Anxiety

Question 1

Is an anxiety disorder self-limiting?

Answer 1

No

Question 2

What is the most common anxiety disorder?

Answer 2

GAD =
Generalised Anxiety Disorder

Question 3

What physiological symptoms can be associated with anxiety?

Answer 3

-Fearful anticipation
-Irritability
-Worrying thoughts
-Insomnia
-Night terrors

Question 4

What physical symptoms can be associated with anxiety?

Answer 4

-Dry mouth
-Headache
-Palpitations
-Constriction of chest
-Breathlessness
-Hyperventilation

Question 5

What is first line for anxiety?

Answer 5

SSRI’s

Question 6

What benzodiazepines help with anxiety?

Answer 6

Lorazepam, Diazepam, Oxezepam, Clobazam

Question 7

What antipsychotics can be used for anxiety?

Answer 7

-Risperidone
-Olanzapine
-Quetiapine
-Pericyazine

Question 8

What medications can be use for GAD?

Answer 8

-Venlafaxine
-Duloxetine

Question 9

If SSRI is not tolerated and patient has a panic disorder, what should be offered?

Answer 9

Tricyclic antidepressants
-Clomipramine
-Imipramine

Question 10

What can be used for GAD, Epilepsy and Neuropathic pain?

Answer 10

Pregabalin

Question 11

What other treatment is unlicensed for anxiety but useful for depression, sleep issues and anxiety?

Answer 11

Mirtazapine
-Has a anti-histamine side effect to help with sleep

Question 12

How long does it take for Buspirone to have an effect for anxiety?

Answer 12

4 weeks at 10mg TDS

Question 13

What can Propranolol help with in anxiety?

Answer 13

10-120mg OD for palpitations

Question 14

What antihistamines can be used for anxiety?

Answer 14

Promethazine and Hydroxyzine

Question 15

What anti-depressants are licensed for GAD?

Answer 15

SSRI - Escitalopram, Paroxetine
SNRI - Venlafaxine, Duloxetine, Pregabalin

Question 16

What anti-depressants are licensed for panic disorders?

Answer 16

SSRI’s - Escitalopram, Citalopram, Sertraline, Paroxetine
SNRI - Venlafaxine

Question 17

What antidepressants are licensed for OCD?

Answer 17

SSRI - Escitalopram, Sertraline, Paroxetine, Fluoxetine

Question 18

What antidepressants are licensed for social anxiety disorder?

Answer 18

SSRI’s - Escitalopram, Sertraline, Paroxetine

SSNI - Venlafaxine

Question 19

What antidepressants are licensed for PTSD?

Answer 19

SSRI’s - Sertraline, Paroxetine

Question 20

What is Clomipramine (TCA) licensed for?

Answer 20

Obsessional and phobic states

Question 21

What is Propranolol licensed for?

Answer 21

Relief of situational anxiety and generalised anxiety symptoms, particularly those of somatic type

Question 22

Can SSRI’s worsen symptoms initially?

Answer 22

Yes - Low dose and increase as s/e with tolerability

Question 23

How long do you need to wait to see response from SSRI’s for Anxiety?

Answer 23

12 WEEKS

Question 24

What dose of escitalopram do we start at for anxiety?

Answer 24

5mg/day

Question 25

What dose of Fluoxetine do we start at for Anxiety?

Answer 25

5-10mg/day

Question 26

What dose paroxetine do we start at for anxiety?

Answer 26

Paroxetine 5-10mg/day

Question 27

What dose Sertraline do we start at for anxiety?

Answer 27

25mg/day

Question 28

What dose Citalopram do we start at for anxiety?

Answer 28

5-10mg/day

Question 29

When do we increase the dose of antidepressants in anxiety?

Answer 29

Every two weeks or as tolerated

Question 30

What can be prescribed alongside the SSRI's initially to help with anxiety?

Answer 30

Benzodiazepines

Question 31

How many weeks does it take for diazepam to not have any effect?

Answer 31

4 weeks - leave plenty of time in-between dose reductions

Question 32

If anxiety doesn't go away and lasts for at least 6 months, what can this be classed as?

Answer 32

GAD

Question 33

Can people with GAD be suicidal?

Answer 33

Yes

Question 34

When is the onset of GAD?

Answer 34

Early adulthood and tends to evolve with age.

Question 35

What is the DSM IV criteria for GAD?

Answer 35

Must have both Major symptoms and 3 Additional symptoms.

Question 36

What are the two major symptoms of GAD? *must have both*

Answer 36

-Excessive anxiety and worry about a number of events and activities -Difficulty controlling the worry

Question 37

What are the additional symptoms of GAD? *must have 3/6*

Answer 37

-Restlessness or feeling keyed up or on edge -Being easily fatigued -Difficulty concentrating or mind going blank -Irritability -Muscle tension -Sleep disturbance

Question 38

What is the differential diagnosis of GAD?

Answer 38

-Depression -Schizophrenia -Dementia -Substance misuse -Physical illness - Hypo or Thyrotoxicosis

Question 39

Step 1 of GAD: All known and suspected presentations of GAD, what do we do?

Answer 39

Identification and assessment - active monitoring

Question 40

Step 2 of GAD: Diagnosed GAD that has not improved after education or marked functional impairment. What do we do?

Answer 40

-Low intensity psychological interventions -Individual non-facilitated self-help -Individual guided self-help and psychoeducational groups

Question 41

Step 2 of GAD: GAD with an inadequate response to step 2 interventions or marked functional impairment. What do we do?

Answer 41

Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment.

Question 42

Step 4: Complex treatment-refractory GAD and very marked functional impairment, such as self-neglect or high risk of self-harm. What do we do?

Answer 42

-Highly specialist treatment such as complex drug and or psychological treatment regiments; input from MDT, crisis, day hospitals or inpatient care.

Question 43

What is first line for GAD?

Answer 43

SSRI's (fluoxetine or sertraline off-license) Venlafaxine Pregabalin Mirtazapine

Question 44

How should beta-blockers be used for GAD?

Answer 44

Low dose short-term

Question 45

How should antihistamines be used for GAD?

Answer 45

Low dose short-term

Question 46

What is first line for OCD?

Answer 46

Clomipramine

Question 47

What is first line for Social Anxiety?

Answer 47

SSRI's - Escitalopram or Venlafaxine

Question 48

What is first line for Panic Disorders?

Answer 48

First line - SSRI's such as Escitalopram, Sertraline, Citalopram and Paroxetine

Question 49

What is second line for panic disorders?

Answer 49

Imipramine or Clomipramine. If SSRI not suitable or no improvement after 12-week course.

Question 50

What is used for mod/severe panic disorders?

Answer 50

Venlafaxine

Question 51

Benzodiazepines are not recommended for use in Panic disorders but when could they be used?

Answer 51

In Emergency Management