Anxiety Disorders

Question 1

PTSD Criteria

Answer 1

A. Exposure to actual/threatened death, serious injury or sexual violence 
B. Intrusive symptoms 
C. Avoidant symptoms 
D. Alterations in cognition and mood 
E. Arousal symptoms 
F. Duration of symptoms 1 month or more

Question 2

Management of PTSD

Answer 2

Biological: SSRIs (2nd line)
Psychological: Psychoeducation, EMDR, CBT (trauma-focused), CPT
Social: Academic and occupational achievement, peer support, healthy diet, cease substance abuse

Question 3

OCD Criteria

Answer 3

A. Presence of obsessions, compulsions or both
Obsessions:
1. recurrent, persistent thoughts/urges/images that are intrusive and unwanted and would cause distress in most people
2. patient attempted to ignore/suppress them or neutralize them with some other thought or action
Compulsions
1. repetitive behaviors/mental acts that patient feels driven to perform in response to an obsession/rules that must be applied rigidly
2. behaviour/mental acts are aimed at preventing/reducing anxiety or distress or some dreaded event/situation but they are not realistically connected to it or are excessive

Question 4

Management of OCD

Answer 4

Biological
- first-line SSRIs 
- second-line Clomipramine
- can augment with AP 
- ECT if treatment-resistant 
Psychological 
- psychoeducstion
- CBT 
- exposure and response prevention
Social

Question 5

Panic Disorder Criteria

Answer 5

A. recurrent unexpected panic attacks
B. 1 or more of the attacks followed by at least a month of 1 or more of the following
- persistent concern/worry about additional panic attacks/consequences
- significant maladaptive change in behaviour related to attacks
C. not attributable to substance/other medical condition
D. not better explained by another mental disorder

Question 6

Investigations for panic disorder

Answer 6

Biological: FBC, LFT, TFT, UEC, BSL, lipids, ECG, CXR, urine drug analysis
Psychological: DASS, BAI
Social: Collaborative history

Question 7

Management of panic disorder

Answer 7

Biological: SSRI, PRN benzo (as needed and short term initially)
Psychological: psychoeducation, CBT, relaxation techniques
Social: as usual

Question 8

Management of GAD

Answer 8

Biological
- antidepressants: SSRI first line, SNRI, Buspirone, TCA, MAOis
- benzo: initially before SSRI takes effect, taper by switching to long-acting bdz
Psychological:
- CBT, insight-oriented psychotherapy, supportive therapy, deep breathing, relaxation

Question 9

Investigations for GAD

Answer 9

Biological: like MDD
Psychological: DASS

Question 10

GAD criteria

Answer 10

A. Excessive anxiety and worry occurring more days than not for at least 6 months, about a NUMBER of events or activities
B. patient finds it difficult to control the worry
C. The anxiety/worry are associated with 3 or more of the following
- restlessness/keyed up/on edge
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance