Anxiety disorders

Question 1

What is anxiety

Answer 1

*a normal physiological response to potential threat/ danger
* subjective, unpleasant sense of unease and worry

Question 2

What is generalised anxiety disorder

Answer 2

excessive and disproportional anxiety, which is not related to a specific event, that negatively impacts the person’s everyday activity

Question 3

Give 6 key features of anxiety. What is required for diagnosis

Answer 3

• Restlessness
• irritability
• fatigue
• poor concentration
• sleep disturbance
• muscle tension
  at least 3 symptoms occurring most days for at least 6 months need to be present for diagnosis

Question 4

Give 4 emotional/ cognitive symptoms of anxiety

Answer 4

• excessive worrying
• difficulty concentrating
• apprehension
• restlessness

Question 5

Give 5 physical symptoms of anxiety

Answer 5

• muscle tension - inability to relax, tremor
• tension headaches
• Sweating
• palpitations and tachycardia
• diarrhoea and nausea

Question 6

Give 5 secondary causes of anxiety

Answer 6

• hyperthyroidism
• alcohol/ drug abuse
• drug withdrawal
• phaeochromocytoma - tumour of medulla and adrenal glands
• hypoglycaemia

Question 7

What questionnaire is used to assess the severity of anxiety

Answer 7

• generalised anxiety disorder questionnaire (GAD-7)

Question 8

Describe GAD-7

Answer 8

7 questions each scored depending on how often the symptoms are experienced.

Question 9

What score indicates mild anxiety on GAD-7

Answer 9

5-9

Question 10

What score indicates severe anxiety on GAD-7

Answer 10

15-21

Question 11

A score of 10-14 on GAD-7 indicates what

Answer 11

moderate anxiety

Question 12

What are panic attacks

Answer 12

sudden onset of intense physical and emotional symptoms of anxiety
* last <20 mins

Question 13

Give 5 symptoms of a panic attack

Answer 13

• physical: dry mouth, palpitations, sweating, SOB
• Emotional: panic, fear, danger, depersonalisation

Question 14

What is a panic disorder

Answer 14

unpredictable recurrent panic attacks resulting in worry about further attacks and maladaptive behaviour
* >4 episodes within one month

Question 15

How is anxiety managed psychosocially

Answer 15

• psychoeducation - reassurance about physical Sx
• Stress reduction: exercise, breathing techniques, mindfulness, sleep
• avoid caffeine/ alcohol/ drugs
• CBT

Question 16

How is anxiety pharmacologically managed

Answer 16

Anxiolytics
* SSRI - sertraline
* SNRI - venlafaxine
* pregabalin if unresponsive to above
* propranolol - reduce sympathetic overactivity
* benzodiazepines - only short term/ crisis

Question 17

What is social phobia

Answer 17

fear of social situations due to preoccupation about being judged negatively by others

Question 18

What is a phobia

Answer 18

extreme, irrational fear of certain situations/ things causing symptoms of anxiety and panic

Question 19

Define agoraphobia

Answer 19

• fear of unfamiliar surroundings in which they may be unable to escape if something goes wrong
• avoidance of open air/ crowded spaces

Question 20

What is post traumatic stress disorder (PTSD)

Answer 20

Condition that may develop following exposure to a traumatic event/ experience

Question 21

State 4 examples of events that could cause PTSD

Answer 21

• military/ war/ combat
• major health event - heart attack, traumatic childbirth
• violence - SA, domestics, abuse
• natural disasters

Question 22

Give 3 core features of PTSD

Answer 22

• re-experiencing the event in the present (flashbacks, nightmares)
• deliberate avoidance of triggers
• persistent perceptions of heightened current threat - hypervigilance, enhanced startle reaction to stimuli

Question 23

Give 5 additional features of PTSD

Answer 23

• derealisation and depersonalisation
• emotions - anger, shame, guilt
• sleep disturbance
• social withdrawal
• suicidality

Question 24

What is use to screen for PTSD

Answer 24

Trauma screening questionnaire (TSQ)
* >6 +ve responses = risk of PTSD = referral

Question 25

How is PTSD managed psychosocially

Answer 25

• risk assess - others, self (suicide)
• Trauma-focused CBT
• eye movement desensitisation and reprocessing (EMDR)
• support groups

Question 26

How is PTSD managed pharmacologically

Answer 26

only if adult has a preference for drug Tx
* SSRI - sertraline
* SNRI - venlafaxine
* antipsychotics - risperidone
* <18y - don’t offer meds

Question 27

What is obsessive compulsive disorder

Answer 27

• mental health disorder characterised by persistent obsessions and compulsions

Question 28

Define an obsession

Answer 28

• repetitive irrational, irresistible, intrusive thoughts/ images that the person finds very difficult to ignore
• unwanted and uncontrolled

Question 29

Define a compulsion

Answer 29

• repetitive behaviours the person feels they must do often in response to an obsession
• generating anxiety if they are not done

Question 30

Give an example of an obsession

Answer 30

overwhelming fear of contamination with dirt or germs

Question 31

Give an example of a compulsion

Answer 31

repetitively checking that all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down

Question 32

Describe the cycle in OCD

Answer 32

obsession
anxiety
compulsion
temporary relief
obsession reappears - cycle reoccurs

Question 33

What is the scale used to assess the severity of OCD

Answer 33

Yale-Brown obsessive-compulsive scale (Y-BOCS)

Question 34

How is OCD managed

Answer 34

• CBT with exposure and response prevention (ERP)
• SSRIs (fluoxetine)
• Clomipramine (TCA) - alt to SSRI

Question 35

Compared to depression, what is usually required for an initial response to SSRIs in OCD

Answer 35

Higher doses and a longer duration of SSRI treatment (10-12w)

Question 36

What is exposure and response prevention

Answer 36

involves exposing a patient to an anxiety provoking situation and then stopping them engaging in their usual safety behaviour