2.1 Generalized anxiety, panics and phobias

Question 1

What type of anxiety disorder is described:

• generalized and persistent anxiety
• not restricted to environment
• variable symptoms- nervousness, trembling, muscle tension, sweating, light headed, papitations, dizziness, epigastric discomfort
• fears pt or relative will become ill or accident shortly overexpressed

Not due to substance abuse or other medical condition eg. hyperthyroidism

Answer 1

Generalized Anxiety Disorder

Question 2

What are the qualifiying criteria for anxiety in GAD?

Answer 2

Severity:

• most days for at least 6 motnhs
• not controllable
• causing significant distress/impairment in function

Typically associated with

• restlessness
• early fatigue
• difficulty concentrating
• irritable
• muscle tension
• sleep disturbance- difficulty falling or staying asleep ,restless, or unsatisfying sleep

Question 3

What type of anxiety does this describe:

• recurrent attacks of severe anxiety (panic)
• not restricted to situation or circumstances so unpredictable
• sominent somatic symptoms as for GAD

secondary fear of dying, losing control or going mad
Not due to direct effect of drugs or medical condition
Not better explained by other mental disorder eg. depression

Answer 3

Panic disorder

Question 4

What is the 10 year follow-up outcomes for panic disorder?

Answer 4

1/3 unchanged or worse
1/3 modest improvement
1/3 well

Question 5

What can the following induce in suceptible people?

• infusion of lactate
• increased CO2
• bicarbonate
• hyperventilation
• hypertonic saline
• doxapram
• caffeine
• noradrenergic agents- TCA, NA
• serotonergic agents
• Benzodiazapine receptor inverse agonist, antagonst (flumazenil)
• CCK
• hypoglycaemia
• cognitive

Answer 5

A panic attack

Question 6

What are the PET findings in panic attacks?

Answer 6

Increased metbolism in the anterior pole of the temporal lobe - the parahippocampal gyrus.

Question 7

What are the differences between:

• agoraphobia
• social phobia
• specific phobia?

Answer 7

Agoraphobia: fear of leaving home, entering shops, crowds, and public plages, or travelling in trains, buses, or planes. Typically avoid the situations so well so some have little anxiety.

Social phobia/anxiety disorder: persistent fear of social or performance situations where exposed to unfamiliar people or possible scrutiny by others

Specific phobia:marked and persistent fear that is excessive or unreasonable cued by the presence or anticipation of specific object or situation eg. flying, heights, animals, or insects, injection, seeing blood. Insight maintained. Normal function impaired by avoidance/anxiety/distress.

Question 8

What brain changes may exist in social phobia?

Answer 8

increased bilateral activation of the amygdala
-increased rCBF to the amygdala and related limbic areas

these normalise on successful treatment, pharmacological or psychological.