Anxiety and Anxiety Disorders

Question 1

What is anxiety?

Answer 1

An emotion accompanied by a physiological changes (increased HR, increased BP, nausea, tingling muscles and RR increase)
Prepares the body for fight or flight

Question 2

Why do we experience anxiety?

Answer 2

a biological/physiological motivator - helps the body to reach the fight or flight response in an emergency

Question 3

When does anxiety become problematic?

Answer 3

Tends to be out of proportion/experience it more often than not

Question 4

What is a “panic attack”?

Answer 4

A discrete episode of intense fear or discomfort
* Starts abruptly
* Reaches a maximum within a few minutes and lasts at least some minutes
* At least 4 specific symptoms of anxiety

Question 5

What are common bodily symptoms of anxiety?

Answer 5

1. headaches
2. sweating
3. light headedness
4. chest pains
5. palpitations
6. stomach pains/diarrhoea/bladder weakness

Question 6

Does one panic attack mean someone has a panic disorder?

Answer 6

No - isolated panic attacks are normal

Question 7

What classifies diagnosis of Generalised Anxiety Disorder?

Answer 7

anxiety is continuous, the anxiety is there all the time

Question 8

What are the types of episodic anxiety disorders?

Answer 8

Panic disorder
Phobias

Question 9

Features of Generalised anxiety disorder

Answer 9

Over 6 months of tension, worry and apprehension about everyday events
Inclusive of finances, housing, relatives and health

Question 10

Panic disorder features

Answer 10

1. recurrent panic attacks
2. unpredictable in nature
3. dominant physical symptoms e.g. palpitations, chest pain, depersonalisation
4. 4 panic attacks in 4 weeks

Question 11

What is a phobia?

Answer 11

Fears of specific situations or objects and the anxiety is restricted to just that situation or object.

The anxiety cannot be reasoned or explained in any way and is seen as out of proportion.

Question 12

What is Agoraphobia?

Answer 12

• fear of an open or closed space
• usually a fear of leaving home or being away from home
• fear of crowds, entering public spaces

Question 13

Common additional symptoms of agoraphobia

Answer 13

• Depressive and obsessional symptoms
• Social phobias

Question 14

Social phobias/social anxiety - what is it?

Answer 14

1. Fear of being judged
2. Blushing/hand tremor/nausea/urgency of urination
3. Symptoms may progress into panic attacks
4. Most commonly onset is in adolescence

Question 15

Common age of onset for agoraphobia

Answer 15

20-35 years of age

Question 16

When do specific phobias usually develop?

Answer 16

In childhood e.g. flying, dentists, certain animals

Question 17

Psychological management of GAD

Answer 17

• CBT
• applied relaxation
• Self help

Question 18

Psychological management of Phobias

Answer 18

psycho education
exposure

Question 19

Medication to manage generalised anxiety disorder

Answer 19

1. SSRIs
2. Beta blockers for peripheral symptoms
3. AVOID benzodiazepines but can be used in short term e.g. for a one time flight

Question 20

What is obsessive compulsive disorder?

Answer 20

1. Recurrent obsessional thoughts and compulsive acts
   “ideas, images or impulses that enter their mind repetitively”

Question 21

Examples of obsessions in OCD

Answer 21

fear of getting a disease
fear of coming to harm
fear of causing harm to others

Question 22

What are compulsions in OCD?

Answer 22

• Stereotyped behaviours that are repeated again and again.
• Not inherently enjoyable, nor do they result in the completion of inherently useful tasks.
• Function is to prevent some unlikely event, usually involving harm.

Question 23

Step wise approach of management in OCD (based on how much symptoms impair their daily life/functioning)

Answer 23

1. CBT and ERP (exposure and response prevention) in mild impairment
2. SSRI usually Sertraline in moderate impairment
3. Clomipramine is given in cases of severe impairment

Question 24

Signs and Symptoms of PTSD

Answer 24

• Re-experiencing symptoms eg flashbacks, nightmares, intrusive memories
• Avoidance of activities and situations associated with trauma
• Hyper-arousal/anxiety with hyper-vigilance and increased startle reaction ie jumpy
• Numbness, emotional blunting, detachment from others
• Associated depression and suicidal ideation

Question 25

What is PTSD?

Answer 25

describe a specific set of symptoms that develop in the aftermath of such an event, but that also persist

Question 26

When is the onset of symptoms after the trauma in PTSD?

Answer 26

Usually 1-6 months after the event

Question 27

High risk groups of PTSD

Answer 27

1. soldiers
2. disaster victims
3. rape victims
4. assault victims

Question 28

Predisposing factors of PTSD

Answer 28

– Personality traits (compulsive, asthenic)– previous history of neurotic illness,
– Genetic
– Predisposing factors may lower the threshold for the development of the syndrome or aggravate its course (but they are neither necessary nor sufficient to explain its occurrence)

Question 29

Risk factors for GAD

Answer 29

Aged 35-54
Being divorced or separated
Living alone
Being a lone parent

Question 30

Whats the difference between PTSD and acute stress disorder?

Answer 30

They have the same symptoms but to be PTSD, it means that the symptoms have to last for more than 4 weeks. If under 4 weeks, this is Acute stress disorder

Question 31

Treatment of Acute Stress Disorder

Answer 31

First line: trauma focused CBT
Benzodiazepines can be used for acute symptoms e.g. agitation and sleep disturbance but not for long due to dependence

Question 32

What is the first line management for PTSD?

Answer 32

Cognitive behavioural therapy or eye movement desensitisation and reprocessing therapy