Anxiety Disorders

Question 1

Under which part of the ICD-10 are anxiety disorders classified?

Answer 1

Neurotic, stress related and somatoform disorders

Question 2

How do phobic anxiety, panic disorder and generalised anxiety differ in terms of:

1. occurence of anxiety
2. associated cognitions
3. associated behaviours

Answer 2

1. phobia - situational; panic disorder - episodic; GAD - constant
2. phobia - fear of situation; panic disorder - fear of symptoms; GAD - fear of future
3. phobia - avoidance of situation; panic disorder - escape; GAD - inhibition

Question 3

Describe psychological symptoms of anxiety

Answer 3

• feeling of fear/impending doom
• feelings of dizziness and faintness
• restlessness
• exaggerated startle response
• poor concentration
• irritability
• insomnia and night terrors
• depersonalisation and derealisation
• globus (lump in throat)

Question 4

Describe physical symptoms of anxiety

Answer 4

• palpitations, tachycardia, chest discomfort
• dry mouth, globus, nausea, abdominal discomfort, diarrhoea
• hyperventilation, breathlessness
• urinary frequency, failure of erection, amenorrhoea
• hot flushes or cold chills, tremor, sweating, headache, muscle pains, dys/parasthesia, dizziness

Question 5

1. What is the general age of onset of anxiety disorders?
2. Which gender are affected more by anxiety disorders?
3. What is the diagnosis if both diagnostic criteria for depression and anxiety are met?

Answer 5

1. early adulthood; middle age (less common)
2. women
3. mixed anxiety and depressive disorder

Question 6

Describe the following psychological management techniques for anxiety disorders:

1. relaxtion techniques
2. anxiety management training
3. biofeedback
4. behavioural therapies
5. CBT

Answer 6

1. breathing techniques, meditation, yoga; can be particularly useful in management of mild/moderate anxiety
2. involves two stages: first, verbal cues and mental imagery are used to arouse anxiety and demonstrate the link with symptoms. Second, patient is trained to reduce this anxiety with relaxation, distraction and reassuring self statements
3. useful for showing patients that they are not relaxed, even when they fail to recognise it, having become so used to anxiety. Involves feeding back to the patient a physiological measure that is abnormal in anxiety. These measures may include electrical resistance of the skin of the palm, heart rate, muscle electromyography or breathing pattern
4. treatments that are intended to change behaviour and thus symptoms. e.g. graded exposure
5. treatment of choice for panic disorder and GAD. Therapist and patient need to identify the mental cues (thoughts and memories) that may subtly provoke exacerbations of anxiety or panic attacks

Question 7

Name 4 drug classes used in the management of anxiety disorders

Answer 7

1. benzodiazepines
2. SSRIs
3. Antipsychotics - aripiprazole and olanzapine
4. beta blockers

Question 8

What is generalised anxiety disorder characterised by?

Answer 8

long standing, free floating anxiety, that may fluctuate, but is neither situational nor episodic
- there is apprehension about a number of events far out of proportion to the to the likelihood or impact of these feared events

Question 9

Describe clinical features of GAD (4)

Answer 9

1. patient appears worried, tense and restless
2. sleep disturbance - difficulties getting to sleep; intermittent awakening
3. hyperventilation common
4. physical symptoms

Question 10

1. Name 3 psychological therapies used in the management of GAD
2. Name 4 pharmacological approaches to the management of GAD

Answer 10

1. CBT, counselling, behavioural therapy

2. SSRIs, SNRIs, sedating antidepressants, benzos

Question 11

What is panic disorder characterised by?

Answer 11

repeated, sudden attacks of overwhelming anxiety, accompanied by severe physical symptoms
- there is fear of the implications and consequences of a panic attack, which in itself triggers further attacks

Question 12

How are panic attacks managed?

Answer 12

• CBT

- SSRIs, TCAs and benzos

Question 13

What are phobias?

Answer 13

intense fear/anxiety triggered by a stimulus/group of stimuli that are predictable and normally cause no particular concern to others

Question 14

Which psychological therapy is particularly useful in the management of phobias?

Answer 14

graded exposure therapy

Question 15

What is OCD?

Answer 15

disorder characterised by obsessional ruminations and compulsive rituals
- obsessions - intrusive thoughts which cause anxiety
- compulsions - repetitive behaviours/rituals which neutralise the anxiety caused by obsessions
the obsessions and compulsions are time consuming and intrusive, so that they affect functioning and cause significant distress

Question 16

1. Name 2 conditions that OCD commonly co-occurs with
2. describe the gender distribution for OCD
3. What is the medan age of onset of OCD?

Answer 16

1. depression and Tourette’s syndrome
2. effects both genders equally
3. 20-40 years

Question 17

1. What is the focus of CBT for OCD?

2. What phamacological approaches are used for OCD?

Answer 17

1. exposure and response prevention
   
   • confronting the anxiety provoking stimulus in a controlled environment and not performing the associated ritual
2. SSRIs and TCAs (may be required in higher doses than required to treat depression; relapse rates on discontinuation are high)

Question 18

What is an acute stress reaction?

Answer 18

an acute, severe stress reaction occurring in response to exceptional physical and/or psychological stress.

Question 19

Describe 7 clinical features of PTSD

Answer 19

• flashbacks
• insomnia (usually accompanied by nocturnal flashbacks)
• emotional blunting
• intense anxiety on exposure to events that resemble an aspect of the traumatic event
• avoidance of activities/situations reminiscent of the trauma
• emotional detachment from others
• hypervigilence