Anxiety and Mood-Related Disorders

Question 1

What are the DSM criteria for panic disorder?

Answer 1

• A - recurrent panic attacks
• B - 1+ attack followed by one or both of
  
  • Worry about more attacks or consequences
  • Significant change in behaviour to avoid them
• C - not GMC or substance
• D - not another MH disorder

Question 2

What defines a panic attack in the DSM?

Answer 2

• Abrupt intense fear/discomfort peaking in minutes with 4+ of the following:
  
  • Palpitations/tachycardia
  • Sweating
  • Trembling/shaking
  • Shortness of breath or smothering feeling
  • Feelings of choking
  • Nausea or abdominal distress
  • Dizziness/light-headedness
  • Chills or heat sensations
  • Paraesthesias
  • Derealisation (unreality) or depersonalisation (detachment from self)
  • Fear of losing control or going crazy
  • Fear of dying

Question 3

What might you consider in the management of a patient with panic disorder?

Answer 3

• Control of hyperventilation: breathing retraining
• Cognitive therapy: decatastrophising of bodily symptoms
• Pharmacotherapy (if severe/refractory)
  
  • SSRIs (maintenance, 2-4 week onset)
  • Benzodiazepines (acute)
• Graduated exposure therapy

Question 4

What are the DSM criteria for agoraphobia?

Answer 4

• A - marked fear/anxiety about 2+ of:
  
  • Using PT, being in open space, closed space, in line/part of a crowd, outside/part of a crowd
• B - avoids these because escape might be hard OR help not availble in the event of panic/embarrassment
• C - situations almost always provoke fear/anxiety
• D - situations actively avoided or tolerated only with companion
• E - response OOP to actual danger
• F - >6/12
• G - socio-occupational dysfunction
• H - if GMC present, avoidance excessive
• I - not other MH disorder

Question 5

What might you consider in the management of a patient with agoraphobia?

Answer 5

• Psychoeducation: CBT
• Exposure/response training: graduated conquering of fear
• Pharmacotherapy: generally only used in patients with severe or non-responsive symptoms
  
  • SSRIs/SNRIs

Question 6

What are the DSM criteria for generalised anxiety disorder?

Answer 6

• A - excessive worry (apprehensive expectation) and anxiety, more days than not for 6+ months, about a number of events or activities
• B - worry is difficult to control
• C - associated with 3+ of the following:
  
  • Restlessness/keyed-up/on edge
  • Easily fatigued
  • Difficulty concentrating or mind-blanks
  • Irritability
  • Muscle tension
  • Sleep disturbance
• D - socio-occupational dysfunction
• E - not due to substance or GMC
• F - not better explained by another MH disorder

Question 7

What might you consider in the management of someone with generalised anxiety disorder?

Answer 7

• Lifestyle advice: caffeine, EtOH avoidance, sleep hygiene
• Psychological: CBT including relaxation/mindfulness
• Pharmacotherapy: generally used when symptoms not-responsive or there is concurrent depression
  
  • SSRIs/SNRIs

Question 8

What, in general, are the DSM criteria for PTSD?

Answer 8

• A - exposure to actual or threatened death/serious injury/sexual violence
• B - presence of 1+ of the following symptoms after the event: recurrent or intrusive dreams or memories, flashbacks, internal cues cause psych or physical distress
• C - persistent avoidance of stimuli associated with the event
• D - negative alterations in cognitions and mood associated with event: memory around event, negative self-belief/blame
• E - marked alterations in arousal and reactivity associated with event: irritability, recklessness, hypervigilance, poor concentration/sleep
• F - >1/12
• G-H - socio-occ dysfunction, not substance or GMC

Question 9

What is acute stress disorder (in simple terms)?

Answer 9

• PTSD < 1 month

Question 10

What are the DSM criteria for adjustment disorder?

Answer 10

• A - development of emotional/behavioural symptoms in response to an identifiable stressor occurring within 3/12 of the stressor onset
• B - symptoms or behaviours clinically significant: 1+ of
  
  • Marked distress out of proportion to severity of stressor
  • Significant impairment in socio-occupational function
• C - does not meet criteria for another mental disorder
• D - symptoms do not represent normal bereavement
• E - once the stressor has been terminated, symptoms do not persist > 6/12