Anxiety Disorders

Question 1

What is acute stress disorder, its features and management?

Answer 1

Acute stress reaction which occurs in first 4 weeks after stresser.
Features - intrusive thoughts, dissociation, negative mood, avoidance, arousal.
Rx - CBT is first line. Second line is benzos (sometimes for acute symptoms eg, agitation/sleeo disturbence)

Question 2

What are differential diagnosis for anxiety and meds which may trigger anxiety?

Answer 2

Differentials - hyperthyroidism, cardiac disease or medication induced.

Meds - salbutamol, theophylline, corticosteroids, antidepressants and caffine.

Question 3

Management of generalised anxiety disorder?

Answer 3

1. education and monitoring.
2. Low intensity psychological intervention.
3. High intensity psychological intervention or drug treatment - sertraline first line, if ineffective then offer alternative SSRI or SNRI.
4. Highly specialist input.

Question 4

Management of panic disorder?

Answer 4

1. Recognition and diagnosis
2. Treat in primary care (CBT or drugs), SSRI first line, if contraindicated or no response > 12wks then imipramine or clomipramine
3. Review.
4. Review and referral to specialist mental health teams,
5. Care in specialist mental health service

Question 5

5 stages of greid?

Answer 5

Denial,
Anger,
Bargaining,
Depression,
Acceptance

Question 6

atypical grief reactions?

Answer 6

Delayed grief - > 2 weeks before grieving starts.
Prolonged grief - Difficult to define as normal grief can take > 12 months

Question 7

What features are associated with insomnia?

Answer 7

Female age,
Increasing age,
Lower educational attainment,
Unemployment,
Economic activity,
Widowed, divorced or separated.

Question 8

Risk factors for insomnia?

Answer 8

Alcohol and substance abuse,
Stimulant usage,
Meds eg, corticosteroids,
Poor sleep hygeine,
Chronic pain,
Chronic illness,
Psychiatric illness,

Question 9

Investigations and management of insomnia?

Answer 9

Ix - Patient interview. Sleep diary and actigraphy may aid diagnosis.
Rx - identify potential cause, advice on good sleep hygeine and not to drive when sleepy. Only use hypnotics if daytime impairment is severe.

Question 10

Risk factors for OCD?

Answer 10

Family history,
Age - peak onset is between 10-20 years.
Pregnancy/postnatal period.
History of abuse, bullying or neglect.

Question 11

Management of OCD?

Answer 11

If mild - low intensity CBT and ERP. May need SSRI.
Moderate - SSRI or clomipramine
Severe - secondary care mental health team and offer SSRI and CBT

Question 12

Length of treatment required for OCD?

Answer 12

SSRI usually required at higher dosages and for longer duration (at least 12 weeks) for initial response.
If SSRI treatment is effective then continue for at least 12 months to prevent relapse.

Question 13

Risk factors and other features of panic disorder?

Answer 13

Risk factors - living alone, early parental loss, history of abuse, poor educational history, urban living.
Symptoms must be present for at least one month.
Treated with SSRIs and CBT

Question 14

Presentation of post-concussion syndrome?

Answer 14

Headaches,
Fatigue,
Anxiety and depression,
Dizziness

Question 15

What are the features of post traumatic stress disorder?

Answer 15

Following symptoms present for more than one month:
1. Re-experiencing (flashbacks, nightmares)
2. Hyperarousal (hypervigilance to threat, exaggerated startle response).
3. Emotional numbing,
4. Depression.
5. Drug/alcohol misuse.
6. Anger.
7. Unexplained physical symptoms

Question 16

What is the management of PTSD?

Answer 16

Watchful waiting if mild and lasting less than 4 weeks.
Trauma focused CBT or eye movement desensitisation and reprocessing (EMDR) used in severe cases.
If severe then venlafaxine or SSRIs can be used.
If very severe then rispiridone can be used.