Anxiety Disorders - Specific Treatments

Question 1

What is the first step in the treatment of GAD?

Answer 1

Self help and psychoeducation

Question 2

If self help and psychoeducation does not help GAD, what is the next line treatment?

Answer 2

High intensity psychological therapy (CBT) OR drug treatment (usually SSRI)

Question 3

Can short-term benzodiazepines be used in the treatment of GAD?

Answer 3

Yes

Question 4

Apart from SSRIs, what are some other drugs that could be considered in the treatment of GAD?

Answer 4

SNRIs and pregabalin

Question 5

It can take up to how long to assess efficacy of treatment of GAD? Usually, if there has been no response by when, a response is unlikely?

Answer 5

12 weeks / 4 weeks

Question 6

Treatment for GAD should be continued for how long?

Answer 6

18 months

Question 7

What is the first line treatment for panic disorder?

Answer 7

Self help

Question 8

If self help doesn’t work for panic disorder, what is the next line treatment?

Answer 8

CBT

Question 9

If panic disorder is longstanding, or CBT hasn’t worked, what is the treatment?

Answer 9

SSRI

Question 10

Can short-term benzodiazepines be used in the treatment of panic disorder?

Answer 10

No

Question 11

Why should benzodiazepines and sedating anti-histamines not be used in the treatment of panic disorder?

Answer 11

Because they are associated with poorer long term outcomes

Question 12

Apart from benzodiazepines, what are some other medications which should be avoided in panic disorder?

Answer 12

Propranolol, buspirone and bupropion

Question 13

What is a last resort medication that can be used for panic disorder?

Answer 13

Tricyclics

Question 14

Treatment for panic disorder should be continued for how long?

Answer 14

6 months

Question 15

What is the first line treatment for OCD?

Answer 15

Low intensity psychological therapy with CBT or exposure therapy

Question 16

If low intensity psychological therapy does not work for OCD, what is the next step in treatment?

Answer 16

High intensity psychological therapy OR SSRI

Question 17

Treatment for OCD should be continued for how long?

Answer 17

1 year

Question 18

If you are uncertain of the response to an SSRI for OCD, when can you increase the dose?

Answer 18

After 4-6 weeks

Question 19

What is a medication that is highly effective for OCD but is used second line due to side effects?

Answer 19

Clomipramine

Question 20

If PTSD is mild, and it has been < 4 weeks since the traumatic incident, what is the treatment?

Answer 20

Watchful waiting

Question 21

If a person has PTSD and it is within 3 months of the trauma, what are some treatment options?

Answer 21

Brief psychological intervention with trauma focussed CBT and hypnotic medication for sleep disturbance

Question 22

If a person has PTSD and it has been > 3 months since . the trauma, what are some treatment options?

Answer 22

Trauma focussed CBT or EMDR

Question 23

Is drug treatment useful for the treatment of PTSD?

Answer 23

There is limited evidence for this

Question 24

What is the first line treatment for social anxiety?

Answer 24

Individual CBT

Question 25

If individual CBT is not sufficient treatment for social anxiety, what can be done next?

Answer 25

Give an SSRI and review at 12 weeks, combine this with CBT if not sufficient

Question 26

If drug treatment is required for PTSD, what are some that can be used? How long should it be continued for?

Answer 26

Mirtazapine, paroxetine, amitriptyline, phenelzine / continue for 1 year if effective