Anxiety

Question 1

Generalised anxiety disorder

Answer 1

excessive, persistent, unreasonable anxiety about every day things. People with GAD feel their anxiety is out of their control

Question 2

Symptoms of GAD

Answer 2

Restlessness, difficulty concentrating, irritability
Physical symptoms- digestive symptoms, muscle spasms, difficulty sleeping- chronic fatigue, sweating, lightheadedness, dizziness, palpitations.

Question 3

Diagnosis of GAD

Answer 3

Needs to be severe enough to be-
long lasting- most days for at least 6 months
not controllable
causing significant distress/impairment in function

Question 4

Incidence and prevalence of GAD

Answer 4

lifetime prevalence- 9%

Age onset- 20-40yrs, F>M, chronic fluctuating course

Question 5

Treatment of GAD

Answer 5

CBT
SSRIs/SNRIs
Pregablin
Benzos- short term only

Question 6

Panic disorder

Answer 6

Recurrent attacks of sever anxiety/panic which are not restricted to any particular situation or set of circumstances (unpredictable). Typical anxiety symptoms present, often also secondary fear of dying, loosing control, or going mad.
May occur with/without agoraphobia, not due to direct physiological effects of a medication or medical disorder

Question 7

Agoraphobia

Answer 7

Fear of being in situations where escape may be difficult or that help wouldn’t be available if things went wrong

Question 8

Incidence and prevalence of panic disorder

Answer 8

lifetime prevalence 2-3%
50-67% also have agoraphobia
onset- late adolescence to mid thirties
10 year follow up- 1/3 unchanged or worse, 1/3 modest improvement, 1/3 well
comorbid with other anxiety disorders, depression, alcohol and drug use

Question 9

Treatment of panic disorder

Answer 9

CBT, SSRIs/SNRIs/ tricyclics, Benzos (short term

Question 10

what can trigger panic attacks in susceptible individuals

Answer 10

infusions of lactate, rebreathing air

Question 11

3 types of phobia

Answer 11

specific phobia
agoraphobia
social phobia

Question 12

age of onset of phobias

Answer 12

Early onset- social and specific- 80% by early adolescence

Fear recognised as irrational, typified by avoidance and anticipatory anxiety

Question 13

Agoraphobia

Answer 13

Fear of leaving house, crowds, travelling alone in planes, trains or buses. Avoidance of phobic situation often prominent- can experience little anxiety as a result. Associated with other mental disoreders

Question 14

Specific phobia

Answer 14

marked persistent fear that is excessive or unreasonable eg pf heights, flying etc
Exposure almost invariably provokes and anxiety response

Question 15

Treatment of specific phobia

Answer 15

Behavioural therapy- graded exposure/desensitisation

SSRIs/SNRIs if required

Question 16

Social phobia/social anxiety disorder

Answer 16

Persistent fear of one/more social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
Individual fears that they will act in a way (show anxiety symptoms) that will be embarrassing
Usually occurs in small social settings

Question 17

Symptoms of social anxiety

Answer 17

blushing/shaking, fear of vomitting, urgency/fear of micturition/defecation
can result in poor school performance, school refusal etc

Question 18

Treatment of social anxiety

Answer 18

CBT, SSRIs/SNRIs, benzos

Question 19

OCD

Answer 19

Obsessional symptoms, compulsive acts must be present for at least 2 weeks and be a source of distress and interference with activites

Question 20

Symptoms of OCD

Answer 20

Obsessions must be individuals own thoughts, resistance must be present, rituals- not pleasant

Question 21

epidemiology

Answer 21

no gender bias
mean age onset 20yrs
60-90% experience one major depressive episode
significant morbidity with schizophrenia, Tourettes, darting disorders, trichtomallomania

Question 22

treatment of OCD

Answer 22

CBT, SSRIs/clomipramine