Anxiety Disorders

Question 1

What are the different models of stress that can cause anxiety?

Answer 1

Psychological or transactional
Medicopsychological
Biomechanical

Question 2

What are the different ways of coping with stress?

Answer 2

Problem focussed

Emotion focussed

Question 3

What kind of symptoms come with anxiety?

Answer 3

Psychological arousal e.g. fear & irritability

Autonomic arousal (symp) e.g. dry mouth, dizzy, sweats, tight chest etc

Muscle tension –> Tremor & headache

Hyperventilation –> SOB & numbness

Sleep Disturbances

Question 4

Obviousbly anxiety disorders can be quite similar or overlap with MDD, schizophrenia, dementia etc. But what physical disorders can cause anxiety?

Answer 4

Thyrotoxicosis

Phaeochromocytoma

Hypoglycaemia

Asthma

Question 5

What’s the difference between Generalised Anxiety Disorder (GAD) & Phobic Anxiety Disorders

Answer 5

GAD is persistant in all situations

Phobic anxiety disorders arise in specific situations

Question 6

What are the most common anxiety disorders in order of prevalence?

Answer 6

GAD - 4.4% 1yr prevalence
OCD - 2% 1yr prevalence
PTSD - 1-4% 1yr prevalence

Question 7

GAD can give you any of the symptoms described earlier. But what extra “symptoms” can come with Phobic anxiety disorders?

Answer 7

Anticipatory anxiety
This is where symptoms arise with a perceived threat of the feared situation arising

Phobic Avoidance - of those circumstances

Question 8

What triggers GAD?

Answer 8

A stressor acting on a person who is already predisposed by genetic & environmental factors

Question 9

How do we manage a case of GAD?

Answer 9

Counselling - Planning, education & advice re caffine, exercise etc

Relaxation training

Medication - Antidepressants (SSRI/TCA) or sedatives

CBT

Question 10

What are the subtypes of phobic anxiety disorders?

Answer 10

Specific phobias e.g. uncircumcisedpenisphobia

Social Phobia

Agoraphobia

Question 11

Define social vs agoraphobia?

Answer 11

Social - Anxiety in a situation where they feel observed or at risk of criticism e.g. public speaking

Agoraphobia is a fear of being unsafe/trapped/unable to escape e.g. in open spaces, crowds, restaurants etc

Question 12

What symptoms of anxiety predominate in social phobia?

Answer 12

Blushing & tremor, but any anxiety symptoms can arise

Question 13

How do we manage someone with Social Phobia?

Answer 13

CBT
Education & Advice
SSRIs

Question 14

How does gender affect your risk of anxiety disorders?

Answer 14

GAD - F predominates

OCD is equal

PTSD - F predominates (prevalence also varies based on population exposure to disaster & culture)

Question 15

OCD is a mixture of obsessional thoughts and compulsive repetitive acts. Describe the obsessive thoughts of someone with OCD?

Answer 15

They are not willed
Oft unpleasant or distressing
Recognised as their own thought (i.e. not psychotic)

The anxiety symptoms arise from the distressing nature or resistance to the thoughts

Question 16

Describe the compulsive acts of someone with OCD

Answer 16

Repetitive
Not enjoyable or helpful for the individual
Viewed as either pointless or as preventing harm in some unrealistic way

Resistance/inability to perform the actions creates anxiety symptoms

Question 17

How is OCD managed?

Answer 17

Education (include family/partner)

Seratonergic drugs e.g. SSRI or TCA

CBT

Psychosurgery

Question 18

Define PTSD?

Answer 18

Delayed or protracted reaction to a stressor of exceptional severity

Meaning its so bad it would upset/stress anyone

Question 19

What kind of events can trigger ptsd?

Answer 19

combat
Disasters
Rape/assault
Torture
Etc

Question 20

What are the major features of PTSD?

Answer 20

1) Hyperarousal - persistant anxiety, irritability, insomnia & poor conc
2) Re-experience phenomena - flashbacks or nightmares
3) Avoidance of reminders

Question 21

What risk factors predispose you to PTSD?

Answer 21

• Mood disorders
• Previous trauma (Esp childhood)
• Low social support
• Female
• Genetics
• Life threatening stressor
• Greater exposure to stressor

Question 22

What factors can protect against PTSD? aka protective factors!!

Answer 22

Higher educational/social group

Good paternal relationship

Question 23

What do we do to prevent PTSD?

Answer 23

Screen disaster survivors at 1 month

IF they have mild symptoms we review them in another month

If they’re more severe we send straight to CBT

Question 24

How do we treat PTSD?

Answer 24

CBT
EMDR (Eye movement desensitization & reprocessing)
SSRIs/TCAs