Anxiety

Question 1

Define anxiety. When does it become a problem?

Answer 1

Anxiety is a natural bodily reaction to stressful stimuli which acts as a defensive mechanism, teaching the organism what stimuli to avoid. Anxiety only becomes a problem when there are no external stimuli, but the symptoms of anxiety persist.

Question 2

Name the class of drugs which treat anxiety.

Answer 2

Anxiolytics.

Question 3

Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of general anxiety disorder.

Answer 3

5.1%. Non-specific anxiety. SSRI & benzos. CBT. 65-75% recover.

Question 4

Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of panic disorder.

Answer 4

3.5%. Recurrent panic. SSRI & alprazolam. Exposure. 25.45% improve.

Question 5

Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of phobia (specific).

Answer 5

11.3%. Fear of specific stimulant. Possibly benzos to allow exposure. Exposure. Reduction is common but less rare.

Question 6

Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of phobia (social).

Answer 6

13.3%. Fear of social situations. SSRI. CBT. 35-75% relapse on drug withdrawal.

Question 7

Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of OCD.

Answer 7

2.5%. Repetitive irrational actions. SSRI. CBT & surgery. 60% improve within 1 year.

Question 8

Give the life time prevalence, symptoms, drugs used to treat, other treatments for, and the prognosis of PTSD.

Answer 8

1-3%. Sequel to trauma, recurring fear and memories. TCA, SSRI, MAOI. CBT. <50% leave clinical class.

Question 9

Anxiety or worry is associated with 3 or more of what symptoms?

Answer 9

Restlessness, easily fatigued, difficulties with concentration, irritability, muscle tension, sleep disturbances.

Question 10

Who are more likely to seek help for anxiety; men or women? Why?

Answer 10

Women are about twice as likely to seek help than men; this is mainly due to social pressures on men to ‘bottle up’ their emotions.

Question 11

List three interventions that have evidence for treatment in GAD?

Answer 11

Psychological therapy (CBT), pharmacological therapy (SSRIs), self-help (bibliotherapy).

Question 12

How long can benzodiazepines be used for? Why cant they be used for longer?

Answer 12

They should not normally be used for longer than 2-4 weeks due to the risk of dependence and potential withdrawal symptoms.

Question 13

What is the current pharmacological treatment for GAD?

Answer 13

Current therapy is SSRI plus benzodiazepine during the initial 3-4 weeks to control initial exacerbation of symptoms and provide immediate relief. Benzodiazepines are then slowly withdrawn with SSRIs remaining.

Question 14

Give some classes of anxiotytic drugs.

Answer 14

Opiates, barbiturates, alcohol, buspirone, benzodiazepines, SSRIs, beta-blockers.

Question 15

How do benzodiazepines act to alleviate the symptoms of anxiety?

Answer 15

All benzodiazepines potentiate GABA by acting on the benzodiazepine site on the GABAA/Cl- channel macromolecule; this inhibits anxiety symptoms. They are very selective for their receptors so cause no problem side effects due to non-selectivity.

Question 16

As well as being anxiotytic, what other affects do benzodiazepines have?

Answer 16

Sedation, anti-epileptic, amnesia, impulsivity, loss of inhibitions, dependence risk.

Question 17

List commonly used anxiolytic benzodiazepines.

Answer 17

Bromazepam, chlordiazepoxide, clorazepate, diazepam, ketazolam, lorazepam, oxazepam.

Question 18

List the problems with using barbiturates.

Answer 18

Low therapeutic index, marked respiratory depression, fatal in overdose, rapid tolerance, dangerous in withdrawal, induce liver enzymes.

Question 19

What should one do if a patient doesn’t respond to one SSRI?

Answer 19

Individual patients may prefer, or respond better to a certain class; thus, multiple trials with a patient is not uncommon.

Question 20

What form of anxiety are beta blockers used to treat? Which drug is preferred?

Answer 20

Beta blockers are useful in the treatment of performance anxiety with propranolol is the drug of choice.

Question 21

List the symptoms that appear during a panic attack.

Answer 21

Palpitations, raised heart rate, SOB, nausea, abdominal distress, depersonalisation, numbness, flushes, tingling sensations.

Question 22

List three interventions used in PD.

Answer 22

Psychological therapy (CBT), pharmacological therapy (SSRIs), self-help (bibliotherapy).

Question 23

Which benzodiazepine is licensed for treatment of PD?

Answer 23

Alprazolam.

Question 24

Which antidepressants effectively and frequently used to treat PD?

Answer 24

SSRIs, tricyclic antidepressants, monoamine oxidase inhibitors.

Question 25

Define OCD.

Answer 25

This illness is characterised by repetitive fruitless physical activity e.g. washing of hands as well as intrusive and repetitive thoughts that cause distress.

Question 26

Explain the intervention used in OCD.

Answer 26

CBT is offered to alleviate the condition; if the patient is unable to effectively engage in CBT or there is no adequate response, an SSRI is introduced.