anxiety disorders 1

Question 1

define anxiety

Answer 1

Anxiety is a normal response to threat or danger

and part of the usual human experience

Question 2

when does anxiety become a problem?

Answer 2

Anxiety becomes a mental health problem if the
response is exaggerated, lasts more than three
weeks and interferes with daily life.

Question 3

how is anxiety characterised?

Answer 3

Anxiety is characterised by worry and agitation,
often accompanied by physical symptoms such as
rapid breathing and a fast heartbeat or hot and cold
sweats.

Question 4

what are the somatic symptoms of anxiety?

Answer 4

Goosebumps emerge
Muscles tense
Heart rate increases
Respiration accelerates
Respiration deepens
Peripheral blood
vessels dilate
Liver releases
carbohydrates
Bronchioles widen
Pupils dilate
Perspiration increases
Adrenaline is secreted
Stomach acid is
inhibited
Salivation decreases

Question 5

what are the emotional symptoms of anxiety?

Answer 5

Sense of dread
Terror
Restlessness
Irritability

Question 6

what are the cognitive symptoms of anxiety?

Answer 6

Anticipation of
harm
Exaggerating of
danger
Problems in
concentrating
Hypervigilance
Worried,
ruminative
thinking
Fear of losing
control
Fear of dying
Sense of unreality

Question 7

what are the behavioural symptoms of anxiety?

Answer 7

Escape
Avoidance
Aggression
Freezing
Decreased
appetitive
responding
Increased aversive
responding

Question 8

how is GAD characterised?

Answer 8

Characterized by excessive and inappropriate
worrying that is persistent (lasting some months in
ICD-10, six months or longer in DSM- 5) and not
restricted to particular circumstances.

Question 9

what are the symptoms of GAD?

Answer 9

Patients have physical anxiety symptoms and key

psychological symptoms

Question 10

what can GAD become comorbid with?

Answer 10

Can be comorbid with major depression (but not
arise solely in its context), panic disorder, phobic
anxiety disorders and OCD

Question 11

how is panic disorder charactersed?

Answer 11

Characterized by recurrent unexpected surges of
severe anxiety (‘panic attacks’), with varying
degrees of anticipatory anxiety between attacks

Question 12

what are panic attacks?

Answer 12

• Panic attacks are discrete periods of intense fear or
discomfort, accompanied by at least four physical or
psychological anxiety symptoms.
• Typically panic attacks reach their peak within ten
minutes and last around 30–45 minutes.

Question 13

around 2/3 patients develop agoraphobia with panic disorder, what is this?

Answer 13

defined as fear in places or
situations from which escape might be difficult or in
which help might not be available, in the event of
having a panic attack.

Question 14

give an example of agoraphobia

Answer 14

These situations include being in a crowd, being
outside the home or using public transport (two
situations required in ICD-10): they are either
avoided or endured with significant personal
distress (avoidance at some stage is required for
ICD-10 diagnosis).

Question 15

how is social phobia characterised?

Answer 15

Characterized by a marked, persistent and
unreasonable fear of being observed or evaluated
negatively by other people, in social or performance
situations, associated with physical and
psychological anxiety symptoms.

Question 16

what is specific phobia?

Answer 16

Specific, simple or isolated phobia is
characterized by excessive or unreasonable
fear of (and restricted to) single people,
animals, objects, or situations (for example,
flying, dentists, seeing blood, etc.) which are
either avoided or are endured with
significant personal distress (avoidance must
be prominent for ICD-10 diagnosis).

Question 17

how is PTSD characterised?

Answer 17

Characterized by a history of exposure to trauma
(actual or threatened death, serious injury, or threats
to the physical integrity of the self or others) with a
response of intense fear, helplessness or horror: with
the later development of re-experiencing symptoms
(intrusive recollections, flashbacks or dreams),
avoidance symptoms (for example efforts to avoid
activities or thoughts associated with the trauma),and
hyper-arousal symptoms (including disturbed sleep,
hypervigilance and an exaggerated startle response).

Question 18

what is the time limit for diagnosing PTSD?

Answer 18

Must usually be within six months of the exposure to

trauma for an ICD-10 diagnosis.

Question 19

how is OCD characterised?

Answer 19

Characterized by recurrent obsessional
ruminations, images or impulses, and/or
recurrent physical or mental rituals, which are
distressing, time-consuming and cause
interference with social and occupational
function.

Question 20

what are the common OCD obsessions?

Answer 20

Common obsessions relate to contamination,
accidents, and religious or sexual matters:
common rituals include washing, checking,
cleaning, counting and touching.

Question 21

what is step 1?

Answer 21

Following assessment and diagnosis of GAD:
• provide education about GAD and options for
treatment
• monitor symptoms and functioning (known as active
monitoring).
• Discuss the use of over-the-counter medications and
preparations

Question 22

what is step 2?

Answer 22

Low-intensity psychological
interventions
• For people with GAD that has not improved after
education and active monitoring in step 1, offer one
or more of the following, guided by the person’s
preference:
• individual non-facilitated self-help*
• individual guided self-help
• psychoeducational groups

Question 23

what is step 3?

Answer 23

high intensity treatment
• an individual high-intensity psychological intervention
using either CBT or applied relaxation or drug
treatment using a selective serotonin reuptake
inhibitor (consider offering sertraline first because it is
the most cost-effective drug)*

Question 24

what should you not offer for high intensity treatment?

Answer 24

Do not offer antipsychotics for GAD in primary care.
• Do not offer benzodiazepines except as a short-term
crisis measure.

Question 25

what if a person has an indaequate response to step 3?

Answer 25

• A high-intensity psychological intervention, thenoffer a drug treatment
• Drug treatment, then offer either a high-intensitypsychological intervention or an alternative drugtreatment.
• If a person’s GAD has partially responded to drugtreatment, consider offering a high-intensitypsychological intervention in addition to drugtreatment.

Question 26

when should you refer to step 4?

Answer 26

• A risk of self-harm or suicide or
• Significant comorbidity or
• Self-neglect or
• An inadequate response to step 3 interventions.

Question 27

what is step 4?

Answer 27

• Consider offering combinations of treatment:
• psychological and drug treatments or
• combinations of antidepressants or
• augmentation of antidepressants with other drugs.

Question 28

what is the biological basis for anxiety?

Answer 28

• Decreased 5-HT neurotransmission
• Overactivity of the NA systems
• Deficient inhibition of the GABA interneurons with
reduced sensitivity to postsynaptic GABAA receptors
• Excessive activity of glutamate neurons at NMDA
receptors in the amygdala responsible for fear
conditioning
• Super sensitivity of receptors for peptide
neurotransmitters such as cholecystokinin and
neuropeptide Y.
• Increased evidence for central role of brain derived
neurotropic factor (BDNF) in modulating neural plasticity
in anxiety state