Anxiety Disorders

Question 1

What are the models of stress?

Answer 1

Biomechanical engineering
Medicophysiological
Psychological

Question 2

Describe the psychological model of stress

Answer 2

Transactional

• interactive
• reaction to stress depends on balance between cognitive processing of perceived threat and perceived ability to cope

Question 3

Describe coping

Answer 3

Can be problem focussed or emotion focussed

Problem; efforts directed toward modifying stresor i.e. preparation, studying

Emotion; modify emotional reaction, mental defence mechanisms i.e. denial, relaxation training

Question 4

Describe the symptom groups in anxiety

Answer 4

Psychological arousal
Autonomic arousal
Muscle tension
Hyperventilation
Sleep disturbance

Question 5

Describe psychological arousal symptoms

Answer 5

Fearful anticipation
Irritability
Sensitivity to noise
Poor concentration
Worrying thoughts

Question 6

Describe autonomic arousal symptoms

Answer 6

Gastrointestinal arousal; dry mouth, difficulty swallowing

Resp; tight chest, struggle inhaling

Cardio; palpitation, chest pain

Genitourinary; frequency, amenorrhoea/dysmennorhoea, erectile failure

CNS; dizziness, sweating

Question 7

Describe muscle tension symptoms

Answer 7

Tremor
Headache
Muscle pain

Question 8

Describe hyperventilation symptoms

Answer 8

CO2 deficit hypocapnia
Numbness tingling in extremities may lead to carpopedal spasm
Breathlessness

Question 9

Describe sleep disturbance symptoms

Answer 9

Initial insomnia
Frequent waking
Nightmares and night terrors

Question 10

What is the difference between phobic anxiety disorder and generalised anxiety disorder?

Answer 10

Same symptoms but phobia only when faced with trigger, GAD occurs persistently

Question 11

What are some differential diagnoses for anxiety disorders?

Answer 11

Psychiatric; depression, schizophrenia, dementia, substance misuse

Physical condition; thyrotoxicosis, phaeochromocytoma, hypoglycaemia, asthma/arrythmias

Question 12

Describe options in management of generalised anxiety disorders

Answer 12

Counselling; management plan, explanation and education, advice re caffeine, exercise etc

Relaxation training; group/individual, DVD/tape/clinician led

Medication; sedatives have high risk dependency, antidepressant SSRI or TCA

CBT

Question 13

What are clinically important syndromes in phobic anxiety disorders?

Answer 13

Specific phobias
Social phobia
Agoraphobia

Question 14

Describe social phobia

Answer 14

inappropriate anxiety in situation where feel observed or could be criticised;

• shops/queues
• restaurants
• public speaking

Blushing and tremor predominate, but any GAD symptoms can occur

Question 15

How can social phobia be managed?

Answer 15

CBT addressing groundless fear of criticism

CBT Challenges

• negative views of self
• “safety barriers”
• unrealistically high standards
• excessive self-monitoring

Education and advice

Medication SSRI antidepressants

Question 16

Describe OCD

Answer 16

Obsessional thoughts;

• ideas, images or impulses
• occurring repeatedly not willed
• unpleasant and distressing; obscene, violent or senseless
• recognised as own thoughts

Usual key anxiety symptoms bc of distress or attempts to resist

Question 17

Describe compulsive acts or rituals in OCD

Answer 17

Stereotypical behaviours repeated again and again

Not enjoyable or helpful

Often viewed by sufferer as preventing some harm or as pointless and resisted resulting in anxiety symptoms

Question 18

What is the aetiological theory in OCD?

Answer 18

Genetic e.g. gene coding for 5HT receptors

5HT function abnormalities

Question 19

Describe management OCD

Answer 19

Good history and MSE; exclude treatable depressive illness
- education and explanation, involve partner and family

Serotonergic drugs

• SSRI eg fluoxetine
• clomipramine

CBT

• exposure and response prevention
• examination of evidence to weaken convictions

Psychosurgery

Question 20

What is PTSD

Answer 20

Delayed and/or protracted reaction to a stressor of exceptional severity

• combat
• natural or human-caused disaster
• rape
• assault
• torture
• witnessing any of the above

Question 21

What are the key elements to reaction in PTSD?

Answer 21

Three key

1. Hyperarousal
2. Re-experiencing phenomena
3. Avoidance of reminders

Question 22

Describe hyperarousal

Answer 22

Persistent anxiety
Irritability
Insomnia
Poor concentration

Question 23

Describe re-experiencing phenomena

Answer 23

Intense intrusive images

• flashbacks when awake
• nightmares during sleep

Question 24

Describe avoidance

Answer 24

Emotional numbness
Cue avoidance
Recall difficulties
Diminishes interests

Question 25

Describe the aetiology of PTSD

Answer 25

Nature of stressor
- life threatening and degree of exposure generally confers greater risk

Vulnerability factors

• mood disorder
• previous trauma
• lack of social support
• female
• protective factors
• higher education and social group
• good paternal relationship

Question 26

Describe the management of PTSD

Answer 26

Survivors of disasters screened at one month

Mild symptoms “watchful waiting” and review further month

Trauma focussed CBT if more severe

Eye movement desensitisation and reprocessing

Risk dependence with any sedatives but patient may prefer medication SSRI or TCA