Anxiety Disorders

Question 1

What are medical conditions commonly associated with anxiety?

Answer 1

Hyperthyroidism, anaemia, hypoglycaemia, phaeochromocytoma, Cushing’s, COPD, CCF, malignancies

Question 2

What is generalised anxiety disorder GAD?

Answer 2

A syndrome of ongoing, uncontrollable, widespread worry that the patient recognises as excessive and inappropriate. Symptoms must be present on most days for at least 6 months

Question 3

What is the biological and environmental aetiological factors of GAD?

Answer 3

Genetic, ANS dysfunction, neurotransmitter alterations, exaggerated responses in amygdala and hippocampus.
Environmental: adverse events (child abuse, relationship problems, illness, employment), substance dependence

Question 4

What are common features of a presentation of GAD that fit with the mnemonic ‘WATCHERS’?

Answer 4

W- worry
A- autonomic hyperactivity
T-tension in muscles/ tremor
C- concentration difficulty/ chronic aches
H-hyperventilation/ headaches
E- energy loss
R- restlessness
S- startled easily/ sleep disturbance (hard getting to sleep, intermittent waking and nightmares)

Question 5

What is the diagnostic criteria for GAD in ICD-10?

Answer 5

Over 6 months of prominent tension, worry and feelings of apprehension
At least 4 symptoms of anxiety and at least 1 symptom of autonomic arousal

Question 6

What are psychological symptoms of anxiety?

Answer 6

Anticipatory fear of impending doom, worrying thoughts, exaggerated startle response, restlessness, poor concentration and attention, irritability, depersonalisation/derealisation

Question 7

What are cardiovascular symptoms of anxiety?

Answer 7

Palpitations, chest pain

Question 8

What are respiratory symptoms of anxiety?

Answer 8

Hyperventilation, cough, chest tightness

Question 9

What are gastrointestinal symptoms of anxiety?

Answer 9

Abdominal pain (butterflies), loose stools, N+V, dysphagia, dry mouth

Question 10

What are genitourinary symptoms of anxiety?

Answer 10

Increased frequency of micturition, failure of erection, menstrual discomfort

Question 11

What are neuromuscular symptoms of anxiety?

Answer 11

Tremor, myalgia, headache, paraesthesia, tinnitus

Question 12

Are depressive symptoms seen in neurosis?

Answer 12

Yes depressive symptoms are actually common in neuroses

Question 13

What are some key questions to ask about anxiety symptoms?

Answer 13

Rate of onset, duration, severity, do they arise spontaneously or in response to certain situations

Question 14

What are some medical conditions associated with anxiety?

Answer 14

Hyperthyroidism, hypoglycaemia, anaemia, phaeochromocytoma, Cushing’s, COPD, CCF, malignancies

Question 15

What are three features that separate phobic anxiety from GAD?

Answer 15

1. Anxiety occurs in a specific situation
2. There is anticipatory anxiety when thinking they will encounter the feared situation
3. There is attempted avoidance of the circumstances that make them anxious

Question 16

What does the Yerkes-Dodson curve represent?

Answer 16

The relationship between anxiety and performance. It shows that a little anxiety can help improve our performance, but too much can be disruptive

Question 17

What are physiological responses to anxiety which lead to anxiety symptoms?

Answer 17

Decreased blood flow to the gut
Smooth muscle contraction in the gut
Increased blood flow to skeletal muscle
Increased muscle tension
Pupil dilation
Nausea
Increased heart rate and BP

Question 18

What is psychoeducation in anxiety?

Answer 18

Explaining the anxiety symptoms and why they occur to comfort patients, it can help them make sense of strange physical symptoms.

Question 19

What are some examples of specific types of anxiety?

Answer 19

GAD, separation anxiety, social anxiety, agoraphobia, specific phobia, PTSD, OCD and panic disorder

Question 20

Diagnosis of GAD requires three of which symptoms?

Answer 20

Restlessness, fatigue, irritability, poor concentration, sleep disturbance, muscle tension

Question 21

How does you assess the severity of GAD?

Answer 21

Ask about the impact it has on the patients daily functioning
Use a diagnostic questionnaire

Question 22

What are some organic differentials for GAD?

Answer 22

Hyperthyroidism, drug/alcohol withdrawal, hypoglycaemia, tachyarrhythmias, B12 deficiency, phaeochromocytoma

Question 23

Other than medication, how can we manage GAD?

Answer 23

Psychoeducation
Avoid exacerbating lifestyle factors e.g caffeine, nicotine, alcohol
Encourage exercise
Stress reduction/management: mindfulness
CBT
Breathing techniques

Question 24

What is carpopedal spasm and why do we occasionally see this in panic attacks?

Answer 24

Involuntary muscle contraction in hands and feet.
Results from hyperventilation due to the low CO2 levels leading to alkalosis, which is corrected by H+ from plasma proteins. The excess protein anions take up calcium resulting in a hypocalcaemic tetany