Anxiety

Question 1

What is anxiety

Answer 1

A minor affective disorder that manifests as a reaction to stress and adjustment

Question 2

What are the symptoms of anxiety

Answer 2

Worry
Sadness
Fatigue
Pain
Sleep

Question 3

What are the psychological effects

Answer 3

Awareness of threat- on edge
Unpleasant anticipation
Mental tension
Insomnia

Question 4

What are the somatic effects

Answer 4

Cardiovascular- palpitations, bradycardia, tachycardia, elected BP

Respiratory: shallow breathing, breathlessness

Muscle tension

GI: diarrhoea, dyspepsia, dysphagia, churning stomach

Bleeding
Sweating

Question 5

What are the treatment aims

Answer 5

1. Discover cause and address and remove it
2. Assess severity of anxiety response
3. relieve distress
4. Institute long term measures to avoid recurrence
5. Institute long term measures in case of chronic anxiety

Question 6

What is the first line treatment of generalised anxiety disorder

Answer 6

1. Psycho education as first line interventions
2. Counselling
3. Cognitive Behavioural Therapy

Question 7

What is the first and second line pharmacological treatment of anxiety disorders and describe them

Answer 7

1. SSRIs first line: sertraline
   If sertraline is ineffective, use SNRI such as venlafaxine or duloxetine
2. Benzodiazepines are used only for short term relief by acting by acting as positive allosteric modulators of GABA binding to GABAa receptor
3. Pregabalin if cannot tolerate SSRIS or SNRIs

Question 8

What are the advantages and disadvantages of benzodiazepines

Answer 8

Advantages:
Effective as hypnotic
Safe in overdose
Few interactions

Disadvantages:
Tolerance and dependence
Withdrawal effects 
Amnesia
May produce abnormal sleeping patterns

Question 9

Which benzodiazepine has a long and short half life

Answer 9

Short (4-12): Temazepam

Long (>20): Diazepam

Question 10

Describe how pregabalin works

Answer 10

1. Analogue of GABA, but binds to voltage gated calcium channels to change their confirmation and reduce excitatory neurotransmission

Question 11

How do you treat panic disorder (with or without agoraphobia)

Answer 11

1. SSRIs: sertraline, citalopram, escitalopram
2. TCAs: Clomipramine or imipramine
3. Sedating antipsychotics or antihistamines should not be prescribed

Question 12

How do you treat social anxiety disorder

Answer 12

1. Offer CBT

2. SSRI