Anxiety and Fear-related Disorders

Question 1

What is Generalised Anxiety Disorder?

Answer 1

A chronic cdtn characterised by excessive, uncontrollable worry extending across various life domains.

Duration: at least 6 mths.

Question 2

What are the sx present in GAD in the following:
1. Psychological
2. Motor sx
3. Neuromuscular
4. GI
5. CVD
6. Resp
7. GU

Answer 2

1. Fears, worries, poor concentration, insomnia
2. Restlessness, fidgeting
3. Tremor, tension headache, tinnitus
4. Dysphagia, nausea, indigestion
5. Palpitations
6. Dyspnoea, tight chest
7. Urinary frequency, erectile dysfunction, amenorrhoea

Question 3

Ddx for GAD

Answer 3

• Hyperthyroidism (tremor, tachy, wgt loss, arrhythmia)
• Cardiac causes (palpitations/arrhythmia)
• Medication-induced anxiety
• Substance misuse and intoxication
• Excessive caffeine intake
• Depression

Question 4

Mx of GAD

Answer 4

1st line - low intensity psychological interventions:
* Individual self-help (guided or non-facilitated)
* Psychoeducational groups

2nd line - if not approved:
* High intensity CBT
* Medical - SSRIs (sertraline)
* Symptomatic management (propranolol for palpitations)

Question 5

What is panic disorder?

Answer 5

Occurrence of recurrent, unexpected panic attacks. At least one attack followed by a month of persistent worry about future attacks and may lead to avoidance behaviours.

Question 6

Sx of panic disorder?

Answer 6

Breathing difficulty
Chest discomfort
Palpitations
Hyperventilation - leads to tingling or numbness in peripheries
Shaking

Question 7

Mx of panic disorder?

Answer 7

CBT - 1st line
SSRIs - 2nd line to CBT
Psychoeducation

Question 8

What is agoraphobia?

Describe its onset

Answer 8

Fear of open spaces and associated factors (i.e. presence of crowds, escape to a safe place like home)

Onset may be gradual or precipitated by sudden panic attack.

Question 9

Mx of phobias

Answer 9

CBT - 1st line

Question 10

What is social phobia / social anxiety disorder (SAD)?

Answer 10

Fear of scrutiny by others in relatively small groups (rather than to crowds) resulting in avoidance if social situations.

Question 11

Difference between panic attacks and panic disorder?

Answer 11

Panic attacks - short lived episodes approx 20 mins, severe anxiety

Panic disorder - unpredictable repeated panic attacks within 1 month with no specific psychiatric cause.

Question 12

Difference between acute stress reaction (ASR) and PTSD?

Answer 12

ASR - sx that occur up to 4 wks after traumatic event

If sx last longer than 1 month then it’s PTSD

Question 13

Define acute stress reaction (ASR)

Answer 13

Direct/indirect exposure to traumatic event resulting in intense emotional distress that persists between 3 days to 4 weeks.

Question 14

Sx of ASR?

Answer 14

Intrusive memories
Dissociation
Heightened arousal
Avoidance
Overwhelming anxiety
Palpitations
Efforts to escape reminders

Question 15

Mx of ASR

Answer 15

1st line - trauma-focused CBT
Symptomatic mx - e.g. benzodiazepines

Question 16

Difference between ASR and adjustment disorder

Answer 16

The nature of the stressor:
ASR = severe or life-threatening events
Adjustment disorder = not severe (e.g. made redundant or divorced)

Question 17

Define PTSD

Answer 17

Direct/indirect exposure to a traumatic event that persists for more than 6 months.

Question 18

Sx of PTSD

Answer 18

• Intrusion sx - recurrent distressing memories, nightmares, flashbacks
• Avoidance sx - avoid trauma related reminders
• Negative alterations in mood and cognition - distorted blame
• Arousal sx - conc. difficulties, sleep disturbances, hypervigilance

Question 19

Tx of PTSD

Answer 19

1st line - Trauma-focused CBT
If more severe: EMDR (eye movement desensitisation and reprocessing)
If other sx present such as anxiety/depression: SSRIs and SNRI