Anxiety

Question 1

Name the three main types of anxiety disorders

Answer 1

Generalised anxiety disorder (GAD)
Post traumatic stress disorder (PTSD)
Panic disorder (PD)

Question 2

For generalised anxiety disorder (GAD), over how many months should “excessive anxiety and worry” (for most days) be present to make a diagnosis

Answer 2

For over 6 months.

ALSO autonomic symptoms must be present to make a diagnosis

Question 3

What are some symptoms of PTSD?

Answer 3

“Flash-backs”, nightmares, hypervigilance, hyperarousal

Question 4

Describe how attacks may occur in someone with panic disorder

Answer 4

Attacks come on quickly, rise to a crescendo/climax and resolve after a few minutes

PD = unpredictable acute attacks of anxiety or panic

Crescendo these nuts

Question 5

What is agoraphobia? _______ may occur with or without agoraphobia

Answer 5

Agoraphobia = fear of public places

Panic disorder may occur with or without agoraphobia

Question 6

True or false

Pharmacological treatment can sometimes be 1st line in anxiety disorders

Answer 6

FALSE
Non-pharmacological treatment is 1st line for ALL anxiety disorders

(relaxation, anger management, cognitive behavioral therapy CBT, Eye movement desensitisation and reprocessing EMDR)

Question 7

When pharmacological treatment is required, which class of drugs is always 1st line for anxiety disorders?

Answer 7

SSRIs - selective serotonin re-uptake inhibitors

Question 8

Why is the normal starting dose of SSRIs halved when treating GAD and PD?

Answer 8

SSRIs can cause initial worsening of symptoms in GAD and PD

Question 9

Which type of benzodiazepines are preferred (long or short acting) for anxiety and why?

Answer 9

Long acting - diazepam

Higher risk of dependence with short acting

Question 10

Which of the 3 anxiety disorders may pregabalin be used in if treatment with SSRIs fail?

Answer 10

GAD
1. After psychological therapies offer SSRI
2. If ineffective offer another SSRI
3. Consider offering pregabalin if not tolerated

Question 11

For PTSD, what is the primary non-pharmacological treatment? and how long after tigger event should it be started? Boing Winnie the pooh

Answer 11

Focused cognitive behavioral therapy (CBT)
Started within 3 months of trigger event

Question 12

If the first SSRI fails in treating PTSD, what is the next step?

Answer 12

Consider alternative SSRI or mirtazapine.

Question 13

For PTSD and PD, how long should drug therapy continue after responding to treatment?

Answer 13

After response:
PTSD: 12 months
PD: 6 months

Question 14

What is the only SSRI that is recommended for each anxiety disorder? (Useful example)

Answer 14

PAROXETINE

Question 15

Why shouldn’t you use benzodiazepines for PTSD?

Answer 15

Can interfere with recovery process by impairing formation of new memories