Anxiety

Question 1

Types of anxiety

Answer 1

Generalised anxiety disorder.
Phobias.
Panic disorder.
Obsessive-Compulsive disorder

Question 2

Associated factors with anxiety

Answer 2

Lower social class, unemployment, divorced, no educational quals, urban living, FHx, childhood adversity

Question 3

Psychological symptoms of anxiety

Answer 3

Fears, worries, poor concentration, irritability, depersonalisation, derealisation, insomnia, night terrors

Question 4

Motor symptoms of anxiety

Answer 4

Restlessness, fidgeting, feeling on edge

Question 5

Neuromuscular symptoms

Answer 5

Tremor, tension headache, muscle ache, dizziness, tinnitus

Question 6

GI symptoms

Answer 6

Dry mouth, can’t swallow, nausea, indigestion, butterflies, flatulence, frequent or loose motions.
Urinary frequency, erectile dysfunction, amenorrhoea

Question 7

CVS and resp symptoms

Answer 7

Chest discomfort and palpitations, difficulty inhaling and tight chest

Question 8

Features of GAD

Answer 8

Generalised and persistent free floating anxiety symptoms. Apprehension, motor tension, autonomic overactivity

Question 9

Symptoms of autonomic overactivity

Answer 9

Light-headedness, sweating, tachycardia, epigastric discomfort, dizziness

Question 10

Symptoms of motor tension

Answer 10

Restlessness, fidgeting, tension headaches, trembling, inability to relax

Question 11

Symptoms of apprehension

Answer 11

Worries about future misfortune, feeling on edge, difficulty concentrating

Question 12

Differential diagnoses

Answer 12

Hyperthyroidism, substance misuse, excess caffeine, depression, avoidant personality disorder, dementia and schizophrenia early

Question 13

General management of GAD

Answer 13

Counselling, self help materials, CBT, anxiety management, relaxation techniques, autogenic techniques, brief focal therapy

Question 14

First line drug therapy in GAD

Answer 14

SSRI or SNRI

Question 15

When are beta blockers useful

Answer 15

Effective in patients with somatic anxiety symptoms

Question 16

Features of panic disorder

Answer 16

Recurrent attacls of severe anxiety not restricted to any particular situation or set of circumstances and therefore unpredictable. Secondary fears of dying, losing control or going mad

Question 17

Characteristic attacks in panic disorder

Answer 17

Attacks usually last for minutes, often there is a cresendo of fear and autonomic symptoms. Freedom from anxiety between attacks

Question 18

Which gender is anxiety more common in

Answer 18

Females

Question 19

Age of anxiety starting

Answer 19

Very rarely presents above 30,and if it does it is likely due to depressive disorder or organic disease

Question 20

What can panic disorder lead to

Answer 20

Can lead to fear of situation where panic attacks occur or agoraphobia, a conditioned fear of fear pattern develops

Question 21

Differentials of GAD

Answer 21

GAD, agoraphobia, depression, alcohol or drug wthdrawal, organic causes (CVS, resp, hypoglycaemia, hyperthyroidism)

Question 22

Psychological management of panic disorder

Answer 22

Reassurance, CBT effective >80% and first line.
Education, cognitive restructuring.
Interoceptive exposure techniques.
Secondary agoraphobic avoidance

Question 23

Drug management of panic disorder

Answer 23

SSRIs are first line but second line to CBT.
Clomipramine