Anxiety

Question 1

What is anxiety?

Answer 1

• a normal response to threat or danger
• if exaggerated (+3wks or interfering with daily life) can be a mental health problem

Question 2

What is GAD?

Answer 2

• generalised anxiety disorder ~ excessive and inappropriate worrying that is persistent
• FISL sx (fatigue, irritability, sleep disturbance, lack of concentration)
• lasting over 6months - DSM5, few months according to ICD10

Question 3

What is panic disorder?

Answer 3

• recurrent unexpected surges of severe anxiety attacks
• periods of intense fear/discomfort
• peak in 10 mins and last up to 30-45
• can occur with or without agoraphobia

Question 4

What is agoraphobia?

Answer 4

Fear or places/situations that might be difficult to escape

Question 5

What is social phobia?

Answer 5

• marked persistent and unreasonable fear of being observed/evaluated negatively in social situations
• these situations are either avoided or endured (with severe distress)

Question 6

What is PTSD?

Answer 6

• post traumatic stress disorders
• due to hx of exposure to trauma
• intense fear develops when re experiencing symptoms in flash backs/dreams

Question 7

What is OCD?

Answer 7

• obsessive compulsive disorder
• recurrent ruminations, impulses, images or rituals
• are distressing/time consuming
• interfere with social and occupational function

Question 8

What are the steps of GAD treatment?

Answer 8

Step 1 - education, treatment (OTC), monitoring
Step 2 - low intensity psychological intervention (guided or non facilitated self help or groups)
Step 3 - high intensity treatment (CBT, SSRI)
Step 4 - highly specialist treatment (combo drug antidepressant and psychological)

Question 9

Which drugs are used for step 3 of GAD treatment?

Answer 9

• sertraline is first line for SSRI
• benzodiazepines can be used short term for crisis management

Question 10

When should a GAD pt be referred to step 4?

Answer 10

If severe anxiety with marker functional impairment +
• risk of SH/suicide
• significant comorbidity
• self neglect
• inadequate response to step 3

Question 11

What is the pathophysiology of anxiety?

Answer 11

• decreased 5-HT neurotransmitters
• overactive NA systems
• excessive activity of glutamate neurons at NMDA receptors in amygdala

Question 12

What is responsible for fear conditioning?

Answer 12

The glutamate neurons at the NMDA receptors in the amygdala