Anxiety

Question 1

PTSD clinical presentation

Answer 1

Re-experiencing symptoms:PIF
-flashbacks about event
-intrusive symptoms: recurrent, involuntary and distressing intrusive memories and dreams including nightmares about the event
-psychological or physiological distress to external cues about events
Avoidance AA
-avoidance of distressing memories, thoughts, feelings and conversations
-avoidance of external reminder of event (people, place, objects or environment)
Negative cognitive or affective symptoms ADCNENBIPDEIP
-unable to recall details about the event
-persistent, distorted cognition of causes or consequences (self blame)
-constant negative emotional states
-persistent negative belief of self and others and the world
-persistent inability to feel positive emotion
-feels detached/estranged from others
-decreased interest or participation in activities
Increased Arousal IIIHDR
-insomnia
-increased startle response
-irritability or anger outburst
-hyper vigilance
-decreased concentration
-reckless or self-destructive

Question 2

The bio-psych-social management of SOCIAL Phobia

Answer 2

Bio:
Antidepressants: SSRI mainstay or MAOI
May take 6 to 8 weeks to work maximum 16 weeks
B-blockers: propanol
Psycho:
CBT mainstay (individual vs group)- with exposure therapy gradual is better for this phobia
Virtual Reality Exposure therapy also used
Social:
Motivational Interviewing: substances
Family support and psychoeducation
OT: assess job and any ways to help with managing disorder while employed
SW: income or SASSA temporary
Assessing relationships

Question 3

Antidepressant for SOCIAL phobia treatment. Including MOA, SE, and example

Answer 3

1.SSRI serotonin selective receptor inhibitor,
MOA: inhibits the re-uptake of serotonin at the presynaptic neuron by binding to the serotonin transporter enzyme. Increasing the synaptic availability of serotonin.
SE: CGMRS
CNS: headache, ear pain and tinnitus
GIT: nausea and vomiting and appetite changes
Metabolic: hyponatremia
Reproductive: sexual dysfunction
Serotonin Syndrome
eg citalopram or fluoxetine
2. Irreversible MAOI monoamine oxidase inhibitors,
MOA: irreversibly bind to monoamine oxidase enzymes to prevent the breakdown of serotonin resulting in increased synaptic availability of serotonin
SE: CCGO(mss)
CNS: sedation
CVS: hypertensive crisis (when tyramine rich food are taken simultaneously resulting in the influx of NA like cheese, salami, droerwors aged meat wine), palpitations
GI: Nausea
Other: muscle rigidity, sweating and serotonin syndrome
e.g. Trancyclopramine

Question 4

Benzodiazepine used in Social Phobia, including contraindications, MOA, SE

Answer 4

Clonazepam
MOA: enhance the inhibitory effect of GABA neurotransmitter,
May be anxiolytic (diazepam) if long half life or hypnotic short half life (midazolam)
SE: SAD2
Oversedation
Amnesia
Drowsiness
Dependence

Question 5

Presenting symptoms of Panic Disorder
C3H STUD2ENTS

Answer 5

An abrupt surge of fear/ sudden and unexpected onset of acute anxiety, with at least 4 physical and autonomic symptoms of anxiety. These include:
C
-feeling of choking/chest pain/ feelings of loss of control (feeling crazy)
H
-heat or chills sensation
S
-sweating
T
-trembling or shaking
U
-feelings of unsteadiness, dizziness, faint or light-headedness
D
-depersonalisation or derealisation/feelings of dying
E
-excessive heart rate or palpitation or pounding heart
N
-nausea or abdominal distress
T
-tingling or parasthesia
S
Sensation SOB an smothering

These are recurrent and there is a worry of another panic month for a month or more or maladaptive change in behaviour related to the panic attack

Question 6

Managing panic attack

Answer 6

Pharmacology
SSRI- citalopram or fluoxetine CGRMS
MAOI- trancypromine CCGO(mss)
SNRI Serotonin noradrenaline reuptake inhibitors e.g. duloxetine/ venlafaxine
SE: BAD SNRI
body weight changes/blood pressure changes
Anorexia
Drowsiness and dizziness
Suicidal thoughts
Nausea and vomiting, diarrhoea
Reproductive: sexual dysfunction
Insomnia
Benzodiazepines for initial anxiogenic effect of SSRI or if there is extreme anxiety
Psychology
CBT-which help in countering anxious belief, being exposed to fear cues and change in their anxiety-maintenance behaviour
psycho education
Must highly motivated