Anxiety disorders

Question 1

Models of stress

Answer 1

• Biomechanical ‘engineering’
• Medicophysiologucal
• Psychological (transactional)

Question 2

Psychological model of stress

Answer 2

• Interactive
• Response to stress depends on interplay between cognitive processing of perceived threat and ability to cope
• Coping can be problem focused or emotion focused

Question 3

Coping mechanisms

Answer 3

• Problem focused → efforts directed at altering the stressor
• Emotion focused → efforts directed at altering emotional reaction/ mental processes to the stress

Question 4

Symptom groups of anxiety

Answer 4

• Psychological arousal
• Autonomic arousal
• Muscle tension
• Hyperventilation
• Sleep disturbances

Question 5

Phobic anxiety and generalised anxiety disorder

Answer 5

• Both involve the core presentation of anxiety
• Phobias → symptoms only occur in a particular circumstance i.e agoraphobia, social phobia specific (isolated) phobias
• Generalised anxiety disorder (GAD) → persistently and pervasively

Question 6

Generalised anxiety disorder

Answer 6

• Symptoms are not confined to a specific situation or object
• Presentations include a whole range of different systems

Question 7

Differentials to anxiety disorders

Answer 7

• Psychiatric
  
  • Depression
  • Schizophrenia
  • Dementia
  • Substance misuse
• Physical
  
  • Thyrotoxicosis
  • Phaechromocytoma
  • Hypoglycaemia
  • Asthma
  • Arhythmias

Question 8

Epidemiology of GAD

Answer 8

• 4.4% prevalence in England
  
  • More common in women

Question 9

Aetiology of GAD

Answer 9

• No clear line between anxiety and anxiety disorders
• Often caused by interplay between stressor and personality predisposed to GAD
• Combination of genetic and environmental factors in childhood

Question 10

Management of GAD

Answer 10

• Counselling
• Relaxation training → group, individual, DVD
• Medication
  
  • Antidepressants → SSRIs and TCA
  • Sedatives (highly addictive)
• Cognitive behavioural therapy

Question 11

Characteristics of phobic anxiety disorder

Answer 11

• Same core features of GAD
• Only in specific circumstances
• ‘Phobic avoidance’
• Clinically important → specific, social and agoraphobia

Question 12

Specific phobias

Answer 12

• Spiders
• Heights
• Germs
• Blood

Question 13

Social phobia

Answer 13

• Inappropriate anxiety in social situations
• Feelings of being observed or criticise → restaurants, shops, public speaking
• Can be a cluster of anxiety symptoms → blushing, tremor etc

Question 14

Management of social phobia

Answer 14

• CBT
  
  • Work on ‘thought errors;
  • Negative self-appearance
  • Unrealistic high standards
  • Excessive self monitoring
• Education and advice
• Medication → SSRI antidepressants

Question 15

Characteristics of Obsessive Compulsive Disorder (OCD)

Answer 15

• Recurrent obsessional thoughts and compulsive behaviours
• Obsessional thoughts
  
  • Ideas, images, impulses
  • Repeated and not willed
  • Unpleasant and disturbing → obscene, violent, senseless
  • Individuals own thoughts
  • Accompanied by anxiety symptoms
• Compulsive behaviours
  
  • Pattern of behaviours repeated again
  • Not enjoyable and associated with shame
  • Not helpful or meaningful
  • Aims at temporarily easing anxiety

Question 16

Epidemiology of OCD

Answer 16

• Overall one year prevalence → 2%
• Affects men and women equally
• Genetic component → gene coding for 5HT receptor

Question 17

Management of OCD

Answer 17

• Detailed history and MSE → exclude depressive illness
• Education and explanation
• Serotonergic drugs → SSRI, clomipramine
• Cognitive behavioural therapy → ERP
• Psychosurgery

Question 18

Post traumatic stress disorder (PTSD)

Answer 18

• Delayed and prolonged reactor to stressor of exceptional severity
• E.g. combat, natural/ human caused disaster, rape, assault, torture, witnessing abhorrent acts

Question 19

Key elements of PTSD

Answer 19

• Hyperarousal
  
  • Persistent anxiety
  • Irritability
  • Insomnia
  • Poor concentration
• Re-experiencing phenomena
  
  • Intensive intrusive thoughts → flashbacks when awake and nightmares in sleep
• Avoidance of reminders
  
  • Emotional numbness
  • Cue avoidance
  • Recall difficulties
  • Diminished interests

Question 20

Aetiology of PTSD

Answer 20

• Nature of stressoR → life-threatening and degree of exposure
• Vulnerability factors
  
  • Mood disorder
  • Previous childhood trauma
  • Lack of social support
  • Female
  • Lack of protective factors → higher education, social group, good paternal relationship
• Genetic susceptiblity

Question 21

Management of PTSD

Answer 21

• Survivors of disasters screened from one month
• Mild symptoms → ‘watchful waiting’ and review
• Severe symptoms → trauma-focused CBT
• Eye movement desensitisation and reprocessing
• Medications → sedatives, SSRI or TCA

Question 22

Summary

Answer 22

• Anxiety is a normal physiological response
• Anxiety disorder → when it exceeds ‘normal’ threshold
• This varies according to individuals
• Treatments are tiered → self-guided help, psychological therapy, medications