Anxiety Disorders

Question 1

Problem focussed coping vs emotion focussed coping

Answer 1

Where efforts are directed toward modifying stressor

Modify emotional reaction using mental defence mechanisms, e.g. Denial, relaxation, taking sedative drugs

Question 2

Fight or flight response - symptoms of anxiety - symptom groups

Answer 2

Psychological arousal

Autonomic arousal

Muscle tension

Hyperventilation

Sleep disturbance

Question 3

Symptoms of psychological arousal during fight or flight response - psychological arousal

Answer 3

Fearful anticipation
Irritability
Sensitivity to noise

Poor concentration
Worrying thoughts

Question 4

Autonomic arousal symptoms during anxiety

Answer 4

GI - dry mouth, swallowing difficulty

Resp - tight chest, difficulty breathing

GU - frequency/urgency of micturation, erectile failure

CV - palpitations, chest pain

CN - sweating and dizzy

Question 5

Muscle tension as a symptom of anxiety

Answer 5

Tremor
Headache
Muscle pain

Question 6

Hyperventilation as a feature of anxiety

Answer 6

Causing CO2 deficit hypocapnia - blow off too much CO2
Numbness and tingling in extremities, may lead to carpopedal spasm
Breathlessness

Question 7

Generalised anxiety disorder

Answer 7

Persistent (several months) symptoms not confined to a situation or object. All the symptoms of human anxiety can occur - psychological arousal…

Question 8

DD for anxiety disorders

Answer 8

Psychiatric - 
Depression 
Schizophrenia 
Dementia
Substance misuse 

Physical - 
Thyrotoxicosis 
Phaeochromocytoma 
Hypoglycaemia 
Asthma or arythmia

Question 9

Epidemiology of generalised anxiety disorder

Answer 9

One year prevalence 3% in US

More women than men affected

Question 10

Aetiology of generalised anxiety disorder

Answer 10

Stressor acting on a personality predisposed to the disorder by a combo of genetic factors and environmental influences in childhood

Question 11

Management of generalised anxiety disorder

Answer 11

Counselling

• explanation and eduction,
• advice on caffeine, xs alcohol

Relaxation training

• group or individual
• DVD, tapes, or clinician

Medication

• sedatives have high dependency risk
• antidepressants SSRI or TCA

Cognitive behavioural therapy

Question 12

Phobic anxiety disorders

Answer 12

ONLY in specific circumstances

Person behaves to avoid these circumstances - “phobic avoidance”

Sufferer also experience anxiety if perceived threat of encountering the feared object or situation - “anticipatory anxiety”

Agoraphobia - fear of being in open spaces
Social phobia - fear of people
Specific (isolated) phobias - cats, birds…

Question 13

Obsessive compulsive disorder

Answer 13

Core features are experience of recurrent obsessional thoughts or compulsive acts

• obsessional thoughts…
• compulsive acts or rituals…

Question 14

Epidemiology of OCD

Answer 14

Overall one year prevalence is 2%

Equally affects men and women

Aetiology suspect serotonin, genes…

Question 15

Management OCD

Answer 15

General measures

Serotonergic Drugs - SSRI, clomipramine

CBT - exposure and response prevention, examination of evidence to weaken convictions

Psychosurgery (uncommon)

Question 16

PTSD

Answer 16

Delayed and or protracted reaction to a stressor of exceptional severity - would distress anyone

Combat
Natural or man made disaster 
Rape 
Assault 
Torture 
Witnessing any of the above

Question 17

Symptoms of PTSD

Answer 17

Hyperarousal
- persistent anxiety, irritable,

Re-experiencing phenomena
- flashbacks when awake, nightmares

Avoidance
- emotional numbness, cue avoidance, diminishes interests

Question 18

Epidemiology PTSD

Answer 18

Women sufferers outnumber men 2 to 1

Question 19

Aetiology of PTSD

Answer 19

Nature of stressor - life threatening degree of exposure

Vulnerability factors - mood disorder, previous trauma, lack of social support, female gender

Protective factors - higher education and social group, good paternal relationship

Susceptibility partly genetic

Question 20

Management of PTSD

Answer 20

Mild symptoms - watchful waiting

Trauma focussed CBT if more severe

EMDR

Risk of dependence with any sedatives but patient may prefer SSRI or TCAD

Question 21

Psychological (transactional) model of stress

Answer 21

An individual reaction to steers will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope

Coping is problem focussed or emotion focussed