Anxiety Disorders

Question 1

Anxiety - other DDx

Answer 1

• other psych disorder
• cardiac (MI or valvular)
• endocrine (hyperthyroidism)
• resp (asthma or PE)
• street drugs and medications - salbutamol, theophylline, corticosteroids, antidepressants and caffeine

Question 2

Generalised Anxiety Disorder

Answer 2

• prolonged period of constant anxiety (chronic and less severe)
• worried about variety of things eg school, friends, work
• normally present with physical symptoms and may impair function

NICE define the central feature as an ‘excessive worry about a number of different events associated with heightened tension.’

Question 3

Panic Attack

Answer 3

• sudden onset extreme anxiety (acute and severe)
• numerous signs and symptoms eg tachy, palpitations, chest pain, sweating, SOB, nausea, dizziness, feeling of choking, self detachment, fear of death
• sense of impending doom
• 10 to 30 min
• disabling
• there may or may not be a trigger

Question 4

Panic Disorder

Answer 4

• recurrent panic attacks (at least 2, one year prevalence)
• unprovoked, unpredictable
• in between attacks, anxiety about having future attack
• fear of attack itself rather than external factor (as opposed to phobias)

Question 5

Agoraphobia

Answer 5

• fear of open spaces and/or crowded places
• afraid of being helpless and embarrassed in such situations, leading to avoidance
• if severe, may never leave home
• most often a/w panic disorder

Question 6

(specific) phobia

Answer 6

• fear of specific situation or item eg spider, heights, medical injections
• interferes with function
• asymptomatic if avoid exposure
• can lead to panic attack or agoraphobia (provoked)
• exposure therapy for treatment

Question 7

Social axiety disorder (social phobia)

Answer 7

• eg public speaking, eating in public, using public restrooms
• fear of scrutiny and judgment
• can lead to panic attack
• beta blockers for symptomatic relief
• SSRI for underlying disorder

Question 8

OCD

Answer 8

• anxiety and intrusive thoughts –> repetitive actions (compulsions) eg counting steps, washing hands, preoccupation with certain numbers, locking doors
• compulsions may relieve anxiety or pt might feel like they “have to” do it
• have insight (unlike OCPD)
• some research suggest childhood group A beta-haemolytic streptococcal infection may have a role

Question 9

OCD - treatment

Answer 9

• CBT
• 1st line med: SSRI
• 2nd lind med: usually clomipramine (TCA)

Question 10

PTSD

Answer 10

• develops following exposure to traumatic event - may be life threatening or serious injury or sexual violence
  4 behaviours:
• intrusion: flashbacks, nightmares, intrusive images
• avoidance: avoiding people, situations a/w event
• hyperarousal: hypervigilance for threat, sleep problems, irritability and difficulty concentrating
• emotional numbing - lack of ability to experience feelings, feeling detached, negative/distorted beliefs

Question 11

PTSD - treatment

Answer 11

• 1st line: trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy
• watchful wait
• > 3 months can consider meds:
  SSRI - sertraline
  venlafaxine
  severe cases –> risperidone