Anxiety disorders

Question 1

Describe generalised anxiety disorder

Answer 1

Onset usually before the age of 25

Chronic apprehension in the absence of panic attacks 
-occurs on most days
-for at least 6 months 
Worry is usually out of proportion to the impact of the fears event and usually revolves around routine life circumstance 
The patient has difficulty in controlling worry
Associated with three or more of 
-restlessness
-easily fatigues
-difficulty concentrating 
-irritability 
-muscle tension 
-sleep disturbance 

Symptoms cause impairment of functioning
physical symptoms common

Question 2

Describe OCD

Answer 2

Rare as an ED presentaiton

Features

1) obsessions
- fear of cuasing harm to someone else
- fear of harm coming to self
- fear of contamination
- need for symmetry or exactness
- secual and religious obsessions
- fear of beahving unacceptable
2) compulsions
- cleaning
- hand washing
- checking
- ordering and arranging
- hoarding
- asking for reassurance
- counting
- repeating words silently

Features present on most days for at least 2 weeks

Question 3

Describe panic disorders

Answer 3

Recurrent episodes of spontaneous intense periods of anxiety usually lasting less than one hour
-often sudden onset

Requires >4 of the following 12 features

1) most common symptoms
- paraethesia
- chest tightness
- difficulty breathing
- choking/difficulty swallowing
2) less common
- flushes or sensation of chills
- nausea or abdomina distress
3) de-realisation (feeling of unreality)
4) depersonalisation (feeling that ones body is surreal)
5) fear of loss of control/going mad
6) fear of injury or death

Episodes often occur following an acute stressor
features of panic usually resolve spontaensouly
-often soon after ED arrival

Exam

• during an episode
• -RR >20
• -Sinus tachy
• -Anxious appearance
• -Rapid or pressured speech
• -tremor
• normal spo2
• noraml temp
• nil evidence of oragnic disease (VTE, bronchospasms, hyperreflexia/clonus, sweating, mydriasis, hypertnesion)

Question 4

Briefy describe stres debriefing (didnt look at PTSD but may come up as management post resus)

Answer 4

Single session intervention may have detremental effects
-multiple sessions appear to be effective

Hot Debrief (STOP5)

• Summarise the case
• Things that went well
• Opportunities to improve
• Points to action and responsibilities