Anxiety Disorders

Question 1

What are the main models of stress?

Answer 1

Biomechanical engineering
Medicophysiological
Psychological (transactional)

Question 2

Describe the psychological model of stress?

Answer 2

The psychological/transactional model of stress as having either problem focussed, or emotion focussed coping methods. Problem focussed coping is where efforts are directed towards modifying the stressor, where emotion focussed involves modifying the emotional reaction.

Question 3

What are the five symptom groups associated with anxiety?

Answer 3

Psychological arousal
Autonomic arousal
Muscle tension
Hyperventilation
Sleep disturbance

Question 4

What are the specific symptoms associated with psychological arousal?

Answer 4

Fearful Anticipation
Irritability
Sensitivity to noise
Poor concentration
Worrying Thoughts

Question 5

What are the specific symptoms associated with autonomic arousal?

Answer 5

Gastrointestinal:
-Dry mouth
-Swallowing difficulties
-Dyspepsia
-Nausea
-Frequent diarrhoea
Respiratory:
-Tight chest
-Difficulty breathing
Cardiovascular:
-Palpitations
-Chest pain
Genitourinary:
-Frequency/urgency of micturition
-Amenorrhoea or dysmenorrhoea
-Erectile failure
Nervous System:
-Dizziness
-Sweating

Question 6

What are the specific symptoms associated with muscle tension?

Answer 6

Tremor
Headache
Muscle pain

Question 7

What are the specific symptoms associated with hyperventilation?

Answer 7

CO2 deficient hypocapnia
Numbness in periphery- can cause carpopedal spasm
Breathlessness

Question 8

What are the specific symptoms associated with sleep disturbance?

Answer 8

Initial insomnia
Repeated wakening
Nightmares/ night terrors

Question 9

What is the difference between generalised and phobixc anxiety disorders?

Answer 9

Both phobic and generalised anxiety disorders share the core anxiety symptoms but phobic anxiety disorders only occur in certain situations and generalised anxiety disorder occurs persistently.

Question 10

What are the three main types of phobic anxiety disorder?

Answer 10

Agoraphobia
Social phobia
Specific phobias

Question 11

How is generalised anxiety disorder characterised?

Answer 11

By persistent (several months) of the anxiety symptoms detailed above that are not tied to a situation or object

Question 12

What is included on a differential diagnosis for anxiety disorders?

Answer 12

Depression
Schizophrenia
Dementia
Substance misuse
Thyrotoxicosis
Phaeochromoctoma
Hypoglycaemia
Asthma and/or arrhythmias

Question 13

How are generalised anxiety disorders managed?

Answer 13

Counselling
Relaxation training
Medication (ideally avoid sedatives due to risk of dependence, SSRIs or TCAs better choices)
Cognitive behavioural therapy

Question 14

How are phobic anxiety disorders characterised?

Answer 14

Phobic anxiety disorders have the same core features of generalised anxiety disorders but they only present in specific situations. The patient will act to avoid these situations, which is known as phobic avoidance. The sufferer will also likely experience anxiety if there is a risk of them encountering the perceived threat.

Question 15

How is social phobia managed?

Answer 15

CBT
Education/advice
SSRIs

Question 16

What is the core feature of obsessive compulsive disorder?

Answer 16

Experiencing recurrent obsessional thoughts and/or compulsive acts

Question 17

What are the features of obsessional thoughts?

Answer 17

Ideas, images or impulses
Occurring repeatedly and not willed
Unpleasant and distressing
Recognised as the individuals own thoughts (will likely realise they are irrational ideas)
Usual key anxiety symptoms arise because of distress of thoughts or attempts to resist

Question 18

What are the features of compulsive acts/rituals?

Answer 18

Stereotypical behaviours repeated again and again
Not enjoyable
Not helpful i.e. do not result in useful activity
Often viewed by sufferer as either preventing some harm to self or others or viewed as pointless and resisted with key anxiety symptoms accompanying resistance

Question 19

How is OCD managed?

Answer 19

Thorough history and MSE to exclude treatable depressive illness
Education, explanation and the involvement of family/partner
Serotonergic drugs such as SSRIs or clomipramine
CBT
Psychosurgery

Question 20

How is post traumatic stress disorder defined?

Answer 20

A delayed and or protracted reaction to a stressor of exceptional severity

Question 21

What are some common causative stressors for PTSD?

Answer 21

Combat
Natural or human-caused disaster
Rape
Assault
Torture 
Witnessing any of the above

Question 22

What are the key elements to the reaction associated with PTSD?

Answer 22

Hyperarousal
Re-experiencing the phenomena
Avoidance of reminders

Question 23

What are the characteristics of hyperarousal?

Answer 23

Persistent anxiety
Insomnia
Irritability
Poor concentration

Question 24

What are the potential presentations of re-experiencing of phenomena?

Answer 24

Intense, intrusive images which can be nightmares or flashbacks

Question 25

What are the potential presentations of avoidance of reminders?

Answer 25

Emotional numbness
Cue avoidance
Recall difficulties
Diminishes interests

Question 26

What factors increase an individual’s susceptibility to PTSD?

Answer 26

Mood disorder
Previous trauma especially as child
Lack of social support 
Female sex
Higher education and social group
Good paternal relationship
Partly genetic

Question 27

How is PTSD managed?

Answer 27

Management of mild PTSD involves observing for a month to check if symptoms worsen. In more severe disorder, the following can be helpful:
• Trauma focused CBT
• Eye movement desensitisation and reprocessing
• SSRI or TCA but be wary of risk of dependence