anxiety disorders

Question 1

stress response

Answer 1

amygdala = assess whether stress or fear

acute stress leads to dose-dependent increase in catecholamines + cortisol
- cortisol acts to mediate (+shut down) stress response (cortisol increase in acute stress)

Question 2

generalised anxiety disorder

Answer 2

anxiety that’s generalised + persistent but not restricted to any particular environmental circumstances

• chronic, fluctuating course
• typical age of onset 20-40
• lifetime pravalence = 9%
• 90% co-morbid with other psychiatric

**not hyperthyroidism

Question 3

diagnosis of generalised anxiety disorder

Answer 3

• long lasting - most days for at **least 6 months*
• not controllable
• causing significant distress/impairment in function

-> diagnosis of exclusion

Question 4

management of generalised anxiety disorder

Answer 4

1 - education, self-help
2 - CBT
2 - SSRI - sertraline
3 - another SSRI
4 - SNRI - duloxetine, venlafaxine
5 - pregabalin

Question 5

after how long should pharmacological management of GAD be reviewed?

Answer 5

up to 12 weeks to assess efficacy - absence of effect within 4 wks, response unlikely

continue for 18month

when stopping reduce dose gradually to avoid discontinuation

Question 6

point of note in pharmalogically managing under 25yrs with GAD?

Answer 6

increased risk of suicidal thinking + self harm
- weekly follow up recommended in first month

Question 7

essential feature of panic disorder

Answer 7

recurrent attacks of severe anxiety (impending doom) + unpredictable - not assoc with particular circumstances

Question 8

during a panic attack, where is there increased metabolism on a PET scan?

Answer 8

anterior pole of temporal lobe - parahippocampal gyrus

Question 9

part of brain responsible for avoidance/flight or flight

Answer 9

periaqueductal gray

Question 10

management of panic disorders

Answer 10

• CBT
• SSRI
• contraindicated or no response after 12 weeks - imipramine or clomipramine (tricyclics
• continue for 6 months

Question 11

agoraphobia

Answer 11

fears of leaving home, entering shops, crowds/public places
50% present by 20, 75% by early 30s

may be primary, more commonly secondary to panic disorder, depression

Question 12

agoraphobia presentation

Answer 12

avoidance - experience little anxiety as they avoid phobic situation
often involves other people/tech to avoid
- food shopping online

Question 13

management of social anxiety

Answer 13

1 - CBT
2 - SSRI (escitalopram or sertraline) - review at 12wks
3 - SSRI plus CBT
4 - alternative SSRI (fluvoxamine, paroxetine) or SNRI (venlafaxine)
5 - MAOI (moclobemide)

Question 14

example of specific phobias

Answer 14

flying, heights, animals, seeing blood
- person knows fear is excessive

Question 15

pathophysio of specific phobias

Answer 15

increased bilateral activation of amygdala

increased rCBF to amygdala (+related limbic areas) that normalizes on successful treatment

Question 16

treatment of specific phobias

Answer 16

behavioural therapy - exposure
- graded exposure/systematic desensitisation
- add CBT if necessary

SSRIs/SNRIs if required
benzodiazepines - short term only

Question 17

onset of OCD

Answer 17

mean - 20yrs

peak males - 13-15yrs
peak females - 24-25yrs

Question 18

comorbid conditions with OCD

Answer 18

depression
schizophrenia
tourettes
eating disorders

Question 19

OCD diagnostic criteria

Answer 19

Obsessional or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and interference with activities
o Obsessions must be individuals own thoughts
o Resistance are not pleasant
o Rituals are not pleasant
o Obsessional thoughts/images/impulses must be repetitive

Question 20

management of OCD

Answer 20

1- CBT + ERP (exposure + response prevention)
2- SSRI (fluoxetine) - if effective continue for a year
3- consider increasing dose after 4-6wks
4- SSRI plus CBT+ERP