Anxiety disorders

Question 1

What are the defining features of generalised anxiety disorder?

Answer 1

Pervasive symptoms of worry and anxiety which are disproportionate, and cause impairment in functioning;
Not caused by another mental disorder, physical health problem or drug/alcohol abuse

Question 2

Medications which can cause anxiety?

Answer 2

SSRIs
Salbutamol
Steroids

Question 3

Controllable anxiety which is related to a particular life event

Answer 3

Situational anxiety

Question 4

Temporary anxiety occuring in response to a life stressor which persists no longer than 6 months after the stressor ends

Answer 4

Adjustment disorder

Question 5

Recurrent episodes of acute anxiety with physical symptoms e.g. SOB, palpitations, nausea, fear of dying

Answer 5

Panic disorder

Question 6

Anxiety or persistent fear which is limited to social situations and fear of scrutiny/embarrassment

Answer 6

Social phobia

Question 7

Anxiety due to intrusive thoughts or unwanted behaviours

Answer 7

Obsessive compulsive disorder

Question 8

Anxiety provoked by exposure to reminders of past trauma

Answer 8

Post-traumatic stress disorder

Question 9

Anxiety related to specific physical health complaints which have no medical basis

Answer 9

Somatoform disorders

Question 10

Anxiety related to fear of gaining weight

Answer 10

Anorexia nervosa

Question 11

Suggested by weight loss, heat intolerance, opthalmopathy, tremor

Answer 11

Hyperthyroidism

Question 12

Paroxysmal episodes of anxiety co-existing with hypertension and/or tachycardia

Answer 12

Phaeochromocytoma

Question 13

Which tool can be used to assess possible GAD?

Answer 13

GAD-7 questionnaire

Question 14

Step 1 interventions for anxiety?

Answer 14

Optimal management of other co-morbid physical/mental health problems, substance misuse
Practical solutions to other stressors e.g. work, personal life
Provide written material about GAD and treatment options

Question 15

Step 2 interventions for anxiety?

Answer 15

Low-intensity psychological interventions e.g. individual self-help, psychoeducational groups

Question 16

Step 3 interventions for anxiety?

Answer 16

High intensity psychological interventions

Drug treatment

Question 17

Preferred drug treatment for GAD?

Answer 17

SSRIs e.g. sertraline, escitalopram

SNRI e.g. duloextine or venlafaxine is a possible alternative

Question 18

Adverse effects of SSRIs/SNRIs early in treatment?

Answer 18

Increase in anxiety, agitation, suicidality, self harm

Question 19

When should benzodiazepines be offered?

Answer 19

Only for short term management of crisus

Question 20

When should patients be referred for specialist input? (3)

Answer 20

Severe anxiety with marked functional impairment
Self-harm, suicide, self-neglect
Anxiety that has not improved with step 3 interventions

Question 21

Self-care advice for patients with anxiety?

Answer 21

Sleep hygiene- e.g. avoidance of caffeine after 3pm, avoidance of alcohol after 6pm
Exercise- all-round health benefits but also shown to have specific benefit in anxiety

Question 22

Drug option if SSRIs/SNRIs not tolerated or contraindicated?

Answer 22

Pregabalin

Question 23

What is propranolol indicated for?

Answer 23

Physical symptoms such as tremor, hyperhidrosis, palpitations