Anxiety disorders

Question 1

Name 5 anxiety disorders?

Answer 1

Generalised anxiety disorder (GAD)
Panic disorder
Simple/specific phobia
Obsessive compulsive disorder (OCD)
Post traumatic stress disorder (PTSD)

Question 1

What is the triple vulnerability model?

Answer 1

genetics + loss of control + stress

Question 2

what are the biopsychosocial RF?

Answer 2

Bio - genetics, stimulant drugs, palpitations, high T4, withdrawal

Psycho - Mental health Hx, trauma, abuse

Social - stress, life events

Question 3

what is the definition of Generalised anxiety disorder?
time length?

Answer 3

Pervasive (affects every day life), persistent, Non specific anxiety for 6+ months

Question 4

Are males or females affected more?
Which age group?

Answer 4

Females
40-65y/o

Question 5

what are the symptoms of GAD?
Acronym?

Answer 5

EGADS (Excessive GAD x Six months)
I’m MISERABLE

Question 6

What does I’m MISERABLE stand for?

Answer 6

Muscle tension
Irritability/insomnia
Sweaty
Energy Low
Restlessness
Autonomic - Palpitations
SOB, Tremor

Question 7

What Ix would you do for the diagnosis of GAD?

Answer 7

Bloods - FBC, U+E, TFT, Glucose, Urine Tox

Question 8

what questionnaire would you do?

Answer 8

GAD-7
HADS

Question 9

What is the GAD-7 questionnaire out of?
What are the scores and levels?

Answer 9

5-9 = mild
10-14 = moderate
15+ = severe
/22

Question 10

Tx for GAD?

Answer 10

Px education - low intensity CBT –> higher intensity CBT –> Higher intensity CBT + SSRI
+ CMHT referral

Question 11

what could you prescribe for muscle tension?

Answer 11

propanolol

Question 12

what is the definition of panic disorder?

Answer 12

More than 1 month of more than 4x weekly spells of 10-30 mins panic attacks (MISERABLE)

Question 13

What age and sex does it affect most?

Answer 13

20-30y
Female

Question 14

Sx of panic attacks?

Answer 14

MISERABLE
3Cs - chest pain, choking, chills

Question 15

Dx of panic disorder?

Answer 15

Panic disorder severity scale (PDSS)
PHQ-PD

Question 16

Tx of Panic disorder?

Answer 16

self help CBT + Education –> higher intensity CBT + SSRI (+ CMHT referral)

Question 17

Definition of simple / specific phobias?

Answer 17

Irrational extreme fear - avoidance and catastrophising

Question 18

Tx for simple / specific phobias?

Answer 18

ERP (Exposure re exposure prevention therapy)
and then consider SSRI

Question 19

Definition of obsessive compulsive disorder? timeframe?

Answer 19

2+ weeks of 4 days + pervasive obsessions recurrently, resulting in compulsions for relief
Px recognises this as unnecessary but is obsessed

Question 20

Sx of OCD?

Answer 20

4 Days/wk for 2+ weeks where obsessions need compulsions for anxiety relief
no action = no relief
eg. hand washing, checking lights/locks, cleaning

Question 21

Dx of OCD?

Answer 21

Yale brown OCD scale (YBOCDS)

Question 22

Tx of OCD?

Answer 22

ERP CBT –> + SSRI (2nd = clomipramine (TCA))

Question 23

how long does the initial dose need to be taken for?
How long does the Px need to take it for?

Answer 23

initial dose SSRI taken for 12 weeks
Px need to keep taking for a year

Question 24

what is the definition of post traumatic stress disorder?

Answer 24

28+ days prolonged stress reaction to a previous traumatic event (eg. war veteran, rape, natural disaster)

Question 25

Sx of PTSD?

Answer 25

HEAR
Hyperarousal (on their toes)
Emotional blunting (numb)
Avoidance
Reliving experience (eg. dreams)

Question 26

Dx of PTSD?

Answer 26

Trauma screening questionnaire

Question 27

DDX of PTSD?

Answer 27

Acute stress section
28 or less days, self resolving

Question 28

Tx of PTSD?

Answer 28

EMDR (Eye movement desensitisation Reprocessing) therapy
Consider SSRI in severe cases

Question 29

EMDR Therapy is good for all except which type of trauma?

Answer 29

combat related

Question 30

what Tx is used instead in combat related trauma?

Answer 30

1st line - trauma focused CBT