Anxiety disorders - 1

Question 1

Somatic symptom d/o (SSD)

Answer 1

F>M
High stress causing many symptoms, no physical explanation
1. GIT: nausea, vomiting, abdominal pain
2. Genital/sexual: dysmenorrhoea, dyspareunia, genital pain, anorgasmia
3. Cardiovascular: palpitations,SOB, chest pain
4. Pseudoneurological: amnesia, loss of voice, dizziness, difficulty walking/talking/swallowing
5. Pain: diffuse, neck/back ache, joint/limb pain, headaches
6. Other: fatigue, globus, fainting

Question 2

Mx of SSD

Answer 2

1. Single physician
2. Can try CBT

No specific Mx

Question 3

Conversion disorder

Answer 3

Neurological symptoms only post stress
Cannot be explained by medical/neurological conditions
Mc:
1. Mutism
2. Blindness
3. Paralysis

Other
* Sensory: Anesthesia, paresthesia
* Motor: Abnormal movements, gait disturbance, weakness, paralysis, tics, jerks, etc.
* CNS: PSEUDOSEIZURES
*Primary gain: Keeps internal conflicts outside patient’s awareness
* Secondary gain: Benefits received from being “sick”
*LA BELLE INDIFFERENCE: unconcerned about impairment
* Identification: model their behaviour on someone who is important to them

Question 4

Mx of conversion d/o

Answer 4

CBT

Question 5

Illness anxiety d/o

Answer 5

Belief to be sick (not delusional)
*>6 months
Also called hypochondriasis
Mx: CBT

Question 6

Body dysmorphic d/o**

Answer 6

Part of body is abn/defective looking according to pt (when normal)

Can be a/w depression/anxiety d/o

Mx: CBT, SSRI

Question 7

Factitious d/o**

Answer 7

Munchausen syndrome (imposed on self)
Munchausen syndrome by proxy (inflicted on others, ex- child)
Production of complaints only for attention, hospitalisation.
*No secondary gain (+in malingering)
Want medication (unlike malingering)

Question 8

Mx of Munchausen syndrome

Answer 8

No Mx
Discharge pt without confrontation

Question 9

Generalised anxiety d/o (GAD) diagnostic criteria

Answer 9

> 6 months of persistent unrealistic and excessive anxiety
Diagnostic criteria: 3 or more of REfDMI
1. Restless, ‘keyed up’ or ‘on edge’
2. Easily fatigued
3. Difficulty concentrating or ‘mind going blank’
4. Muscle tension
5. Irritability

Question 10

GAD Mx

Answer 10

First line:
CBT (non pharmacological)
Do not rush for Benzodiazepines for insomnia

If not working
SSRI/SNRI - asses after 12wks (6-8wks in depression)
If working, Rx for 6 months

Benzodiazepines 2-6wks (addictive)
*Only if CBT and SSRIs did not work

Question 11

Panic attack, Mx

Answer 11

Brief period of intense fear/discomfort
with 4 or more symptoms like
1. Smothering
2. Dizziness
3. Palpitations
4. Trembling
5. Fear of death*
6. Depersonalisation/Derealisation
etc

Mx: CBT
SSRI no point in using as they take 6-8wks to work

Question 12

D/o which mimic panic attack

Answer 12

1. Hypoglycemia
2. Hyperthyroidism
3. Pheochromocytoma
4. Acute coronary syndrome

Question 13

Panic D/O

Answer 13

Recurrent panic attacks
f/b min 1 month of worry about future attacks
+/- agoraphobia

Mx: CBT
SSRI can be tried

Question 14

Types of phobia

Answer 14

1. Specific
2. Social Anxiety d/o - general/specific

Question 15

Mx for specific phobias

Answer 15

Type of CBT:
**Systemic desensitisation (gradual exposure) and
Assertiveness training

SSRI, B-blockers (stage fright), Buspirone

Question 16

Mx for generalised social anxiety d/o

Answer 16

First: CBT
SSRI, SNRI

Question 17

Agoraphobia vs social anxiety d/o

Answer 17

Agoraphobia a/w panic disorder
It is a fear of CONFINED crowded spaces

Question 18

OCD* components

Answer 18

Obsession - recurrent persistent thoughts
Compulsion - actions to alleviate those thoughts

Pt knows its unreasonable

Question 19

Mx of OCD

Answer 19

Obsession - CBT
Compulsion - exposure and response prevention

If not working - SSRI