Anxiety Disorders

Question 1

Name 3 models of stress

Answer 1

Biomechanical Engineering
Medicophysiological
Psychological (transactional)

Question 2

Describe the Biomechanical Engineering model of stress

Answer 2

External stress - exceeds tolerance leading to damage

Example - catastrophic life event, daily stress

Question 3

What are the 3 stages of stress in the medicophysiological model?

Answer 3

Alarm
Adaptation
Exhaustion

Question 4

2 methods of coping

Answer 4

Problem focused - modify the stressor

Emotion focused - modify reaction

Question 5

What are the 5 symptom groups associated with the fight or flight response?

Answer 5

Psychological arousal
Autonomic arousal
Muscle tension
Hyperventilation
Sleep disturbance

Question 6

What symptoms are associated with psychological arousal in fight or flight response?

Answer 6

Fearful anticipation
Irritability 
Sensitivity
Poor concentration
Worrying thoughts

Question 7

What symptoms are associated with autonomic arousal in fight or flight response?

Answer 7

GI
Resp
Cardiovascular
Genitourinary
CNS

No underlying condition to explain symptoms

Question 8

What symptoms are associated with muscle tension in fight or flight response?

Answer 8

Tremor

Headache

Question 9

What symptoms are associated with hyperventilation in fight or flight response?

Answer 9

CO2 deficit
Breathless
Numbness
Carpopedal spasm

Question 10

What symptoms are associated with sleep disturbance in fight or flight response?

Answer 10

Frequent waking
Insomnia
Nightmares
Tremors

Question 11

What is meant by dissociative disorders?

Answer 11

Disconnection, lack of continuity between thoughts, memories, surroundings etc
Associated with previous trauma

Question 12

What is meant by somatoform in ICD10 classification of anxiety disorders?

Answer 12

Physical symptoms

Can’t be explained by underlying condition

Question 13

Describe in general terms what is meant by phobia

Answer 13

Anxiety associated with particular circumstances

Question 14

Example of phobia

Answer 14

Agoraphobia - leaving home/shops/transport induces anxiety attacks

Social phobia

Question 15

Features of phobias

Answer 15

Same core features as Generalised Anxiety Disorder

+Phobic avoidance

+Anticipatory anxiety

Question 16

What characterises symptoms experienced in Generalised Anxiety Disorder?

Answer 16

Persistent

‘Free-floating’ anxiety

Question 17

Is GAD more common in males or females?

Answer 17

Females

Males tend to present with other issues - substance misuse, alcohol

Question 18

Differential diagnosis for anxiety (Psychiatric)

Answer 18

Depression
Schizophrenia
Dementia
Substance misuse

Question 19

Differential diagnosis for anxiety (Physical)

Answer 19

Thyrotoxicosis
Asthma or arrythmia
Phaeochromocytoma
Hypoglycaemia

Question 20

Management for anxiety

Answer 20

Counselling
Relaxation training
Medication - Sedatives, Antidepressants - SSRIs, TCAs
CBT

Question 21

Presenting complaint for social phobia

Answer 21

Blushing
Tremor
Fear of scrutiny - avoidance of crowds, social gatherings, socialising

Question 22

Management of social phobia

Answer 22

Education
CBT
SSRIs

Question 23

Define Obsessive Compulsive Disorder

Answer 23

Recurring obsessional thoughts and/or compulsive acts
Ideas/images/rituals
Repeated - not willingly
Recognise as individuals own thoughts

Question 24

How does OCD differ from delusions or hallucinatory voices sometimes seen in schizophrenia?

Answer 24

Recognise as individuals own thoughts

Question 25

Describe the acts or rituals seen in OCD

Answer 25

Predictable Not enjoyable or useful Seen to prevent harm Pointless, resisted with key anxiety symptoms

Question 26

How does Obsessive Compulsive Personality Disorder differ from OCD?

Answer 26

Fixation on order Normal state - no distressed Less likely to seek help Rigid

Question 27

What genetic association is there with OCD?

Answer 27

5HT Receptor or 5HT functional abnormalities

Question 28

Management of OCD

Answer 28

Exclude depressive illness Education SSRIS, Clomipramine CBT

Question 29

What option is there for management in treatment-resistant OCD?

Answer 29

Psychosurgery

Question 30

Define PTSD

Answer 30

Delayed or protracted reaction to stressor of exceptional severity

Question 31

Examples of events leading to PTSD

Answer 31

Combat, natural disaster, rape, assault

Question 32

3 states of PTSD

Answer 32

Hyperarousal Reexperiencing phenomena Avoidance

Question 33

Aetiological factors of PTSD

Answer 33

Nature of stressor- life threatening/exposure Vulnerability factors - mood disorder, trauma, lack of support, female Susceptibility partly genetic

Question 34

Management of PTSD

Answer 34

Screen survivors in known natural disasters/traumatic events Watchful waiting Trauma focused CBT Eye Movement Desensitisation- Reprocessing TCAs, SSRIs Edcuation Guided self help Psychotherapies Medication