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A. MLA Map General Practice and Primary Healthcare > Anxiety Disorder: Generalised > Flashcards

Anxiety Disorder: Generalised Flashcards

1
Q

What is stress?

A
  • cognitive appraisal indicates whether an event is perceived as good or bad for the individual
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2
Q

The social readjustment rating scale provides a score for ‘life changing events’. What does this scale aim to do and over what timescale?

1 - rank life events on how stressful they are over 1 month
2 - rank life events on how stressful they are over 6 months
3 - rank life events on how stressful they are over 12 months
4 - rank life events on how stressful they are over 2 years

A

3 - rank life events on how stressful they are over 12 months
- higher scores equates to risk of developing a stress-related disorder

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3
Q

When we talk about the normal response to a stressor, there are 3 components. What are these?

1 - automatic, emotional, psychological
2 - physical, emotional, psychological
3 - somatic, emotional, psychological
4 - mental, emotional, psychological

A

3 - somatic, emotional, psychological

  • somatic (fight or flight)
  • emotional
  • psychological (reduce the response and try to develop coping strategies)
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4
Q

When we talk about the normal response to a stressor, there are 3 components:

1 - somatic (fight or flight)
2 - emotional
3 - psychological (reduce the response and try to develop coping strategies)

What does the somatic response mean?

A
  • physiological response to stressor
  • somatic relates to the body

- do we run or fight?

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5
Q

When we talk about the normal response to a stressor, there are 3 components:

1 - somatic (fight or flight)
2 - emotional
3 - psychological (reduce the response and try to develop coping strategies)

Match the emotional responses feat, anxiety and depression with the following occurrences as an example of emotional response to stress?

  • danger
  • threat
  • separation/loss
A
  • how we may feel to specific occurrences
  • danger = fear
  • threat = anxiety
  • seperation/loss = depression
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6
Q

Fear and anxiety are 2 different responses to a stressor. Which is associated with:

  • immediate danger with risk present
  • excessive and unfocussed fear from a specific stimulus
A
  • fear = immediate danger with risk present
  • anxiety = excessive and unfocussed fear from a specific stimulus
    danger is present

- anxiety = threat is not currently present, rather anxiety/fear of the threat

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7
Q

When we talk about the normal response to a stressor, there are 3 components:

1 - somatic (fight or flight)
2 - emotional
3 - psychological (reduce the response and try to develop coping strategies)

There are 2 main types of psychological response, what are they?

1 - adaptive and toxic
2 - adaptive and maladaptive
3 - maladaptive and toxic
4 - maladaptive and irrational

A

2 - adaptive and maladaptive

  • adaptive (relief and development to deal with in future and develop coping strategies)
  • maladaptive (relief in short term, but long term problem)
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8
Q

Avoidance and denial are short term psychological responses to stressors. These are maladaptive, why?

1 - provides short term relief, but increases risk of depression
2 - provides short term relief, but increases risk of mortality
3 - provides short term relief, but associated with drugs and alcohol
4 - provides short term relief and no coping strategy

A

3 - provides short term relief, but associated with drugs and alcohol

  • short term relief allows continued performance (alcohol or drugs use)
  • alcohol or drugs can become the patients coping strategy
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9
Q

What is an acute stress reaction?

1 - response to exceptionally stressful event (physical or psychological)
2 - symptoms develop quickly
3 - symptoms generally subside within few days of stressor being removed
4 - all of the above

A

4 - all of the above

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10
Q

An acute stress reaction occurs when symptoms develop due to a particularly stressful event. The symptoms develop quickly but do not usually last longer than a few days. The events are usually very severe and an acute stress reaction typically occurs after an unexpected life crisis. Which of the following are common symptoms of an acute stress reaction?

1 - dissociative symptoms
2 - insomnia
3 - restlessness
4 - poor concentration
5 - autonomic arousal
6 - anger/anxiety/ depression
7 - social withdrawal
8 - all of the above

A

8 - all of the above

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11
Q

An acute stress reaction occurs when symptoms develop due to a particularly stressful event. The symptoms develop quickly but do not usually last long. The events are usually very severe and an acute stress reaction typically occurs after an unexpected life crisis. Dissociative symptoms can occur, what are these?

1 - separation from oneself thoughts and their bodies
2 - separation from family, friends and/or the environment they are in
3 - feeling unreal and detached, separated from people, as through by a pane of glass
4 - separated from the environment

A

2 - separation from family, friends and/or the environment they are in

  • patients dissociates from those around them
  • patients often describe an emotional numbness
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12
Q

Dissociative symptoms can occur following an acute stress response, which is an emotional numbness and separation from the stressor. People can also separate from other people, these are called Depersonalisation and Derealisation, which 2 of the below are these?

1 - separation from oneself thoughts and their bodies
2 - separation from family, friends and/or the environment they are in
3 - feeling unreal and detached, separated from people, as through by a pane of glass
4 - separated from your surroundings and feeling as though events are not real

A

3 - feeling unreal and detached, separated from people, as through by a pane of glass
= depersonalisation

4 - separated from your surroundings and feeling as though events are not real
= derealisation

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13
Q

Following an acute stress reaction patients can have a normal physiological response, however, they can also develop an adjustment disorder, what is this?

1 - an gradual and prolonger excessive response to a stressor lasting <6 months
2 - separation from family, friends and/or the environment they are in
3 - feeling unreal and detached, separated from people, as through by a pane of glass
4 - separated from the environment

A

1 - an gradual and prolonger excessive response to a stressor lasting <6 months

  • > 6 months it becomes a different disorder
  • occurs following an acute or ongoing stressor, no stressor means no adjustment disorder
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14
Q

Which of the following is included in the definition of anxiety?

1 - bodies natural response to a stressor
2 - feeling of fear and/or apprehension about what’s to come
3 - stressor may or may be present though
4 - all of the above

A

4 - all of the above

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15
Q

When we think about anxiety, which of the following are psychological responses a patient may present with?

1 - fearful anticipation
2 - irritability
3 - restlessness
4 - poor concentration
5 - worry
6 - all of the above

A

6 - all of the above

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16
Q

When we think about anxiety, what is the common term used to describe our autonomic responses?

A
  • fight or flight response

- cardiac, respiratory, GIT and/or micturition

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17
Q

When we think about anxiety, what happens to muscle tension?

1 - tremors
2 - headaches
3 - aching muscles
4 - all of the above

A

4 - all of the above

  • body prepares for fight or flight
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18
Q

When we think about anxiety, what happens to our respiration rate?

A
  • hyperventilation

- dizziness, tingling of hands and feet, breathlessness

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19
Q

When we think about anxiety, which of the following does NOT occur in the cardiovascular system?

1 - bradycardia
2 - palpitations
3 - chest pain
4 - missed heart beats

A

1 - bradycardia

  • typically it would be tachycardia
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20
Q

When we think about anxiety, which of the following does NOT occur in the genitourinary system?

1 - menstruation issues
2 - reduced libido and erection issues
3 - incontenance
4 - frequent micturition

A

3 - incontenance

21
Q

When we think about anxiety, does our sleep get better or worse?

A
  • worse
  • lack of sleep
  • night terrors
  • insomnia
22
Q

What is agoraphobia?

1 - fear of spiders
2 - fear of being unable to escape
3 - fear of small spaces
4 - fear of open spaces

A

2 - fear of being unable to escape

  • agora = place of meeting and phobia = fear
  • fear of being in situations where escape might be difficult
23
Q

All people can experience anxiety, however, when does it become clinically relevant?

1 - ADL are impaired
2 - lack of sleep
3 - weight gain
4 - irrational anxiety

A

1 - ADL are impaired

  • patient is also distressed
24
Q

What is the annual prevalence of anxiety disorder?

1 - 0.14%
2 - 1.4%
3 - 14%
4 - 44%

A

3 - 14%

25
Q

Do anxiety disorders begin in early or later life?

A
  • early life
26
Q

Are anxiety disorders more common in men or women?

A
  • women
27
Q

Are anxiety disorders more common in patients who are in good health or those with physical illness?

A
  • physical illness
28
Q

There are 2 categories of anxiety. What is the main factor separating them?

1 - continuous or episodic
2 - severity
3 - duration of symptoms

A

1 - continuous or episodic

29
Q

What is a generalised anxiety disorder?

1 - patient has anxiety when exposed to specific stimuli
2 - patient is anxious when in social settings
3 - patient is anxious about sleeping
4 - patient is anxious all, or most of the time

A

4 - patient is anxious all, or most of the time

  • excessive worry about everyday life events

- not restrictive to a specific stressor or stimulus

30
Q

Generalised anxiety disorder is where patients feel anxious most of the time that is not restricted to a specific stressor or stimulus. How long does this last prior to a diagnosis?

1 - 1 week
2 - >1 month
3 - >6 months
4 - >12 months

A

3 - >6 months

  • symptoms must be present for several months on more days than not
31
Q

Generalised anxiety disorder is where patients feel anxious most of the time that is not restricted to a specific stressor or stimulus, that needs to last >6 months before being diagnosed. What is one of the key emotions patients experience?

1 - happiness
2 - sadness
3 - mental tired
4 - worry

A

4 - worry

32
Q

When we think about the aetiology of generalised anxiety disorder (GAD), we need to think about biological, psychological and social aspects and the patients vulnerability. Which of the following is a biological vulnerability factor to developing GAD?

1 - unemployment
2 - attachment style
3 - shared heritability with depression
4 - all of the above

A

3 - shared heritability with depression

  • weak link with genetics
  • could be neurobiological (autonomic link with HPA axis)
33
Q

When we think about the aetiology of generalised anxiety disorder (GAD), we need to think about biological, psychological and social aspects and the patients vulnerability. Which of the following is a psychological vulnerability factor to developing GAD?

1 - over protective parent
2 - past traumatic event with loss of control
3 - insecure attachment with no control over
4 - all of the above

A

4 - all of the above

34
Q

When we think about the aetiology of generalised anxiety disorder (GAD), we need to think about biological, psychological and social aspects and the patients vulnerability. Which of the following is a social vulnerability factor to developing GAD?

1 - unemployment
2 - break up of relationship
3 - financial stressors
4 - all of the above

A

4 - all of the above

  • basically stressful life events can tip these patients over the edge
35
Q

Patients diagnosed weith generalised anxiety disorder are at an increased risk of developing other what?

1 - psychiatric conditions (depression, phobias, panic)
2 - metabolic disorders
3 - dementia
4 - CVD

A

1 - psychiatric conditions (depression, phobias, panic, substance misuse)

  • important to treat substance abuse before managing the anxiety
36
Q

What % of patients with generalised anxiety disorder meet the criteria for another psychiatric disorder?

1 - 3%
2 - 10%
3 - 30%
4 - 60%

A

3 - 30%

37
Q

When diagnosing generalised anxiety disorder, there are common differentials. Which of the following is NOT a common differential?

1 - depressive illness
2 - schizophrenia
3 - dementia
4 - substance misuse
5 - delirium
6 - physical illness

A

5 - delirium

38
Q

Which of the following are associated features of Generalised anxiety disorder according to the ICD-11?

1 - muscular tensions
2 - sympathetic overactivity
3 - subjective experience of nervousness
4 - poor concentration
5 - irritability
6 - sleep disturbance
7 - all of the above

A

7 - all of the above

39
Q

If a family member has experienced generalised anxiety (GAD) disorder, what is the increased risk of developing GAD?

1 - x2
2 - x5
3 - x10
4 - x20

A

2 - x5

40
Q

In patients with generalised anxiety (GAD) disorder, what happens to the hypothalamus pituitary adrenal axis (HPA)?

1 - negative feedback loop is accentuated
2 - less cortisol released
3 - increased secretion of aldosterone
4 - negative feedback loop is inhibited

A

4 - negative feedback loop is inhibited

  • essentially means more cortisol released
41
Q

Can parenting affect a child’s risk of developing generalised anxiety disorder (GAD)?

A
  • yes
  • controlling parent limits child’s control
  • inconsistent parenting, family trauma or chaotic lifestyle can all cause GAD in adult life
42
Q

Some people are more prone to developing generalised anxiety disorder (GAD). From the following options, which is most likely to lead to GAD?

1 - age
2 - gender
3 - personality traits
4 - type of birth

A

3 - personality traits

  • anxious and worry prone personalities are more likely to develop GAD
43
Q

Without treatment, what % of patients with generalised anxiety disorder (GAD) will still have GAD after 3 years?

1 - 8%
2 - 18%
3 - 48%
4 - 80%

A

4 - 80%

  • GAD can become a lifelong condition
44
Q

Which of the following are suitable psychological treatment approaches in a patient at risk of or with mild generalised anxiety disorder?

1 - self help books
2 - group computerised CBT
3 - individual CBT
4 - all of the above

A

4 - all of the above

45
Q

Which of the following are suitable approaches in a patient with moderate or severe generalised anxiety disorder?

1 - CBT alone
2 - pharmacotherapy alone
3 - CBT with pharmacotherapy
4 - all of the above

A

4 - all of the above

46
Q

What group of medications are the 1st line treatment for patients with generalised anxiety disorder?

1 - antipsychotics
2 - antiepileptics
3 - anti-depressants
4 - benzodiazepines

A

3 - anti-depressants

  • SSRIs = Citalopram, Fluoxetine, Sertraline are 1st choice
  • can try tricyclics = Amitriptyline
47
Q

Anti-depressants are the 1st line drug for patients with generalised anxiety disorder, either SSRIs or tricyclic anti-depressants. If these are successful, how long following recovery should they be provided for?

1 - stop when patient feels better
2 - 2 weeks
3 - 2 months
4 - 6 months

A

4 - 6 months

48
Q

Anti-depressants are the 1st line drug for patients with generalised anxiety disorder (GAD), either SSRIs or tricyclic anti-depressants. If at least 2 of these have been tried, but have been unsuccessful, which 2 classes of medication can be prescribed?

1 - anti-epileptics
2 - benzodiazepines
3 - non-benzodiazepines
4 - anti-psychotics

A

2 - benzodiazepines
- Diazepam, Lorazepam, Chlordiazepoxide

3 - non-benzodiazepines

  • must use with caution due to high risk of dependence

A. MLA Map General Practice and Primary Healthcare (28 decks)

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