Anxiety

Question 1

What is the DSM-V criteria for a panic attack?

Answer 1

• A discrete period of intense fear or discomfort in which 4 or more of the following symptoms developed abruptly and reached a peak within 10 mins:
  
  • Trembling or shaking
  • Sweating
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress

Question 2

When presenting with symptoms of panic attack what must be ruled out?

Answer 2

When presenting with these symptoms, need to rule out other diagnosis e.g. alcohol and other substance-use disorders, thyroid disease, cardiac disease, respiratory disease

Question 3

What are the Aims of Treatment of Anxiety?

Answer 3

• Control and cessation of acute anxiety attack
• Control and cessation of fear-driver avoidance (maintenance therapy)
• Reduction in vulnerability to relapse
• Improve social functioning

Question 4

How is a single panic attack treated?

Answer 4

• Treat isolated panic attacks with psychological interventions
• Panic attacks may initially suggest an acute medical condition and must be evaluated for a significant acute physical illness
• Breathing slowly and deeply or rebreathing into a hand-held bag placed over the mouth

Question 5

What is the Self-test for anxiety?

Answer 5

GAD-7

Question 6

Choice of Treatment of Anixety is based on?

Answer 6

• Adverse effect profile
• Tolerability
• Presence of co-existing depression
• History of alcohol/drug use
• Risk of overdose

Question 7

Dosing of SSRIs or SNRIs in Anxiety?

• Start treatment at?
• Titrate slow or quick?
• How long can it take to feel a benefit from the medication?

Answer 7

• Start treatment at a low dose (approximately half of the starting dose given to depressed patients)
• Titrate slowly (increase as tolerated to therapeutic effect within the approved dose range)
• Can take up to 6 weeks to feel a benefit from the medication (or even up to 12 weeks for full benefit)

Question 8

Maintenance in Anxiety?

• Total duration of therpay?
• Continue dose at?
• What does early discontinuation result in?

Answer 8

• Total duration of therapy: 12-24 months and discontinue over 4-6 months
• Continue dose that was used in the acute phase
• Early discontinuation results in high rate of relapse

Question 9

Discuss Stopping and Switching medication in anxiety

• When ceasing SSRIs and SNRIs?
• Discontinuation of TCAs?
• To minimise the potential for discontinuation symptoms?

Answer 9

• When ceasing SSRIs and SNRIs (especially paroxetine and venlafaxine), many individuals experience a discontinuation syndrome, with flu-like symptoms
• Abrupt discontinuation of TCAs can cause similar symptoms
• To minimise the potential for discontinuation symptoms, it’s recommended that clinicians downward-titrate medication slowly over weeks to months while monitoring effects