Anxiety, Panic Disorders and Phobias

Question 1

Describe the physical symptoms of anxiety

Answer 1

Sweating, hot flushes or cold chills
Trembling/shaking
Muscle tension or aches and pains
Numbness or tingling
Feeling dizzy/lightheaded
Dry mouth
Feeling of choking
Lump in throat/difficulty swallowing
Difficulty breathing
Palpitations/tachycardia
Chest pain
Nausea/abdominal distress

Question 2

what are the cognitive symptoms of anxiety

Answer 2

fear of losing control, going crazy or dying
feeling on edge 
difficulty concentrating
Derealization or depersonalisation
Hypervigelance
Racing thoughts
meta worry
health anxiety
Preference for order and routine
beliefs about the importance of worry

Question 3

Which part of the brain initiated our stress response?

Answer 3

Amygdala
Acts as the emotional filter of the brain
Assesses wheter semsory material (via the thalamus) is a danger and requires a stress/fear response

Question 4

Which hormones are release in response to stress

Answer 4

cortisol

catecholamines

Question 5

what is the difference between normal and pathological anxiety

Answer 5

Normal - anxiety occurs in situations which are generally deemed to be anxiety provoking eg before and exam
Pathological- more extreme than normal and not as a response to anxiety provoking stimuli
-ot causes significant distress and impairment of function

Pathological = Inappropriate situation + debilitating to function

Question 6

What are the main types of anxiety disorder

Answer 6

Generalised anxiety disorder (persistant)
Panic disorder (episodic, not in response to stimuli)
Phobias (episodic, in response to stimuli) eg agoraphobia, social phobia

Question 7

What is generalised anxiety disorder

Answer 7

Persistent anxiety not restricted to or predominating in any particular environmental circumstances.
Not due to substance misuse or other medical condition

Question 8

What medical conditions could present with generalised anxiety

Answer 8

Hyperthyroid
Hypoglycaemia
Phaechromocytoma

Question 9

What is the criteria for a diagnosis of gad

Answer 9

Needs to be long lasting - most days for 6 months
Not controllable
causes significant impairment

Question 10

What symptoms are typically associated with GAD

Answer 10

Restlessness
Easily fatigues
Difficulty concentrating
Irritable
Muscle tension
sleep disturbance

Question 11

What are the main clinical features of GAD

Answer 11

Onset usualy aged 20-50
More common in femailes
Chronic, fluctuating course
Seen often in primary care
Associated with disability, medically unexplained symptoms, overutilization of healthcare services
commonly co morbid with other psychiatric disorders

Question 12

What is panic disorder

Answer 12

Recurrent attacks of sever anxiety which are not caused by specific stimuli ie they are unpredictable
Can occur with agoraphobia
Not better explained by another mental disorder eg depression
not related to substances or physical illness

Question 13

What are the most common symptoms of a panic attack

Answer 13

Palpitations
chest pain
difficulty breathing
dizziness 
feelings of unreality
secondary fear of dying/going mad

Question 14

What are the clinical features of panic disorder

Answer 14

50-65 percent have agoraphobia
onset late adolescence- mid 30s
Chronic waxing and waning course
Comorbid with other mental disorders

Question 15

What can ‘trigger’ panic attacks

Answer 15

In susceptible individuals and their relatives

• infusions of lactate
• rebreathing CO2

Question 16

What is seen on a PET scan of someone with panic disorder

Answer 16

Increased metabolism in anterior pole of temporal lobe- parahippocampal gyrus

Question 17

What are the three types of phobias

Answer 17

Agoraphobia
Social phobia
Specific phobia (eg claustrophobia)

Question 18

What is a phobia?

Answer 18

Intense fear is triggered by a stimulus or group of stimuli.
Predictable and normally cause no concern to others eg social phobia
Patient knows it is irrational
But cannot control it
Avoidance and anticipatory anxiety ensues

Question 19

When is the usual onset of a phobia

Answer 19

Early - morst present by age 20 - particularly in social or specific phobias

Question 20

What is agoraphobia

Answer 20

Fear of leaving home, entering crowded public places, travelling alone on public transport. Avoidant behaviour is prominent. Usually not anxious as phobia is avoided.

Question 21

what is a specific phobia

Answer 21

a marked persistent fear that is excessive or unreasonably, cued by the presence or anticipation of a specific object or situation
exposure to the phobia procokes an anxiety response like a panic attack
person recognises the fear is inreasonable
function can be impaired due to avoidance, anticipatory anxiety or distress in feared situations

Question 22

What is social phobia

Answer 22

a persistnat fear of one or more social or performance situation is which the person is exposed to unfamiliar people or to possible scrutiny by others
fear of embarrassment
often in small social settings
exposure provokes anxiety/panic attack