Anxiety - GAD, Panics, Phobias, OCD

Question 1

what acts as an emotional filter of the brain for assessing whether sensory material via the thalamus requires a stress or fear response?

Answer 1

amygdala

Question 2

what is generalised anxiety disorder?

Answer 2

anxiety that is generalised and persistent but not restricted to any particular environmental circumstances (ie free floating)

Question 3

the dominant symptoms of GAD are variable but what do they include?

Answer 3

persistent nervousness
trembling 
muscular tensions 
sweating 
lightheadedness
palpitations 
dizziness 
epigastric discomfort

Question 4

what 3 things make anxiety severe enough to be diagnosed with GAD?

Answer 4

long lasting (most days for at least 6 months)
not controllable 
causing significant distress / impairment in function

Question 5

what are the features of GAD?

Answer 5

restlessness
easily fatigued 
difficulty concentrating 
irritability 
muscle tension 
sleep disturbance

Question 6

what is the typical age of onset of GAD?

Answer 6

20-40

Question 7

what % of GAD patients are co-morbid with other psychiatric disorders (eg depression, substance abuse, other anxiety disorders)?

Answer 7

90%

Question 8

how is GAD treated?

Answer 8

CBT
SSRIs / SNRIs
pregabalin

Question 9

what can be used as short term treatment for GAD?

Answer 9

benzodiazepines (short term only)

Question 10

how does CBT work?

Answer 10

help individual identify thoughts, assumptions, misinterpretations and behaviours that reinforce and perpetuate the anxiety

Question 11

what is panic disorder?

Answer 11

recurrent attacks of severe anxiety (panic) which are not restricted to any particular situation or set or circumstances so are unpredictable

Question 12

panic disorder involves sudden onset of what symptoms?

Answer 12

palpitations 
chest pain 
choking sensations 
dizziness 
feelings of unreality (depersonalisation or derealisation) 

also secondary fear of dying, losing control or going mad

Question 13

panic disorder only occurs with agoraphobia - true or false?

Answer 13

false, can occur with or without

Question 14

what is the typical onset of panic disorder?

Answer 14

adolescence to mid-30s

Question 15

is panic disorder usually chronic?

Answer 15

yes

Question 16

what other disorders is panic disorder usually co-morbid with?

Answer 16

anxiety disorders
depression
drug and alcohol misuse

Question 17

panic attacks can be triggered in susceptible individuals by what biological process?

Answer 17

infusions of lactate (by-product of muscular activity)

or by re-breathing air (increased CO2)

Question 18

what does a PET scan show during a panic attack?

Answer 18

increased metabolism at anterior pole of temporal lobe - parahippocampal gyrus

Question 19

how can panic disorder be treated?

Answer 19

CBT

SSRIs / SNRIs / tricyclics

Question 20

what can be given short term for panic disorder?

Answer 20

benzodiazepines

Question 21

what are the three types of phobia?

Answer 21

agoraphobia
social phobia
specific phobia

Question 22

what is agoraphobia?

Answer 22

a fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds and public places, or travelling alone in trains, buses or planes

Question 23

agoraphobia is mostly a primary disorder - true or false?

Answer 23

false - may be a primary disorder but more often secondary to other pathology (eg panic disorder or depression)

Question 24

what is a specific phobia?

Answer 24

a marked and persistent fear that is excessive or unreasonable, cued by presence or anticipation of a specific object or situation

Question 25

how can specific phobias be treated?

Answer 25

behavioural therapy - exposure add in CBT if necessary SSRIs/SNRIs if required

Question 26

what is a social phobia / social anxiety disorder?

Answer 26

a persistent fear or one or more social or performance situations in which the person is exposed to unfamiliar people or possible to scrutiny by others

Question 27

what are the common anxiety symptoms in social phobia?

Answer 27

blushing or shaking fear of vomiting urgency or fear of micturition or defaecation

Question 28

what behavioural symptoms can social phobias be linked to?

Answer 28

poor school performance, school refusal, poor employment history react to novel situations by avoidance and withdrawal to safety

Question 29

can social phobia be identified in toddlers?

Answer 29

yes

Question 30

what processes go on within brain in social phobia?

Answer 30

increased bilateral activation of amygdala and increased rCBF to the amygdala this normalises on successful treatment

Question 31

how can social phobias be treated?

Answer 31

CBT SSRIs / SNRIs benzodiazepines (short term only)

Question 32

what is obsessive compulsive disorder?

Answer 32

recurrent obsessional thoughts and / or compulsive acts

Question 33

what are obsessive thoughts that occur in OCD?

Answer 33

ideas, images or impulses entering mind in stereotyped way | recognised as patients own thoughts but unpleasant, resisted and ego-dystonic

Question 34

what are examples of compulsive acts in OCD?

Answer 34

``` repeated rituals or stereotyped behaviours not enjoyable not functional recognised as pointless resistance may diminish over time ```

Question 35

what is diagnostic criteria for OCD?

Answer 35

obsessional symptoms or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and interference with activities

Question 36

what are common obsessions in OCD?

Answer 36

contamination from dirt, germs and viruses fear of harm (eg doors locked) excessive concern with order / symmetry obsessions with body or physical symptoms religious or blasphemous thoughts sexual thoughts urge to hoard possessions thoughts of violence or aggression (stabbing ones baby (lol)

Question 37

what are common compulsions in OCD?

Answer 37

``` checking (eg gas taps) cleaning, washing repeating acts mental compulsions (eg special words) ordering, symmetry or exactness hoarding / collecting counting ```

Question 38

what is the peak incidence age for males?

Answer 38

13-15

Question 39

what is the peak incidence age for females?

Answer 39

24-25

Question 40

what conditions do OCD have a significant co-morbidity with?

Answer 40

``` schizophrenia tourettes other tic disorders body dysmorphic disorder eating disorders trichtillomania ```

Question 41

how can OCD be treated?

Answer 41

CBT (including response prevention) SSRs / clomipramine

Question 42

what is the mechanism of benzodiazepines?

Answer 42

enhance effect of GABA (allosteric modulation)

Question 43

what is the role of GABA receptor?

Answer 43

GABA-A receptor is an inhibitory ionotropic receptor in presence of GABA the ion channel allows chloride ion influx membrane hyperpolarisation results in inhibitory postsynaptic potential

Question 44

what other two substances act on GABA-A receptor?

Answer 44

alcohol | barbiutrates

Question 45

name 5 problems encountered with benzodiazepines (particularly if used over 2 weeks)?

Answer 45

``` sedation and psychomotor impairment discontinuation / withdrawal problems dependency and abuse alcohol interaction can worsen co-morbid depression ```