Anxiety

Question 1

what might you find in the mental state exam in someone with anxiety?

Answer 1

• derealisation (feeling that objects aren’t real)
• depersonalisation (feeling that people are not real)
• fear of losing control/ going crazy/ passing out/ dying
• feeling dizzy/ faint

Question 2

how do you define Generalised anxiety disorder?

Answer 2

• period of 6 months with prominent tension, worry and feelings of apprehension about everyday events and problems

Question 3

what are the symptoms of GAD?

Answer 3

• persistent (continuous) free floating anxiety not related to external stimulus
• worry, nervousness, poor concentration, irritability
• hyper-vigilance, restlessness, increased startle response
• muscle tension, headache, trembling

Question 4

what autonomic symptoms do you get? (CVS, rest, GI, GU, neuro)

Answer 4

CVS- palpitations, tightness, pain
Resp- dyspnoea, difficulty inhaling
GI- dry mouth, loose stools, epigastric discomfort, butterflies
GU- frequent micturition

Question 5

how do you define Episodic paroxysmal anxiety (panic disorder)?

what is the time period?

Answer 5

• recurrent attacks of severe anxiety and panic attacks not restricted to any particular situation
• 4 panic attacks in 4 weeks, lasting up to 10 minutes with sudden onset

Question 6

what are the 5 principles of phobic anxiety disorder?

Answer 6

• anxiety symptoms restricted to specific situation
• fear out of proportion
• can not be reasons or explained
• anticipatory anxiety
• avoidance behaviour

Question 7

how do agoraphobics tend to deal with their situation?

Answer 7

• avoidance is common, so they experience little anxiety because they are able to avoid phobic situations

Question 8

how might someone with social phobia react?

who is it most common in?

Answer 8

• blushing
• hand tremor
• urgency of micturition
• adolescence

Question 9

what is the treatment of generalised anxiety disorder?(psychological and medication)

Answer 9

• CBT
• SSRIs
• Beta blockers for acute symptoms
• Avoid benzos

Question 10

how might you treat phobias?

Answer 10

• psycho education

- exposure (systematic desensitisation)

Question 11

how would you explain CBT to a lay person?

Answer 11

• understanding the thoughts feelings and behaviours

Question 12

how would you treat their sleep problems?

Answer 12

• sleep hygiene advice:
  > no daytime napping
  > avoid fluids (caffeine, alcohol)
  > bedtime routine and expectations

Question 13

what kind of questions would you like to ask someone with suspected OCD?

Answer 13

• do you clean a lot?
• check things a lot?
• thoughts that keep bothering you that you’d like to get rid of but can’t?
• do your daily activities take a long time to finish?
• do things have to be in a specific order or are you upset by mess?

Question 14

what is the treatment for OCD?

Answer 14

• psychotherapy
• CBT
• ERP (exposure & response prevention)

Drug treatment:

• SSRI
• TCA (clomipramine)
• combined psychotherapy + drug treatment better than one alone