Anxiety disorders

Question 1

pathological anxiety response

Answer 1

autonomy: no/minimal external trigger
intensity: exceeds bearable
duration: persistent symptoms
behaviour: impairs function, avoidance/safety behaviours (disabling)

Question 2

epidemiology

Answer 2

75% mixed anx/depp
11% of 1o population; commonest psych disorder

panic 1.7%, OCD 2.3%, GAD 2.8%, PTSD 3.6%, phobias 8%

Question 3

aetiology

Answer 3

genetics: 30%; esp. panic/OCD
NT imbalance (NA/5HT)
stimulus misinterpretation/sensitivity
stressors, LT stress, truma

Question 4

types

Answer 4

phobias: specific trigger
agoraphobia: fearful situations
social phobia: negative attention; M>F
panic disorder: >4 attacks/month (Severe 4/w)
GAD: everything all the time
PTSD: hypervig, memory, avoid
OCD: obsessions and compulsions

Question 5

features

Answer 5

autonomic arousal: dry mouth, dd/micturition, SOB/chest pain, palpitations, dizzy, tingling

psych: worrying, irritable, restless, hypervigilant, concentration, fearful anticipation

sleep: insomnia (falling/staying, REM more), night terrors
muscles: tremors, aches

Question 6

panic attacks

Answer 6

sudden, rapid onset, severe, short (

Question 7

GAD

Answer 7

generalised, persistent, most days for months
somatic and psychological
apprehension, decisions, tension and SANS
worry about worry
no avoidance or panic

Question 8

social phobia, other phobias

Answer 8

specific situations/triggers, avoidance behaviour

social: attention/rejection/embarrassment
blushing, tremor, fear of vomiting/micturition
coping: planning, familiarity, avoidance
okay if alone

Question 9

agoraphobia

Answer 9

similar to social phobia: fear of specific situations

• crowds, public places, tight spaces, travelling
• with or without panic attacks
• can still occur if alone

Question 10

OCD - obsessions

Answer 10

themes: contamination, responsible/guilt, health anxiety, doubt, aggro, perfectionism, morality

5 key points: unpleasant, intrusive, repetitive, own thoughts, suppression attempt

Question 11

OCD - compulsions

Answer 11

neutralising acts/rituals; ‘magical thinking’
seem purposeful but are illogical and unpleasant

themes: cleaning, control/perfection, counting/checking, aggression/anger

initially resist but decreases with time; carers may collude (easier) or challenge

Question 12

PTSD - features

Answer 12

after a significant trauma; perceived as life threatening

memory: flashbacks, reliving, nightmares/terrors
hypervigilance: heightened senses, increased startle
avoidance: amnesia, repression, numb/detached
other: sleep, mood, substances

Question 13

PTSD - management

Answer 13

EMDR: reduce association between eye movements and images

Question 14

BPS approach

Answer 14

biological:

• ST: BB (SANS; situations, engage, concentrate); BZD (ST only)
• LT: SSRI, APD, pregabalin (resistant GAD)
  psychosocial: educate, self-help, counselling, CBT, PDT, CAT; social skills
• graded exposure (reverse association)
• response prevention; EMDR

Question 15

anxiety stepped care

Answer 15

I: all known/suspected; education, monitor
II: sI failure; self-help, low intensity psych
III: impairment/SII fail; high intensity psych OR meds
IV: complex, failure, risk, impairment; combo Rx, MDT

Question 16

ADD and BB in anxiety

Answer 16

initially worsening; 2-4 weeks to work
?increase monoamines to regulate mood ?receptor downregulation

decrease NA/SANS; specific situations; cover until ADD work
increase engagement, concentration, learning

Question 17

BZD info

Answer 17

increase GABA, inhibit NT
ST only: max 3/52; tolerance, dependence, withdrawal; sedative
risk of avoidance behaviour
loraz (short), diaze (longer and faster onset)

Question 18

pathophysiology

Answer 18

cycle of anxiety: thoughts, anxiety, Sx, behaviour

• avoidance
• safety behaviours and rationale (compulsion, substances, educate)

reinforcement: Sx worse with each exposure, extend wider (worsens association and avoidance)

Question 19

assessment

Answer 19

triggers/situation; continuous/episodic; physical Sx, cognition, behaviour;

Question 20

DDx

Answer 20

endocrine: thyroid, phaechromo, hypoG
drugs:
-intox: caffeine, cocaine, cannabis, meth
-w/d: alcohol, BDZ, opitates
CRS: MI, arrhyth, hypoxia, anaemia
neuro: TIA, delirium, seizure, vestibular

depp/PD/schizo

Question 21

OCD management

Answer 21

graded exposure

Question 22

graded exposure

Answer 22

identify and grade situations
manageable progressive steps, start mild
exposure + anxiety-reducing stimulus = reverse association

CBT: repeated exposure, gradual recalibration

Question 23

Prognosis

Answer 23

treatment allows normal life
mild GAD may persist, worse if stressed
Panic/PTSD: 50% recover completely, some mild Sx, few persistent