Anxiety disorders

Question 1

Models of stress
Describe the biomechanics engineering model [3]
Remember the proverb

Answer 1

Stress tolerated up to a point. After certain level exceeded, physiological stress will occur [3]
Proverb: straw on camel’s back

Question 2

Models of stress

Describe the medico physiological model - 4 stages

Answer 2

Produces fight or flight response in reaction to a stressor.
If stressor persists, alarm reaction experienced.
Physiological adaptation to stress
Exhaustion

Question 3

Models of stress
Psychological/transactional model is reliant on one idea [1]
Name 2 coping methods

Answer 3

An individual’s reaction to stress will depend on a balance between cognitive processing of perceived threat and perceived ability to cope

Coping methods:
Problem focused
Emotion focused

Question 4

Anxiety disorders - symptoms

Psychological arousal [5]

Answer 4

Fearful anticipation
Irritability
Noise sensitivity
Poor concentration
Rumination

Question 5

What are the GI autonomic symptoms [5]

Answer 5

Dry mouth
Swallowing issue 
Dyspepsia
Nausea
Frequent loose stools

Question 6

What are respiratory and CVS autonomic symptoms [4]

Answer 6

Tight chest, SOB, Difficulty inhaling
Chest pain, Palpitations
Hyperventilation
Hypercapnia

Question 7

What are the genitourinary symptoms

Answer 7

Frequency of micturition
Amenorrhoea
Dysmenorrhoea
Impotence

Question 8

GAD 3 criteria
Risk factors [4]
Protective factors [2]

Answer 8

Same core anxiety symptoms
Not confined to a situation/object
Persistent for several months

Risk factors:
Aged 35- 54
Being divorced or separated
Living alone
Being a lone parent

Protective factors:
Aged 16 - 24
Being married or cohabiting

Question 9

GAD management

(non pregnant) [4]

Answer 9

Counseling, advise lifestyle choices
Relaxation training
Medication - SSRI, TCA, BDZ as adjunct but high dependency
CBT to maintain remission

Question 10

Differential diagnosis of neuroses
4 psychiatric differentials
4 physical/organic disease differentials

Answer 10

Depression
Schizophrenia
Dementia
Substance misuse

Thyrotoxicosis
Pheochromocytoma
Hypoglycemia
Asthma, arrhythmias

Question 11

Phobic anxiety disorders [3]
Describe agoraphobia
Describe social phobia
Mx [2]

Answer 11

1) core anxiety symptoms
2) but only in certain situations
3) leading to avoidant behavior and anticipatory anxiety

Agoraphobia - situations where its difficult to escape
Social phobia - fear of being judged/scrutiny by others

Mx
CBT and SSRI

Question 12

OCD
4 diagnostic criteria
Describe insight

Answer 12

> 1 hour or distress or functional impairment
Obsessional thoughts
Compulsive acts
Key anxiety symptoms if try to resist

Insight - viewed as pointless, resisted > anxiety symptoms worsen

Question 13

OCD management [2]

Second line Rx

Answer 13

Mx: graded exposure and response prevention, SSRIs

Question 14

PTSD
Define [1]
3 key elements to reaction

Answer 14

Delayed or protracted reaction to a stressor of exceptional severity

1. Hyper-arousal
2. Re-experiencing phenomena
3. Avoidance of reminders

Question 15

PTSD management
Screening
Mild symptoms? 2 modes of mx
2 Rx

Answer 15

Survivors of disasters screened at one month
If mild symptoms, watchful waiting and review in one month
2 Rx - SSRI, TCA
EMDR