Anxiety based conditions

Question 1

What possible conditions can cause anxiety?

Answer 1

GAD

Panic disorder

PTSD/Acute stress reaction

OCD

Phobias including social phobia

Organic causes e.g. hyperthyroidism, caffeine or stimulant use, asthma drugs (e.g. salbutamol, theophylline), steroids, hypoparathyroidism, phaeo

Question 2

Symptoms to ask about - general anxiety questions

Answer 2

Depersonalisation

Worrying about the future?
Feeling on edge?
Feelings of fear?

Motor:

• Restlessness
• Fidgeting

Autonomic/somatic symptoms:

• SOB
• Chest pain
• Palpitations
• Sweating
• Dry mouth
• Nausea

Sleep affected/insomnia

Any intrusive thoughts - OCD

Any discrete episodes of panic attacks? Of feeling like about to die?

Question 3

Symptoms to ask about in a PTSD history specifically

Answer 3

Flashbacks
Nightmares

Irritability
Numbness

Avoidance of situations reminiscent of the trauma

Hypervigilance

Insomnia

Dissociation - you don’t feel real or the world around you doesn’t feel real

Question 4

Questions to differentiate between different types of anxiety?

Answer 4

When does the anxiety occur?
- All the time/ no trigger –> GAD likely

What brings the anxiety on?

• Random - GAD, Panic disorder
• Reminds of trauma - PTSD
• Being outside/open spaces/crowds /shops (due to lack of exit) - agoraphobia
• Eating or talking in front of others - social phobia

Do you get panic attacks/ episodes of sudden onset symptoms?
- How do you feel during these episodes? (Panic disorder - feel about to die)

Do you get nightmares/flashbacks? - PTSD

OCD:
Do you get distressing intrusive thoughts into your brain?
Do you ever feel like you have to do an action to get rid of the anxiety? What do you do to get rid of this anxiety?

Question 5

OCD specific questions

Answer 5

Are you getting intrusive thoughts?

• What do these thoughts involve?
• Do you recognise these as your own thoughts?
• How do you feel about these thoughts - do you believe them to be true? Are you aware they are irrational/illogical? (they should have insight into the fact these thoughts are illogical)

COMPULSIONS

• Do you have a routine you need to do to in order to get rid of the intrusive thoughts?
• What do you do to get rid of these intrusive thoughts?

FUNCTIONAL IMPACT OF THIS:
- How does this impact life at home? Relationships? Work?

RISK ASSESSMENT

Question 6

GAD/panic disorder specific questions

Answer 6

• How often does the anxiety occur? How many days a week?
• Triggers for the symptoms?
• Physical Sx - panic attacks, sweating, heart racing
• Psychological symptoms - hypervigilance, poor concentration and sleep
• Behavioural symptoms - rituals, restlessness, agitation, compulsions

Question 7

Rest of the anxiety history questions

Answer 7

RULE OUT OTHER PSYCH:

• Any low mood? Anhedonia?
• Any periods of elevated mood?
• Seen or heard anything you can’t explain or you think others may have not seen/heard?
• Screen for delusions

Past Psych Hx
PMH
ICE
DH and allergies
FHx - of psych esp
SHx - work, smoking and alcohol, recreational drugs!!

Question 8

Biological treatment of anxiety disorders

Answer 8

Can treat anxiety with SSRIs

Often sertraline (could use fluoxetine in OCD)

Often use mirtazapine or paroxetine in PTSD

Question 9

Psychological treatment of anxiety disorders

Answer 9

CBT based usually

OCD - CBT with exposure response prevention

PTSD - trauma focused CBT or EMDR

Question 10

Biological treatment of anxiety disorders

Answer 10

Can treat anxiety with SSRIs

Often sertraline (could use fluoxetine in OCD)

(Often use mirtazapine or paroxetine in PTSD)???

Question 11

Social treatment of anxiety disorders

Answer 11

Self-help

• Mindfulness
• Anxiety UK
• Breathing and grounding techniques