Anxiety Disorders

Question 1

What is the Psychological (transactional) model of stress?

Answer 1

Interactive
An individuals reaction to stress will depend on a balance between their cognitive processing of any perceived threat and perceived ability to cope.
Coping can be problem or emotion focused.

Question 2

What is problem focussed coping?

Answer 2

Where efforts are directed toward modifying stressor.

Question 3

What is emotion focussed coping?

Answer 3

Modifying the emotional reaction. Mental defence mechanisms.

Question 4

What is the brain’s physical response to stress?

Answer 4

Stressor causes hypothalamus to release Corticotropin releasing hormone.
Stimulates pituitary gland to release Adrenocorticotropic hormone, prolactin and growth hormone and hard-wiring of sympathetic innervation.
Adrenocorticotropin acts on adrenal gland to release Glucocorticoid hormones and Noradrenaline and adrenaline.
All these contribute to producing T cells, Monocytes, B cells, NK cells and APC cells. These produce cytokines such as IL-1 that then act on brain.

Question 5

What are some symptom groups of Anxiety?

Answer 5

Psychological arousal
Autonomic arousal
Muscle tension
Hyperventilation
Sleep disturbance

Question 6

What symptoms come under Psychological arousal?

Answer 6

Fearful anticipation
Irritability
Sensitivity to noise 
Poor concentration
Worrying thoughts

Question 7

What symptoms come under autonomic arousal?

Answer 7

GI - dry mouth, swallowing difficulties, dyspepsia, nausea, wind, frequent loss motions.

Resp - chest tightness, difficulty inhaling.

Cardio- palpitations, missed beats, chest pain.

Genitourinary - Frequency/urgency or micturition, amenorrhoea/dysmenorrhoea, erectile failure.

CNS - dizziness, sweating.

Question 8

What features of muscle tension may be present under stress?

Answer 8

Tremor
Headache
Muscle pain

Question 9

What may occur due to hyperventilation under stress?

Answer 9

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

Question 10

How may sleep be disturbed under stress?

Answer 10

Initial insomnia
Frequent waking
Nightmares and night terrors.

Question 11

What is Generalised Anxiety Disorder (GAD)?

Answer 11

Persistent symptoms not confined to a situation or object. All symptoms of human anxiety can occur.
F>M

Question 12

How is Generalised Anxiety disorder managed?

Answer 12

Counselling - clear plan, explanation and education, advice re caffeine, alcohol, exercise.
Relaxation training
Medication - sedatives, antidepressants SSRIs or TCAS.
CBT

Question 13

What is Phobic Anxiety Disorder?

Answer 13

Persistent symptoms that occur only in a specific circumstance. All symptoms of human anxiety can occur.
Person behaves to avoid these circumstances.
Can also experience anticipatory anxiety.

Question 14

What are some examples of Phobic anxiety disorders?

Answer 14

Specific phobias
Social phobia
Agoraphobia

Question 15

What is agoraphobia?

Answer 15

Fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong.

Question 16

What is social phobia?

Answer 16

Inappropriate anxiety in situation where person feels observed or could be criticised. Any anxiety symptoms can occur but blushing and tremor predominate.
Situations include restaurants, shops or queues, public speaking.

Question 17

What is the management for Social phobia?

Answer 17

CBT to address the groundless fear of criticism.
Education and advice
Medication SSRI antidepressants.

Question 18

What is Obsessive Compulsive Disorder (OCD)?

Answer 18

Experience of recurrent obsessional thoughts and or compulsive acts.

Obsessional thoughts are ideas, images or impulses occurring repeated and unwilled. They can be unpleasant and distressing and anxiety arises because of the distress of the thoughts or the attempt to resist them.

Question 19

What is the aetiological theory of OCD?

Answer 19

Genetic involvement of gene coding for 5HT receptors resulting in 5HT function abnormalities.

Question 20

What is the management for OCD?

Answer 20

Education and explanation involving partner/family.
Serotonergic drugs - SSRIs and Clomipramine.
CBT - exposure and response prevention, examination of evidence to weaken convictions.
Psychosurgery

Question 21

What is Post Traumatic Stress Disorder?

Answer 21

Delayed and or protracted reaction to a stressor of exceptional severity. The stressor would distress anyone.

Examples include combat, natural or human caused disaster, rape, assault, torture or witnessing any of the above.

Question 22

What are 3 key elements to a reaction in PTSD?

Answer 22

Hyperarousal
Re-experiencing phenomena
Avoidance of reminders

Question 23

What are some symptoms of hyperarousal?

Answer 23

Persistent anxiety
Irritability
Insomnia
Poor concentration

Question 24

What are some symptoms of Re-experiencing?

Answer 24

Intense intrusive images
Flashback when awake
Nightmares during sleep

Question 25

What are some symptoms of avoidance of reminders?

Answer 25

Emotional numbness
Cue avoidance
Recall difficulties
Diminished interests

Question 26

What are some risk factors for PTSD?

Answer 26

Mood disorder
Previous trauma especially as a child
Lack of social support
Female
Genetics

Question 27

What is the management of PTSD?

Answer 27

NICE guidelines
Survivors of disasters screened once a month.
Trauma focused CBT if severe.
Eye movement desensitisation and reprocessing.
SSRIs or TCAs