Anxiety and OCD

Question 1

How is anxiety defined by NICE?

Answer 1

Excessive worry about a number of different events associated with heightened tension

Question 2

Name 4 anxiety symptoms

Answer 2

• Fears and worries
• Depersonalisation
• Derealisation
• Poor concentration
• Insomnia and night terrors
• Irritability
• Headaches
• Restlessness and fidgeting
• Tremor
• GI upset
• Palpitations
• Chest discomfort

Question 3

Name a potential physical cause of anxiety

Answer 3

• Hyperthyroidism
• Cardiac disease
• Medication-induced anxiety i.e. salbutamol, theophylline, corticosteroids, antidepressants

Question 4

1) What is the first step in the NICE stepwise approach to anxiety management (2)?
2) What is the second step in the NICE stepwise approach to anxiety management?
3) What is the third step in the NICE stepwise approach to anxiety management (2)?
4) What is the fourth step in the NICE stepwise approach to anxiety management?

Answer 4

1) Education about GAD + active monitoring
2) Low-intensity psychological interventions
3) High-intensity psychological interventions or drug interventions
4) Highly specialist input

Question 5

1) Name a low-intensity psychological intervention
2) Name a high-intensity psychological interventions

Answer 5

1) Individual non-facilitated self-help, individual guided self-help, psychoeducational groups
2) CBT, applied relaxation

Question 6

1) What is the first line medication for anxiety, and what group of drugs does it belong to?
2) What group of drugs is second line, and give an example
3) If a patient can’t tolerate these 2 drug groups, what drug is recommended?

Answer 6

1) Sertraline, SSRI
2) SNRI (serotonin-noradrenaline reuptake inhibitor) i.e. venlafaxine, duloxetine
3) Pregabalin

Question 7

Obsessive-compulsive disorder (OCD) is characterised by the presence of either obsessions or compulsions, but commonly both
1) What is meant by obsessive?
2) What is meant by compulsive?

Answer 7

1) Unwanted intrusive thought, image or urge that repeatedly enters the person’s mind
2) Repetitive behaviours or mental acts that the person feels driven to perform

Question 8

1) If functional impairment is mild, what treatment is offered?
2) If this treatment is insufficient, what can be offered?
3) If there’s severe functional impairment, what can be offered?

Answer 8

1) Low intensity psychological treatment (CBT including exposure and response prevention [ERP])
2) Course of an SSRI
3) SSRI and CBT (including ERP)