Anxiety Disorders

Question 1

What are the three models of stress?

Answer 1

Bio mechanical engineering

Mediopsychiological

Psychological (transactional)

Question 2

How does stress occur?

Answer 2

The body is designed to cope with certain amounts of stress but too much causes damage and negative effects on the body

Question 3

What is th medicophysiological theory of stress

Answer 3

Fight or flight reposnse

Alarm reaction
Physiological adaptation
Exhaustion

Question 4

What is the bio mechanical model of stress

Answer 4

Overload on a structure leads to damage e.g. too much force on a muscle leads to damage

Question 5

What is the psychological (transactional) model of stress

Answer 5

An interactive response that is unique to someone’s own perspective

Someone assess a situation and decide how they cope with it. They deal with stress in two ways:
Problem focused
Emotional focused

Question 6

What is a problem focused way to react to stress?

Answer 6

Do things to get rid of things that relate to stress.

Question 7

What is an emotion focused approach to dealing with stress

Answer 7

Modifying your emotional response with mental defence mechanisms.

E.g. go a run, denial, taking a sedative drug

Question 8

What is the pathophysiology of anxiety

Answer 8

The production of steroids causes damage to the reticular system of the brain, heightening its further response in anticipation of stress

Question 9

What are the fight or flight responses of anxiety

Answer 9

Psychological arousal
Autonomic arousal 
Muscle tension
Hyperventilation
Sleep disturbance

Question 10

What symptoms occur due to the psychological component of anxiety?

Answer 10

Fearful anticipation
Irritability
Sensitivity to noise
Poor concentration
Worrying thoughts

Question 11

What symptoms of autonomic arousal occur during an anxiety response?

Answer 11

GI- Dry mouth, swallowing difficulties, dyspepsia

Resp-tight chest, difficulty inhaling

Cardio- palpitations, chest pain

Urinary- erectile failure

CNS- dizziness and sweating

Question 12

What can muscle tension caused by anxiety cause?

Answer 12

Tremor
Headache
Muscle pain

Question 13

What can hyperventilation caused by anxiety lead to

Answer 13

CO2 deficit hypocapnia
Numbness/tingkjng in the extremities may lead to carpopedal spasm
Breathlessness

Question 14

What symptoms of sleep disturbance can be caused by anxiety

Answer 14

Frequent waking
Insomnia
Nightmares and night terrors

Question 15

How are phobic anxiety dorsders and general anxiety disorders

Similar
Different

Answer 15

Symptoms are practically the same

Phobias- occurs in specific situations

Generalised- occurs all the time

Question 16

Describe the presentation of generalised anxiety disorder

Answer 16

Persistant nervousness
Trembling
Muscle tremors
Palpitations
Dizziness
Epigastric discomfort 

Lasts for a few months, described as free flowing anxiety

Question 17

What are the psychiatric differentials for generalised anxiety disorders

Answer 17

Depression
Schizophrenia
Dementia
Substance misuse

Question 18

What are the physical differentials for generalised anxiety disorders

Answer 18

Thyrotoxicosis
Pheaechromoctoma
Hypoglycaemia
Asthma or arrythmias

Question 19

How do you manage generalised anxiety disorder?

Answer 19

Counselling- clear plan of management, explanation and education, advice re caffeine, alcohol and exercise

Relaxation training-group or individual, DVD’s

Medication- sedatives, SSRI or TCA

CBT

Question 20

Describe phobic anxiety disorders?

Answer 20

Same core features as generalised anxiety disorders
Only in specific circumstances
Leads to phobic avoidance
sufferer also experiences perceived threat of encountering the feared object or situation

Question 21

What are the three clinically important syndromes in phobic anxiety disorders

Answer 21

Specific phobias

Social phobias

Agoraphobia- scared to leave house, can cause panic attacks

Question 22

Describe the presentation of social phobia

Answer 22

Avoidance of scrutinisation/ being observed.
Avoid restaurants, shops or queues, public speaking
May present with blushing,hand tremors, nausea
May lead to panic attacks

Question 23

How do you manage social phobias?

Answer 23

CBT, bake to challenge the negative views of self, safety barriers, unrealistically high stands dad and excessive self monitoring

SSRI’s

Education

Question 24

How does OCD present

Answer 24

An association with recurrent thoughts/ideas or impulses
Patient often tries to resist these thoughts and actions
Patient knows it’s their own thought but may not be rational

Question 25

How is OCD different to OCPD

Answer 25

Presence of obsessional thoughts and compulsions to do things is only present in OCD.

People are distressed by intrusive thoughts and compulsions in OCD

People with OCD are more likely to seek help

Question 26

How do you manage OCD

Answer 26

Education and explanation (involve partner/family)

Serotinergic drugs (SSRI)
Clomipramine 

CBF (best outcome)

Psychosurgery- treatment resistant OCD

Question 27

Where can PTSD arise from

Answer 27

A protracted stress reposnse from a substantial event e.g.

Combat
Disaster
Rape
Assault
Torture

Question 28

How is PTSD characterised

Answer 28

Hyperarousal- persistant anxiety, irritability, insomnia, poor concentration

Re-experiencing phenomena- intensive intrusive images, flashbacks when awake, nightmares during sleep, also have anhedonia

Avoidance- emotional numbness, cue avoidances, recall difficulties, diminished interests

Question 29

What may make you vulnerable to PTSD

Answer 29

Mood disorder
Previous trauma as a child
Lack of social support
Female
Lack of higher education and social groups
Good paternal relationships

Question 30

How do you treat PTSD

Answer 30

Survivors of disasters screened at one million GH
Mild symptoms “watchful waiting” and review a month later
Trauma focused CBT if more severe symptoms
Eye movement desensitisation and reprocessing
Risk of dependence with sedatives so SSRI or TCA