Anxiety

Question 1

Four types of Somatisation Disorders, and what do they need to be classified under this?

Answer 1

• they have to lack insight and have medically unexplained symptoms.

1. Hypochondraisis: - always get a different complaint - long periods of time - catatrophising
2. Somatisation/somatiform: - come back to one diagnosis - expression of anxiety and depression through ‘real’ physical/biological
3. Conversion/dissociation disorder: - symptoms from nervous symptom are actually stress/trauma related
4. factitious disorder (Munchausen) - disease identified with deception, present as ill

Question 2

General Anxiety Disorder DSM5 criteria?

Answer 2

1. >6months of excessive anxiety and worry for more days than not
2. difficult to control
3. associated with >3 of: BE SKIM (blank mind, easily fatigued, sleep disturbance, keyed up, irritable, muscle tension)
4. 4) significant distress/functional impairment
5. 5) exclude substance use, medication or other disorders.

Question 3

Panic Disorder DSM 5 criteria?

Answer 3

1. recurrent panic attacks (with sudden abrupt intense discomfort) within minutes with >4 of: - STUDENTS fear 3Cs
2. 2) >1 month of >1 of: - persistent concern/worry about panic attacks - significant maladaptive behaviours
3. 3) not due to substances, or other medical conditions.

• Sweating
• Tremor
• Unsteady/lightheaded
• Dissociation
• Elevated HR
• Nausea
• Tingling (parasthesia)
• Fear of dying or losing control
• Chest pain
• Chills
• Choking

Question 4

PTSD Diagnosis Criteria?

Answer 4

C - TRAUMA:

C - cognition/mood (affects 2 domains) - memory, detach, mood down, distorting or exageration

T - trauma (exposure, threat, sexual violence - direct or indirect)

R - recurrence (intrusions) - dreams, flashbacks, memories

A - avoidance (dissociation, avoidance)

U - causes distress (Unable to function)

M - month, lasts for longer than 1 month

A - arousal change - irritable, hypervigilant, sleep disturbance, startle response

Question 5

Treatment for PTSD?

Answer 5

Psychological:

• CBT = stages

1. Stabilisation
2. Education + information
3. Anxiety mx
4. Trauma exposure (exposure therapy)
5. Cognitive restructuring
6. Relapse prevention + maintenance

• Eye movement desensitisation + reprocessing = in vivo exposure → reprogram memories (controversial use, limited evidence)
• Lifestyle factors
• Pharmacological - not used in less than 8 weeks 1) SSRIs 2) mirtazapine, moclobemide, TCAs, MAOI

Question 6

Talk through the different classifications of anxiety?

Answer 6

Generalised anxiety disorder:

• >6months - difficult to control,
• BESKIM

Panic Disorder:

• panic attacks repeated with >4 of STUDENTS FEAR 3Cs
• >1month of
• persistent, maladaption

Phobic Disorder:

• specific phobia
• about a specific object
• agoraphobic
• >2 of public transport, open spaces, enclosed places, standing in line, out of home. (maybe in response to panic attacks)

Social Anxiety Disorder:

• marked fear about social situations where exposed to scrutiny
• avoid, always provokes feat
• out of proportion
• persistent >6months
• distress

PTSD

• TRAUMA

Adjustment Disorder:

• <3months
• disproportionate stress and functional impairment
• stress-related disturbance

Question 7

What is an acronym for GAD?

Answer 7

Watchers - worry - anxiety - tension in muscle - concentration - hyperarousal - energy loss - restlessness - sleep disturbance