Anxiety Disorders

Question 1

What are the physical symptoms of anxiety?

Answer 1

Sweating, hot flushes 
Trembling, shaking
Muscle tension, aches + pains
Numbness or tingling
Dizziness, unsteadiness, fainting
Dry mouth, feeling of choking/lump in throat
Difficulty breathing
Palpitations, tachycardia
Chest pain
Nausea, abdominal churning

Question 2

What are the cognitive symptoms of anxiety?

Answer 2

Fear of losing control
Feeling tense/on edge
Difficulty concentrating, mind going blank
Derealization
Depersonalization
Racing thoughts
Worry about everything
Preference for order and routine

Question 3

What are the behavioural symptoms of anxiety?

Answer 3

Avoidance
Exaggerated response
Difficulty sleeping
Excessive alcohol/drugs
Restlessness
Irritability
Seeking reassurance

Question 4

What are the features of generalised anxiety disorder (GAD)?

Answer 4

Generalised + persistent anxiety
Not restricted to particular trigger
Long lasting –> most days for > 6 months
Not controllable
Causing significant distress/impairment in function

Question 5

What in the treatment for GAD?

Answer 5

CBT
SSRIs/SNRIs
Pregabalin
Benzodiazepines short term only

Question 6

What are the features of panic disorder?

Answer 6

Recurrent attacks of severe anxiety
Not restricted to particular situation –> unpredictable
Not due to drug or medical conditions e.g. caffeine, hyperthyroidism
Often concurrent agoraphobia

Question 7

What is the treatment for panic disorder?

Answer 7

CBT
SSRIs/SNRIs/TCAs
Benzodiazepines short term only

Question 8

What are the three types of phobias?

Answer 8

Agoraphobia
Social phobia
Specific phobia

Question 9

What is agoraphobia?

Answer 9

Fear of leaving home, crowds, public spaces etc

Question 10

What are the features of a specific phobia?

Answer 10

Excessive or unreasonable fear of a specific object/situation
–> immediate anxiety response

Question 11

What is the treatment for specific phobias?

Answer 11

Behaviour therapy first line:
- graded exposure/desensitisation
Add CBT if necessary
SSRI/SNRI if required

Question 12

What are the features of social phobia/social anxiety disorder?

Answer 12

Persistent fear of social situations or performance

Fear of embarrassing/humiliating self

Question 13

What is the management of social phobia?

Answer 13

CBT
SSRIs/SNRIs
Benzodiazepines short term

Question 14

What are the features of OCD?

Answer 14

Recurrent obsessional thoughts:
- recognised as own thoughts but unpleasant + resisted
+/- Compulsive acts:
- rituals/stereotyped, not enjoyable or functional, recognised as pointless

–> present most days for at least 2 weeks AND must be a source of distress + interference

Question 15

How is OCD treated?

Answer 15

CBT –> including response prevention

SSRIs/Clomipramine

Question 16

What are the pharmacological effects of benzodiazepines?

Answer 16

Reduce anxiety and aggression
Hypnosis/sedation
Muscle relaxation
Anticonvulsant effect
Anterograde amnesia

Question 17

What is the mechanism of action of benzodiazepines?

Answer 17

Increase GABA mediated inhibition

Question 18

What is GABA?

Answer 18

Main inhibitory transmitter in the brain

Question 19

What are the main problems associated with benzos?

Answer 19

Cause tolerance and dependence
Paradoxical aggression
Anterograde amnesia + impaired coordination

Question 20

What are the features of benzodiazepine withdrawal?

Answer 20

Confusion
Insomnia
Subjective anxiety
Loss of appetite
Tremor
Sweating
Tinnitus
Perceptual disturbance
Toxic psychosis
Convulsions

Question 21

How should benzodiazepines be safely withdrawn?

Answer 21

1. transfer patient to equivalent dose of diazepam/chlordiazepoxide, preferably taken at night
2. Reduce dose every 2-3 weeks in steps of 2 or 2.5mg; if withdrawal symptoms occur maintain this dose until they improve
3. continue to reduce dose slowly in small steps
4. stop completely (may take up to a year)