Anxiety

Question 1

What hormone is important in the stress response?

Answer 1

Cortisol

Question 2

What does chronic stress lead to?

Answer 2

Chronic raised cortisol - can damage the hippocampus.

Question 3

What is pathological anxiety?

Answer 3

Anxiety to such an extreme that it exceeds normal, or is present in a situation where it is not needed.

Question 4

Is anxiety normal?

Answer 4

Yes, it is a natural response to a stressful situation.

Question 5

What is generalised anxiety disorder (GAD)?

Answer 5

Anxiety which is generalised and persistent but not fixed (said to be free-floating).

Question 6

What is commonly seen in GAD?

Answer 6

A fear of the future.

Question 7

When is GAD not diagnosed?

Answer 7

If there is a co-morbid condition or substance misuse.

Question 8

How long must symptoms persist for a diagnosis of GAD?

Answer 8

Atleast 6 months.

Question 9

What is the first-line treatment for GAD?

Answer 9

Psychoeducation/CBT

Question 10

If therapy fails, what is given in GAD?

Answer 10

SSRIs, SNRIs or Pregabalin.

Benzodiazepines can also be given short term.

Question 11

How long is GAD drug therapy continued for?

Answer 11

Atleast 18 months - review after 12 weeks.

Gradually reduce dosage prior to cessation.

Question 12

What is panic disorder?

Answer 12

Anxiety that occurs for a short period of time only - it is intense in nature.

Question 13

Is panic disorder predictable?

Answer 13

No

Question 14

What is agoraphobia?

Answer 14

Avoidance of places/situations that may cause anxiety.

Question 15

What age group is most commonly affected by panic disorder?

Answer 15

Young people.

It is not caused by a medical condition or drug therapy.

Question 16

Is there a genetic link to panic disorder?

Answer 16

Yes

Question 17

How is panic disorder treated?

Answer 17

Mild cases- self help.

Moderate/Severe cases - treat with CBT/medication.

Question 18

What drugs are used to treat panic disorder?

Answer 18

SSRIs
SNRIs
Pregabalin
Tricyclics
Benzodiazepines (short term)

Question 19

How long is treatment continued for in panic disorder?

Answer 19

6 months

Question 20

What is a phobia?

Answer 20

Fear characterised by avoidance and anticipatory anxiety.

Patient will know their fear is irrational.

Question 21

How is phobia treated?

Answer 21

Behavioural exposure therapy (may also have CBT).

Question 22

What is social anxiety disorder?

Answer 22

A persistent fear of scrutiny from a small group. Terrified of being humiliated.

Question 23

How is social anxiety disorder treated?

Answer 23

CBT

SSRIs, SNRIs or MAO inhibitors.

Benzodiazepines can be given for short-term relief.

Question 24

What is OCD?

Answer 24

A disorder of obsessional thought and/or compulsive acts.

Tends to run in families.

Question 25

What are common co-morbidities of OCD?

Answer 25

Schizophrenia
Tic disorders
Eating disorders
Depression

Question 26

How is OCD treated?

Answer 26

CBT

If unresponsive, give SSRIs or clomipramine (can be augmented by citalopram therapy).

Question 27

How are thoughts experienced in OCD described?

Answer 27

Ego-dystonic

Unpleasant to the individual experiencing them.

Question 28

What are the 2 core symptoms of anxiety?

Answer 28

Fear

Worry