anxiety disorders

Question 1

what can pathological anxiety involve

Answer 1

generalised anxiety disorder, phobia, panic disorder

Question 2

what is anxiety comorbid with

Answer 2

depression, substance misuse, another anxiety disorder

Question 3

prevalence

Answer 3

6% of the population- generalised is 2-4%

Question 4

what type of people does anxiety more affect

Answer 4

women, young adults, middle aged

Question 5

aetiology

Answer 5

genetics, biological, childhood- abuse, separations, excessive conformity; stress- financial problems, chronic disease

Question 6

what is the biological link

Answer 6

low levels GABA, heightened amygdala activation

Question 7

what is the chance of someone having anxiety disorder if first degree relative has it

Answer 7

x4

Question 8

what is panic disorder

Answer 8

recurrent episodic severe panic attacks- unpredictable and not restricted to one type of situation

Question 9

diagnosis panic disorder

Answer 9

at least 3 panic attacks in 3 week period

Question 10

symptoms panic disorder

Answer 10

palpitations, sweating, breathless, feeling of choking, chest pain, nausea, dizzy, derealisation, depersonalisation. typically last a few mins

Question 11

what is first line treatment panic disorder

Answer 11

SSRIs, CBT

Question 12

what are not recommended in panic disorder

Answer 12

benzos as these can make worse

Question 13

what is generalised anxiety disorder

Answer 13

generalised, persistent, excessive anxiety or worry bout a number of events the patient finds difficult to control

Question 14

diagnostic GAD

Answer 14

at least 3 weeks (ICD10), or >6m (DSM)

Question 15

what is anxiety associated with in GAD

Answer 15

subjective apprehension, increased vigilance, restless and on edge, sleeping difficulties, autonomic hyperactivity

Question 16

ddx GAD

Answer 16

withdrawal from drugs, excessive caffeine consumption, depression, psychosis, organic- thyrotoxicosis, hypoglycaemia, phaechromocytoma,

Question 17

first line treatment GAD

Answer 17

SSRI s and CBT

Question 18

what is agarophobia

Answer 18

fear of places and situations and avoidance

Question 19

management agarophobia

Answer 19

CBT, graded exposure. SSRIs if not working

Question 20

what is social phobia

Answer 20

persistent fear of social situations in which exposed to unfamiliar people or scrutiny

Question 21

management social phobia

Answer 21

CBT, self help, graded exposure, social skills training

Question 22

specific phobia management

Answer 22

graded exposure therapy and response prevention.

Question 23

what can obsessions be

Answer 23

thoughts, images, impulses, ruminations, doubt.

Question 24

difference between obsessions and compulsions

Answer 24

obsessions- thoughts. compulsions- repetitive behaviour

Question 25

prevalence OCD

Answer 25

2-3% population M=F.

Question 26

diagnosis OCD

Answer 26

obsesisons and compulsions for 1+ hours a day and for >2weeks and distressing/interfere with activities

Question 27

treatment OCD

Answer 27

CBT- exposure and response prevention, SSRIs or clopiramine

Question 28

when is OCD typically onset

Answer 28

adolescence

Question 29

aetiology OCD

Answer 29

genetics (OCD or tourettes in family), parental overprotection, may occur after strep infection in children

Question 30

neurochem change in OCD

Answer 30

decr serotonin. abnormalities in cortico striatal thalamic circuit (mediates social behaviour)

Question 31

OCD course

Answer 31

may follow an episodic or chronic course

Question 32

poorer prognosis in OCD

Answer 32

with prominent compulsions, comorbid tic disorders, persistent life stresses, premorbid anankastic personality

Question 33

what is body dysmorphic disorder

Answer 33

obsessional preoccupation with imagined or mild physical defects- mirror gazing, comparing features with others, reassurance seeking

Question 34

what is PTSD

Answer 34

severe psychological disturbance following a traumatic event

Question 35

when do symptoms PTSD arise

Answer 35

arise within 6 months of traumatic event, or present for at least 1 month.

Question 36

ICD10 and DSM diagnosis of PTSD

Answer 36

>2 of: difficulty falling/staying asleep, irritability or anger outbursts, difficulty concentrating, hypervigilance, exaggerated startle response

Question 37

risk of diagnosing PTSD after traumatic event

Answer 37

8-13% men, 20-30% women

Question 38

treatments PTSD

Answer 38

trauma focused CBT, eye movement desensitisation and reprocessing therapy (EMDR), drugs for symptoms

Question 39

features PTSD

Answer 39

persistent intrusive thinking, avoidance, numbing/detachment from others, increased arousal

Question 40

prognosis PTSD

Answer 40

50% recover within a year, 30% chronic course. outcome depends on- good social support, response by others, no further traumatic events, premorbid personality