Anxiety

Question 1

What are the clinical features of anxiety?

Answer 1

Irritability
Worrying thoughts
Dry mouth
Constriction of chest
Breathlessness
Insomnia
Night terrors
Palpitations

Question 2

What are the treatments for anxiety?

Answer 2

• 1st line are SSRIs
• Benzodiazepines
• Anti-psychotics- e.g. in acute environments if patient is agitated or harm to themselves or other
  e.g. Risperidone, Quetiapine, Olanzapine
• Venlafaxine and duloxetine- low dose essentially equivalent to a SSRI and at high doses = more SNRI effect
• TCAs: e.g. clomipramine- where SSRIs are inappropriate. Bad side effects and toxicity in overdose = rarely used here
• Pregablin
• Mirtazapine
• Buspirone
• Beta blockers- e.g. propranolol dose of 40-120mg is licenced in anxiety

Question 3

How long can SSRIs take to have an effect in anxiety?

Answer 3

Up to 12 weeks (is 2-6 weeks in depression)

Question 4

What may happens to symptoms when initiating SSRIs?

Answer 4

They tend to get worse (increase in anxiety) before getting better- minimise by starting low dose.
Shorterm, benzodiazepines can be prescribed to help with this anxiety

Question 5

What are the symptoms of generalised anxiety disorders (GAD)?

Answer 5

hyperventilation
SOB
sweating
trembling
dry mouth
chest and abdo pain
thinking the worst
poor concentrations
irritability
sleep disturbance

Question 6

What are the pharmacological recommendations for GAD?

Answer 6

• 1st line: SSRIs e.g. Fluoxetine and sertraline
• venlafaxine
• Pregablin

Shorterm can use benzodiazepines
combination and treatment resistant cases:
- beta blockers for somatic symptoms e.g. propranolol
- Buspirone- not used much

Question 7

What are the treatment recommendations for OCD?

Answer 7

Only central serotonin enhancers are effective.
SSRIs- dose is high, may exceed BNF max

Question 8

What is 1st lime for social anxiety?

Answer 8

SSRI