug treatment

Answer 4

• NICE suggest sertraline should be considered the first-line SSRI
• if sertraline is ineffective, offer an alternative SSRI or a serotonin–noradrenaline reuptake inhibitor (SNRI)
• examples of SNRIs include duloxetine and venlafaxine
• If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin

interestingly for patients under the age of 30 years NICE recommend you warn patients of the increased risk of suicidal thinking and self-harm. Weekly follow-up is recommended for the first month

Question 5

management of panic disorders

Answer 5

Question 6

Anxiety ICD-11 criteria

Answer 6

ICD-11 Criteria:

Excessive worry and apprehension.
Difficulty controlling worry.
Associated symptoms: Restlessness, muscle tension, fatigue.
Duration: At least 6 months.

DSM-V Criteria:
Excessive anxiety and worry about various domains.
Difficulty controlling worry.
Associated symptoms: Restlessness, muscle tension, fatigue, irritability.
Duration: At least 6 months.

Question 7

Panic disorder definition

Answer 7

ICD-11 Criteria:

Recurrent, unexpected panic attacks.
At least one attack followed by a month of persistent concern.
Avoidance behaviors related to attacks.
DSM-V Criteria:

Recurrent, unexpected panic attacks.
Persistent concern about future attacks.
Behavioral changes: Avoidance of situations associated with attacks.

Question 8

Panic disorder clinical features

Answer 8

Question 9

Panic disorders differentials

Answer 9

• Other anxiety disorders, such as Generalized Anxiety Disorder (GAD) and agoraphobia.
• Depression (takes precedence if it predates panic disorder or fulfills diagnostic criteria).
• Alcohol or drug withdrawal.
• Organic causes like cardiovascular or respiratory diseases, hypoglycemia, hyperthyroidism. Rarely, pheochromocytoma.

Question 10

anxiety disorders classification

Answer 10

Question 11

phobias definition

Answer 11

Phobias, encompassing specific phobia, social anxiety disorder (SAD), and agoraphobia, represent a cluster of anxiety disorders characterized by excessive and irrational fears.
Specific phobia involves intense anxiety triggered by a specific object or situation, leading to avoidance behavior.

These conditions, distinct in their triggering stimuli, share common features of avoidance and significant impairment in daily life

Question 12

General features of phobias include:

Answer 12

• Usually apparent in early adulthood.
• Leads to avoidance behavior.
• Phobias of blood and bodily injury can result in bradycardia and hypotension upon exposure.
• Severity is dependent on the effect on quality of life (e.g., pilots afraid of flying).
• Always rule out comorbid depression.

Question 13

Agoraphobia ICD 11 criteria and onset

Answer 13

Question 14

Social phobia/ social anxiety disorder ICD11 criteria, symptoms and consequences

Answer 14

Question 15

Management of phobias

Answer 15

Question 16

PTSD definition plus important DSM-IV criteria

Answer 16

Post-traumatic stress disorder (PTSD) can develop in people of any age following a traumatic event, for example, a major disaster or childhood sexual abuse. It encompasses what became known as ‘shell shock’ following the first world war.

One of the DSM-IV diagnostic criteria is that symptoms have been present for more than one month.

Question 17

PTSD features

Answer 17

Question 18

PTSD management

Answer 18

Question 19

Phobic anxiety disorders table summary: onset and characteristics

Answer 19

Question 20

Summary table management of anxiety and phobia disorders

Answer 20

Question 21

obsessions vs compulsions definition

Answer 21

An obsession is defined as an unwanted intrusive thought, image or urge that repeatedly enters the person’s mind.

Compulsions are repetitive behaviours or mental acts that the person feels driven to perform. A compulsion can either be overt and observable by others, such as checking that a door is locked, or a covert mental act that cannot be observed, such as repeating a certain phrase in one’s mind.

Question 22

Risk factors for OCD

Answer 22

family history
age: peak onset is between 10-20 years
pregnancy/postnatal period
history of abuse, bullying, neglect

Question 23

Management of OCD

Answer 23

Notes on treatments
* ERP is a psychological method which involves exposing a patient to an anxiety provoking situation (e.g. for someone with OCD, having dirty hands) and then stopping them engaging in their usual safety behaviour (e.g. washing their hands). This helps them confront their anxiety and the habituation leads to the eventual extinction of the response
* if treatment with SSRI is effective then continue for at least 12 months to prevent relapse and allow time for improvement
* compared to depression, the SSRI usually requires a higher dose and a longer duration of treatment (at least 12 weeks) for an initial response

Question 24

Low levels of which neurotransmitter are associated with the development of anxiety?

Answer 24

GABA has an inhibitory effect on the brain and reduces neuronal excitability. This means there is a reduced inhibitory effect in the brain, allowing neurones to activate at an increased rate.

Question 25

post-concussion syndrome definition and symptoms

Answer 25

Post-concussion syndrome is seen after even minor head trauma

Typical features include
headache
fatigue
anxiety/depression
dizziness

Question 26

Acute stress disorder definition

Answer 26

Acute stress disorder is defined as an acute stress reaction that occurs in the first 4 weeks after a person has been exposed to a traumatic event (threatened death, serious injury e.g. road traffic accident, sexual assault etc). This is in contrast to post-traumatic stress disorder (PTSD) which is diagnosed after 4 weeks.

Question 27

Acute stress disorder features

Answer 27

intrusive thoughts e.g. flashbacks, nightmares
dissociation e.g. ‘being in a daze’, time slowing
negative mood
avoidance
arousal e.g. hypervigilance, sleep disturbance

Question 28

Acute stress disorder management

Answer 28

• trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
• benzodiazepines:
• sometimes used for acute symptoms e.g. agitation, sleep disturbance
• should only be used with caution due to addictive potential and concerns that they may be detrimental to adaptation