Anxiety and Depression

Question 1

What are the risk factors of anxiety?

Answer 1

Family history
Childhood adversity
Stressful life events
Certain personality traits – some people are more stressed out naturally
Parenting styles – how we bring up children. Overprotective
Younger age – during teenage years
Female, Unmarried or unemployed
Poor physical and/or mental health
Trauma (upsetting events as a child, childhood rape, witness to a traumatic event)

Question 2

Describe GAD

Answer 2

everyday feel worried and stressed. No triggers. A perfectly normal life. A lot of physical symptoms: insomnia, restlessness, dizziness, heart palpitations, flushing

Question 3

Describe social anxiety disorder

Answer 3

long-lasting and overwhelming fear of social situations. E.g. worried about going to school or work, anywhere where you will be in contact with people.

Question 4

Describe PTSD

Answer 4

caused by stress or trauma. E.g. soldiers from the war. Overwhelming fear or guilt. Flashbacks and nightmares, reliving the situation.

Question 5

Describe Panic disorder

Answer 5

manifested with physical symptoms - tachycardia, chest pain. Panic – overwhelming fear. Its disproportionate in situation they are in. In a calm environment, then get an overwhelming fear of panic.

Question 6

Describe OCD

Answer 6

OCD – obsessive thoughts that lead to compulsive actions that is disproportionate to the situation they are in. House getting burgled – checking locks multiple times, obsessive washing hands, ritualised behaviour

Question 7

Describe BDD

Answer 7

BDD – when people have obsession with what they physically look like. If they have a flaw In their appearance. Flaw is not noticeable. Occurs early teenage years. Can lead to depression, self and suicide. Comparing yourself to others

Question 8

What drugs are used for GAD?

Answer 8

Escitalopram

Paroxetine

Venlafaxine

Question 9

What drugs are used for Social anxiety?

Answer 9

Escitalopram
Paroxetine
Sertraline
Venlafaxine

Question 10

What drugs are used for PTSD?

Answer 10

Paroxetine

Sertraline

Question 11

What drugs are used for panic disorder?

Answer 11

Citalopram

Escitalopram

Question 12

What drugs are used for OCD?

Answer 12

Escitalopram

Sertraline

Question 13

How is GAD diagnosed?

Answer 13

• First 2 questions are the screening questions

* If you score 3 or above for the first 2 questions, need to think more seriously so leads to referral

Question 14

What is CBT?

Answer 14

– Cognitive Behaviour Therapy – examines the way you think and the behaviours you have. It is a talking therapy which focuses on goals. Deals with how your thoughts affects your feelings and lead to behaviours.

Question 15

What
Pharmacological Therapy
is available for GAD?

Answer 15

Drug choice varies depending on diagnosis and severity of symptoms
↑ GABA – Benzodiazepines or pregabalin
- Benzos give rapid relief of acute anxiety but have SE’s
- Pregabalin an option in GAD (increase GABA levels)
↑ Serotonin – SSRIs, SNRI or TCAs and Buspirone
- SSRIs 1st line for most anxiety disorders
- Delay in effect
Beta-blockers for physical symptoms e.g.: tachycardia, tremor, sweating

Question 16

What is depression?

Answer 16

More than simply feeling unhappy or fed up for a few days
Affects people in different ways and can cause a wide range of symptoms
Can be mild or severe (suicidal thoughts)
Sometimes there’s a trigger for depression. Life changing events, such as bereavement, losing your job or having a baby, can bring it on.
Most cases of depression will eventually resolve themselves

Question 17

How is depression diagnoses?

Answer 17

Use the DSM-IV criteria – depressed for more than 2 weeks – Is it affected their social life? And day to day function?

Severe depression: needs to have at least 5 points of the criteria

Question 18

How is an antidepressant chosen?

Answer 18

• adverse events
• potential interactions
• person’s perception of the efficacy and toleratability of any antidepressants previously taken

Normally choose SSRi IN GENERIC FORM

Commonly causes increased risk of bleeding, so consider prescribing GI protection frug for those taken NSAIDS or aspirin

Question 19

What are the principles of prescribing antidepressants?

Answer 19

Discuss with the patient the choice of drug PLUS alternative/additional nonpharmacological options

Not a quick fix!…gradual relief of symptoms over several weeks
- No improvement after 6 weeks and have given the therapeutic dose– switch to an alternative drug
- Must ensure a therapeutic drug is given, especially SSRIs
1/3 patients don’t respond to first choice

Ensure an effective dose (following titration)

For first episode continue for 6-9 months – From when the symptoms have resolves and improved. Should not be on antidepressants for long term, particular if there is been a social trigger.
Withdrawal antidepressants gradually

Question 20

What is

Antidepressant: Swopping and Stopping?

Answer 20

All antidepressants have the potential to cause discontinuation symptoms – not associated with addiction to drug

Cross-tapering – gradually taper off the dose of the drug that you want to stop at the same time you introduce the second drug. Down one dose and increase dose of other drug.
- Reduces symptoms of discontinuing one drug but also improve symptoms of depression at the same time