Anxiety - Burton

Question 1

What are the different groups of symptoms in anxiety?

Answer 1

Psychological, physical (cardiovascular, gastrointestinal, respiratory, genitourinary), other/general

Question 2

What are the psychological symptoms of anxiety?

Answer 2

Feelings of fear and impending doom, feelings of dizziness and faintness, restlessness, exaggerated startle response, poor concentration, irritability, insomnia and night terrors, depersonalisation and derealisation, globus hystericus (lump in throat).

Question 3

What are the cardiovascular symptoms of anxiety?

Answer 3

Palpitations, tachycardia, chest discomfort.

Question 4

What are the gastrointestinal symptoms of anxiety?

Answer 4

Dry mouth, nausea, abdominal discomfort, frequent or loose motions

Question 5

What are the respiratory symptoms of anxiety?

Answer 5

Tachypnoea, difficulty in catching breath, chest tightness.

Question 6

What are the genitourinary symptoms of anxiety?

Answer 6

Urinary frequency, impotence, amenorrhoea?

Question 7

What are the other/general symptoms of anxiety?

Answer 7

Hot flushes or cold chills, tremor, perspiration, headache and muscle pains, numbness and tingling sensations around the mouth and in the extremities, dizziness, faintness

Question 8

What is the definition of anxiety?

Answer 8

A state consisting of psychological and physical symptoms brought about by a sense of apprehension at a perceived threat.

Question 9

What age do people usually develop anxiety disorders?

Answer 9

Take hold in early adulthood or, less commonly, in middle age.

Question 10

Which gender does anxiety affect more?

Answer 10

Women (but not in social phobia and obsessive-compulsive disorder)

Question 11

What is the most common type of anxiety?

Answer 11

Specific (simple) phobias (followed by social phobias and PTSD)

Question 12

What are the three types of phobic anxiety disorders?

Answer 12

Agoraphobia, social phobia, specific (simple) phobias

Question 13

What is agoraphobia and what therapies work?

Answer 13

Fear of places that are difficult or embarrassing to escape from, typically because they are confined, crowded, or far from home.

Cognitive behavioural techniques such as graded exposure and anxiety management. Relapse is common.

Question 14

What is social phobia and what therapies work?

Answer 14

Fear of being judged by others and of being embarrassed or humiliated in one or more social or performance situations such as holding a conversation or delivering a speech.

May respond to cognitive behavioural techniques such as graded exposure and anxiety management.

Question 15

What is specific (simple) phobia and what therapies work?

Answer 15

Most common. Fear of a specific object, activity, or situation. Unlike other anxiety disorders these begin in childhood.

May respond to cognitive behavioural techniques such as graded exposure and anxiety management, flooding, and modelling.

Question 16

What is a panic attack?

Answer 16

Symptoms of anxiety are so sever that the person fears that they are suffocating, having a heart attack, losing control, or even ‘going crazy’.

Question 17

What is a panic disorder?

Answer 17

Recurrent panic attacks due to developing a fear of the panic attacks themselves.

Question 18

What is generalised anxiety disorder and what therapies work?

Answer 18

Long-standing free-floating anxiety that may fluctuate, but that is neither situational nor episodic. Apprehension is present about a number of hypothetical events that are unlikely to happen.

May respond to counselling and cognitive and behavioural techniques.

Question 19

What are the different types of adjustment disorders and reactions to severe stress?

Answer 19

Adjustment disorder, abnormal bereavement reaction, acute stress reaction and PTSD

Question 20

What is adjustment disorder and what therapies work?

Answer 20

A protracted response to a significant life change or life event such as a change of job, migration, or divorce. Characterised by depressive symptoms and/or anxiety symptoms that are not severe enough to warrant a diagnosis of depression or anxiety.

Supportive psychotherapy is often helpful, but adjustment disorders have a good prognosis and normally resolve within 6 months.

Question 21

What is abnormal bereavement reaction?

Answer 21

Unusually intense or unusually prolonged bereavement reaction, that is, if it meets the criteria for a depressive disorder or it lasts for more than six months. Also considered abnormal if delayed, inhibited, or distorted.

Question 22

What is an acute stress reaction?

Answer 22

Acute response to traumatic experience which subsides in a matter of hours or days. Symptoms are variable but typically include an initial state of shock together with symptoms of anxiety and depressions.

Question 23

What is PTSD?

Answer 23

Protracted and sometimes delayed response to a highly threatening or catastrophic experience.
Common symptoms: anxiety, numbing, detachment, flashbacks, nightmares, partial or complete amnesia for the traumatic even. Symptoms can last for several years.

Question 24

What is obsessive compulsive disorder?

Answer 24

Predominantly obsessional thoughts, predominantly compulsive acts, or mixed obsessional thoughts and acts.

Question 25

What are the key features of an obsession?

Answer 25

Is a recurrent idea, image, or impulse
Is recognised as being a product of one’s own mind
Is usually perceived as being senseless
Is unsuccessfully resisted
Results in marked anxiety and distress, as well as functional impairment

Question 26

What are the key features of a compulsion?

Answer 26

Is a recurrent stereotyped behaviour
Reduces anxiety but is neither useful nor enjoyable
Is usually perceived as being senseless
Is unsuccessfully resisted
Results in marked anxiety and distress, as well as functional impairment

Question 27

What treatments are indicated for OCD?

Answer 27

May respond to cognitive behavioural therapies such as exposure and response prevention or to medication in the form of high doses of an SSRI or clomipramine (tricyclic that behaves as an SSRI), with or without augmentation.

Question 28

What are dissociative (conversion) disorders and what is the treatment?

Answer 28

A traumatic even leads to a disruption of the usually integrated functions of consciousness, memory, identity, or perception. They are relatively rare.

Management involves acceptance and support, physical rehabilitation if indicated, and treatment of co-morbid mental disorders. Prognosis is good.

Question 29

What is dissociative amnesia?

Answer 29

Loss of memory, most commonly for a traumatic or stressful event.

Question 30

What is dissociative fugue?

Answer 30

Sudden, unexpected journey that may last several months. There is memory loss and confusion about personal identity or assumption of another identity. One the fugue ends, memory of it is lost.

Question 31

What is dissociative stupor?

Answer 31

Although conscious, the patient is motionless and mute and does not respond to stimulation.

Question 32

What are trance and possession disorders?

Answer 32

Temporary replacement of a patient’s identity by a spirit, ghost, deity, other person, animal, or inanimate object that is not accepted by the patient’s culture as a normal part of a collective cultural or religious experience.

Question 33

What is dissociative anaesthesia?

Answer 33

Dissociative sensory loss may accompany dissociative motor disorders and is most commonly of ‘glove and stocking’ distribution.

Question 34

What is dissociative convulsions?

Answer 34

Seizures that have no organic basis. They are sometimes called ‘pseudo-seizures’ or’psychogenic non-epileptic seizures’.

Question 35

What is Ganser syndrome?

Answer 35

A very rare syndrome characterised by vorbeireden or ‘approximate answers’ (9+10=21), absurd statements, confusion, hallucinations, and psychogenic physical symptoms.

Question 36

What is multiple personality disorder?

Answer 36

Two or more distinct identities that successively take control of the same shared body, and memory loss of each identity for the other. Very rare (if real at all)

Question 37

What are somatoform disorders and what are the three types?

Answer 37

Characterised by physical symptoms that cannot be accounted for by a physical disorder or other mental disorder.

Somatisation disorder, hypochondriacal disorder, persistent somatoform pain disorder.

Question 38

What is somatisation disorder?

Answer 38

A long history of multiple, severe physical symptoms that cannot be accounted for by a physical disorder or other mental disorder. More common in women.

Question 39

What is hypochondriacal disorder?

Answer 39

A fear or belief of having a serious physical disorder despite medical reassurance to the contrary. In ICD-10 body dysmorphic disorder is included.

Question 40

What is persistent somatoform pain disorder?

Answer 40

Chronic pain that cannot be accounted for by a physical disorder or other mental disorder.

Question 41

How do you manage somatoform disorders?

Answer 41

Involves acceptance, do not reinforce any false beliefs. Provide him or her with a clear consistent explanation for the symptoms. Investigations kept to minimum and only clinically necessary.