Anxiety Disorders

Question 1

What is the difference between GAD and phobias?

Answer 1

Both these sets of disorders have same core anxiety symptoms but they EITHER occur in particular circumstances: 
PHOBIAS
Agoraphobia
Social phobia
Specific (Isolated) Phobias
OR Occur persistently
GENERALISED ANXIETY DISORDER (GAD)

Question 2

What are the five symptoms of human anxiety?

Answer 2

Psychological arousal
Autonomic Arousal
Muscle Tension
Hyperventilation
Sleep Disturbance

Question 3

What is the management of GAD?

Answer 3

Counselling- Clear Plan of Management, Explanation and education, Advice re caffeine, alcohol, exercise etc.
Relaxation training
Sedatives have high risk dependency
Antidepressants SSRI or TCA
Cognitive Behavioural Therapy

Question 4

What are the three kinds of phobic anxiety?

Answer 4

Specific Phobias
Social Phobia
Agoraphobia

Question 5

What is the management of social phobia?

Answer 5

Cognitive Behavioural Therapy addressing the groundless fear of criticism.
Education and advice
Medication SSRI antidepressants

Question 6

What is OCD?

Answer 6

Core features are experience of recurrent obsessional thoughts and or compulsive acts
Obsessional Thoughts
Ideas, images or impulses
Occurring repeatedly not willed
Unpleasant and distressing (often the antithesis of personality type)
Obscene
Violent or senseless
Recognised as the individual’s own thoughts
Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist
Stereotypical behaviours repeated again and again

Question 7

What is the management of OCD?

Answer 7

Good history and MSE exclude treatable depressive illness
Education and explanation
Serotonergic Drugs- SSRI eg Fluoxetine
Clomipramine
Cognitive Behavioural Therapy (CBT)
Exposure and response prevention
Examination of evidence to weaken convictions
Psychosurgery

Question 8

What are the three key elements to PTSD reaction?

Answer 8

Hyperarousal (Persistent anxiety, Irritability, Insomnia, Poor concentration)
Re-experiencing phenomena (flashbacks and nightmares)
Avoidance of reminders (Emotional numbness, Cue avoidance, Recall difficulties, Diminishes interests)

Question 9

what is the management for PTSD?

Answer 9

Survivors of disasters screened at one month
Mild symptoms “watchful waiting” and review further month
Trauma-focused CBT if more severe symptoms
Eye Movement Desensitisation and Reprocessing
Risk of dependence with any sedatives but patient may prefer medication SSRI or TCA