Anxiety Disorders

Question 1

(3) Brain structures involved in anxiety disorders

Answer 1

Question 2

Features of General Anxiety Disorder (GAD)

Answer 2

People with GAD worry constantly about numerous, often seemingly trivial things but there is no obvious stimulus to the anxiety (unlike a phobia).

MNEMONIC

Someone who has GAD will WORRY

W Women. GAD is twice as common in females as males

O Obsessions. This isn’t OCD but it is common to obsessively worry

R Restricitve. GAD causes problems in functioning normally

R Restlessness. A common symptom along with other physical symptoms

Y Yawning. Insomnia and feeling tired.

Question 3

How long do the symptoms must last for to diagnose General Anxiety Disorder (GAD)?

Answer 3

symptoms must be present for at least 6 months

Question 4

How OCD differs from Anankastic Personality Disorder?

Answer 4

People with OCD develop a range of intrusive unwanted thoughts or images that they find distressing.

This is referred to a ego-dystonic (a thought/feeling that is unpleasant).

This differs from Anankastic Personality Disorder (APD) when the belief that the person has is in keeping with their feelings (ego-syntonic)

Example: OCD : “I have sexual thoughts about my mother which distress me”

APD : “All my books should be stored alphabetically and I am happy when they are”

Question 5

Difference between ego-dystonic and ego-syntonic

Answer 5

• Ego- dystonic → a thought, feeling that is unpleasant
• Ego - Synthonic → belief that the person has is in keeping with their feelings

Question 6

Features of OCD

Answer 6

• People with OCD develop a range of intrusive unwanted thoughts or images that they find distressing
• Obsessions (the repeated intrusive thoughts) are often attempted to be altered by the patient by engaging in compulsive behaviour e.g. the obsession is a preoccupation with dirt and infection, the compulsion becomes to repeatedly wash my hands

Question 7

Difference between Panic Attack vs Panic Disorder

Answer 7

• Panic attacks could occur as part of any anxiety disorder. Having a fear of dogs (Cynophobia) and then encountering an aggressive dog would most likely result in the person having a panic attack
• People with panic disorder do experience panic attacks … but they occur suddenly, out of the blue with no obvious trigger

Question 8

Features of Panic Disorder

Answer 8

• panic attacks occur suddenly, out of the blue with no obvious trigger
• during panic attack most people assume they are having a heart attack or some form of physical health problem
• There are lots of physical symptoms (chest pain/breathing difficulties/palpitations /tremor/sweating etc)

Question 9

Timeframe needed to diagnose Panic Disorder

Answer 9

To diagnose:

• the person will have had several panic attacks within a month – with relatively symptom free periods in between

Question 10

Types of experiences needed to diagnose PTSD

Answer 10

• PTSD is a severe disorder that causes extreme symptoms in the patient.
• The person will have experiences a major trauma.
• A diagnostic criteria is that the trauma is extreme and out of keeping with normal unpleasant human experiences – so failing an exam, having a relationship breakup are normal experiences – being raped or almost murdered are not.

Question 11

Features of PTSD

Answer 11

Following the trauma the person experiences:

• ‘reliving events’ such as flashbacks, nightmares and intrusive memories when they re-experience the trauma
• avoidance of situations that may trigger memories of the trauma

Question 12

Features of social anxiety

Answer 12

Social anxiety aka social phobia

• intense fear of being negatively evaluated by others or of being publicly embarrassed because of impulsive acts
• people are frightened of a range of social situations – for example a party or a group activity

*It is NOT a fear of being outside (agoraphobia)

• as a result of the anxiety provoked by social situations, the patient (not unsurprisingly) avoids social contact → this can lead to the person becoming reclusive and isolated

Question 13

Name 10 most common phobias

Answer 13

Question 14

Features of phobias

Answer 14

• irrational anxieties → specific to situations or objects/animals
• a person with a phobia only becomes anxious when they are exposed to the situation that causes them anxiety OR faced with a situation where they may be exposed to their anxieties
• most people are mildly phobic about certain things (spiders/insects) but a true phobia is an overwhelming anxiety that results in panic attacks and causes the person to avoid any possible contact with the source of the phobia

Question 15

Different areas of brain responsible for OCD

Answer 15

Question 16

SSRIs use for different anxiety disorders

(name particular SSRI)

Answer 16

Citalopram: Panic disorder

Sertraline : OCD

Fluoxetine : OCD (high dose)

Paroxetine : OCD, Panic, GAD, Phobias

Question 17

Clomipramine

• class
• use in anxiety disorders

Answer 17

Clomipramine

Class: Tricyclic

• OCD
• Phobias

Question 18

What Anxiolytics can we use (name 3 drugs)

Answer 18

• Buspirone
• Diazepam*
• Clonazepam*

*be very wary of using benzodiazepines for anxiety problems as they are highly addictive

Question 19

What types of Anxiety Disorders is CBT good for?

Answer 19

• OCD
• PTSD
• GAD

Question 20

How does CBT for anxiety disorders look like?

Answer 20

CBT is typically a short-term, skills-focused treatment aimed at altering maladaptive emotional responses by changing the patient’s thoughts and behaviours

• Understanding the development and maintenance of anxiety disorders
• Identify automatic negative thoughts
• Identification of negative thoughts and techniques
• to challenge them
• Self-regulated relaxation skills

Question 21

What Eye Movement Desensitisation Reprogramming is used for?

Answer 21

PTSD

Question 22

Phases of Eye Movement Desensitisation Therapy

Answer 22

Question 23

What’s EMDR?

Answer 23

EMDR is a type of trauma-focused psychotherapy

• the original trauma is deliberately re-experienced in as much detail as possible, with the patient narrating or imagining every step in the sequence of events, along with any accompanying negative cognitions or bodily sensations
• simultaneously, they move their eyes from side-to-side or use another form of bilateral (left-right) stimulation- which is thought to aid memory processing- by firstly desensitising the patient to the distressing event, and then allowing them to reprocess the memory so associated cognitions become more adaptive, and allowing them to make sense of the traumatic experience

Question 24

What’s Graded Exposure used for?

Answer 24

Phobias

Question 25

Phases of Graded Exposure therapy

Answer 25

For phobias

Question 26

What’s Neurosurgery for Mental Disorder used for?

Answer 26

For treatment-resistant OCD

Only about 4 cases per year are performed in the UK.

Question 27

(3) Techniques for Neurosurgery for Mental Disorder (NMD)

Answer 27

There are three NMD techniques currently used in the UK for treatment resistant OCD:

Sub caudate tractotomy:

Two probes are inserted via small holes made in your forehead, and guided to a part of your brain called the caudate nucleus. A very small part of this target area is then destroyed using an electrical current.

Bilateral anterior capsulotomy:

Two probes are passed via incisions on each side of the midline on the top of your head into a part of the brain called the internal capsule, which is close to the caudate nucleus. A very small part of this target area is then destroyed using an electrical current.

Bilateral anterior cingulotomy:

This procedure involves a similar technique to bilateral anterior

capsulotomy, but targets the anterior cingulate gyrus.

Question 28

Key features of all anxiety disorders (short revision)

Answer 28