Anxiety Disorders

Question 1

Presentation of anxiety disorders

• physical
• mental
• impacts

Answer 1

Physical symptoms - fight or flight

• head, back pain
• sleep problems

Mental symptoms

• inability to relax, stop worrying
• sense of dread
• low concentration
• needing constant reassurance
• depersonalisation, derealisation
• avoidance
• flashbacks, hypervigilance

Impacts

• poor self care
• affecting job, relationships, hobbies

Question 2

Non anxiety differentials

Answer 2

Physical

• hyperthyroid
• asthma, COPD
• dementia
• infections in older adults

Medication
-akithesia

Psychiatric

• depression
• substance abuse
• PTSD
• schizophrenia
• personality disorder

Question 3

Panic attack

• presentation
• panic disorder diagnosis
• management

Answer 3

Acute discrete events, don’t all have a trigger => climax within mins, resolves in mins-hours
-4+ symptoms present

Physical - fight or flight
-difficulty breathing, choking

Mental - fear of losing control, fainting, dying
-may lead to avoidance of going outside

Panic disorder

• moderate - 4+ panic attacks in 1 month
• severe - 4+ panic attacks in 1 week

Primary care
1st line - CBT
-SSRIs may be added for symptomatic relief
-if no improvement => CMHT

Question 4

GAD
-presentation and diagnosis

Anxiety+Depression
-presentation and diagnosis

Answer 4

Persistent excessive anxiety about everyday events for 6 months => causes distress and causes physical, mental symptoms

Symptoms of anxiety + depression
-meet criteria for both

Question 5

Phobias

• presentation and diagnosis
• types
• management

Answer 5

Anxiety reaction triggered by situation or object
-fear and reaction is out of proportion to danger and impacts ADLs
-lasts for 6months+
May lead to avoidance of stressor

Social - acute fear of embarrassment when focus of attention/in small groups/social situations
Agoraphobia - fear of public places, crowds, travelling alone/away from home
Specific phobias - 1 specific trigger
Needle phobias - fainting episode from BP drop triggered by exposure to needles
-ONLY GENETIC PHOBIA!

Management in addition to anxiety management
-exposure therapy - gradual introduction to trigger to increase tolerance and familiarity

Question 6

Acute stress reaction vs PTSD

• onset, duration
• presentation
• management

Answer 6

Acute stress reaction
Onset - within 1 month of trauma
Duration - U1 month
Management - watchful waiting and follow up

PTSD
Onset - 1 month+ post trauma
Duration - 1 month+

Presentation

• reexperiences - flashbacks, nightmares
• avoidance of similar situations
• hypervigilance
• emotional numbness

PTSD management
1st line
-trauma focused CBT 
-EMDR
-stress and relaxation techniques

Drug- not routinely used
1st line - paroxetine, mirtazapine

Question 7

Treatment of GAD and panic disorders

• 1st line
• 2nd line

Answer 7

1st line - talking therapies and self care
-relaxation techniques + CBT

2nd line - drug management for symptoms

• SSRIs - may increase anxiety in short term
• pregabalin if SSRI not enough
• BB - SNS response
• BZ in crisis AND NOT FOR GAD