Anxiety, Panics, Phobias & OCD

Question 1

What are the physical symptoms of anxiety?

Answer 1

• sweating, hot flushes/cold chills
• trembling/shaking
• muscle tension/aches & pains
• Dry mouth
• Difficulty breathing
• palpitations
• chest pain
• nausea/abd distress

Question 2

What are the cognitive symptoms of anxiety

Answer 2

• Fear of losing control
• feeling keyed up/on edge
• Derealisation (feeling that objects are unreal)
• Depersonalisation (not really here)
• hypervigilance
• racing thoughts

Question 3

What are the behavioural symptoms of anxiety?

Answer 3

• Avoiding certain situations
• Exaggerated response to surprising events
• Sleeping difficulty
• Alcohol/drug abuse
• restlessness
• irritability
• checking behaviours

Question 4

What does the amygdala do?

Answer 4

assesses whether sensory material via the thalamus requires a stress/fear response. This is modified via cortically processed signal which occurs later (act first, think later)

Question 5

What hormones are responsible for stress response?

Answer 5

catecholamines and cortisol

Question 6

What is anxiety disorder?

Answer 6

extreme feeling of anxiousness than normal and in situations that are not normally anxiety provoking

Question 7

What is generalised anxiety disorder (GAD)?

Answer 7

generalised and persistent anxiety in any particular environmental circumstances. It is not due to substance misuse/other medical coditions (hyperthyroidism)

Question 8

What are the criteria for GAD?

Answer 8

-needs to be severe enough to last more than 6 days, uncontrollable and cause function impairment/distress

Question 9

What is GAD associated with?

Answer 9

• restlessness
• easily fatigued
• difficulty concentrating
• irritability
• muscle tension
• sleep disturbance

Question 10

What is typical age of onset of GAD

Answer 10

20-40 years

Question 11

What is the course of the disorder?

Answer 11

chronic & fluctuating

Question 12

Is GAD associated with other psychiatric disorders?

Answer 12

Yes 90% are. Eg, depression, substance abuse/other anxiety disorders

Question 13

What is the treatment of GAD?

Answer 13

• CBT
• SSRI/SNRI
• Pregabalin
• Benzodiazepines (short term only aka 1 month)

Question 14

What is panic disorder?

Answer 14

Recurrent attacks of severe anxiety (panics) which are not restricted to any particular situation (unpredictable)

Question 15

What are the symptoms of panic disorder?

Answer 15

sudden onset of:

• palpitations
• chest pain
• choking sensation
• depersonalisation/derealisation
• secondary fear of dying/ losing control/going mad

Question 16

What may panic disorder be associated with?

Answer 16

• Agoraphobia (fear or avoidance of places that may trigger anxiety/panic attacks)
• depression
• substance misuse

Question 17

What other criteria define panic disorder?

Answer 17

-not associated with substance abuse/ other medical condition

Question 18

What is the typical age of onset

Answer 18

mid 30’s

Question 19

What is the biology of panic attacks?

Answer 19

• can be triggered by infusions of lactate (by-product of muscular activity)/ rebreathing air (inc. CO2)
• PET scan: inc metabolism of anterior pole of temporal lobe (parahippocampal gyrus)

Question 20

What is the treatment for panic disorder

Answer 20

• CBT
• SSRI/SNRI
• Tricyclics
• Benzodiazepines (short course)

Question 21

What are the 3 types of phobias?

Answer 21

• Agoraphobia
• social phobia
• specific phobia
• *(irrational fear)

Question 22

what is agoraphobia

Answer 22

Avoidance of potential phobic situations. Some people with agoraphobia experience little anxiety because they are able to avoid potential phobic situations

Question 23

What are specific phobias?

Answer 23

-Marked/persistent fear that is excessive or unreasonable (person recognises their fear as unreasonable)

Question 24

What are the treatments for specific phobias

Answer 24

behavioural therapy (exposure)

• graded exposure/systematic desensitisation
• CBT (if necessary)
• SSRI/SNRI if required

Question 25

What is social phobia?

Answer 25

Persistent fear of social/performance situations in which exposure to unfamiliar people occurs (more than just being shy). Occurs in relatively small social settings

Question 26

What are the common anxiety symptoms?

Answer 26

• blushing/shaking
• fear of vomiting
• urgency/fear of micturation/defaecation

Question 27

What is the biology of social phobia?

Answer 27

Increased bilateral activation of the amygdala and rCBF (regional cerebral blood flow). Normalises with
treatment

Question 28

What is the treatment for social phobia?

Answer 28

• CBT
• SSRI/SNRI
• Benzodiazepines (short term)

Question 29

What is OCD?

Answer 29

Obsessional symptoms/compulsive present for at least 2 weeks and a source of distress/interference with
activities

Question 30

What is the criteria for OCD?

Answer 30

• obsessions must be individual’s own thoughts
• resistance must be present
• unpleasant rituals
• obsession must be repetitive

Question 31

what co-morbidity may be present with OCD?

Answer 31

• schizophrenia
• tourettes/other tic disorders
• eating disorder
• trichtillomania (pulling out hair)

Question 32

What is the treatment for OCD?

Answer 32

• CBT (including response prevention)
• SSRI
• Clomipramine (TCA)

Question 33

How do benzodiazepines affect anxiety?

Answer 33

It enhances the effect of GABA receptors(GABA-A: inhibitory ionotropic receptor). A benzodiazepine binding site is present on the GABA-A receptor.

Question 34

What do agonists at the BZD site produce?

Answer 34

Relaxation and anticonvulsant effects.

Question 35

What are the benefits of benzodiazepines?

Answer 35

• rapid action
• well tolerated
• efficacious

Question 36

What are the problems with benzodiazepines?

Answer 36

• sedation & psychomotor impairment
• withdrawal
• dependency & abuse
• alcohol interaction
• can worsen co-morbid depression