L7 Anxiety disorders: clinical picture

Question 1

What are the symptoms of acute stress?

Answer 1

Feelings of being numb or dazed
Insomnia
Restlessness
Poor concentration
Autonomic arousal
Anger / anxiety / depression
Withdrawal

Question 2

Describe an acute stress reaction

Answer 2

Lasts hours to 3 days
Response to exceptionally stressful events
Initial daze
Mixed & usually changing picture
Individual vulnerability

Question 3

What is an adjustment disorder?

Answer 3

Wide range of emotional or behavioural symptoms
Stressor not necessarily life threatening
Out of proportion to stressor
Lasts up to 6 months

Question 4

What is PTSD?

Answer 4

Response to exceptionally threatening or catastrophic event
Experienced, witnessed event that involved actual or threatened death or serious injury or threat to physical integrity of self or others
Response involved intense fear, helplessness or horror

Question 5

What are the symptoms of PTSD?

Answer 5

Re-experiencing flashbacks / nightmares
Numbness / detachment
Avoidance
Hypervigilance / startle
Insomnia
Anxiety / depression

Question 6

Describe the course of PTSD

Answer 6

Usually immediate onset
Most recover within 1 year
Rape victims: 
-94% at 2 weeks
-65% at 1 month
-42% at 6 months

Question 7

What are the psychological symptoms of GAD?

Answer 7

Fearful anticipation
Irritability
Sensitivity to noise
Restlessness
Poor concentration
Worrying thoughts

Question 8

What are the physical symptoms of GAD?

Answer 8

Gastrointestinal
Repsiratory
Cardiovascular
Genitourinary
Neuromuscular

Question 9

What is the epidemiology of GAD?

Answer 9

Lifetime prevalence: 8.9%
Women > men
Estimated to be 3X higher in patients in primary care clinics

Question 10

Describe the attachment theory

Answer 10

Parents or other consistent caregivers serve important function in a child’s development
Provide protective & secure base from which the child can operate
Disruption leads to anxious apprehension & dependency
Severe disruption leads to withdrawal & depression

Question 11

What effect did it have if adults rated their parenting as more protecting and less caring?

Answer 11

Had higher trait anxiety scores

Met more criteria for GAD & panic disorder

Question 12

What are the psychic symptoms of panic?

Answer 12

Fear of losing control
Going mad
Fainting
Dying 
Derealisation
Depersonalisation

Question 13

What are the somatic symptoms of panic?

Answer 13

Palpitations
Tachycardia
Sweating
Trembling
Dyspnoea
Choking
Chest pain
Nausea
Urgency
Dizziness
Faintness
Paraesthesia

Question 14

What are some differential diagnoses for panic disorder?

Answer 14

Endocrine: hypoglycaemia, phaecromocytoma, carcinoid
Cardiovascular: arrhythmia
Respiratory: asthma
Drugs
Neurological: seizures, vestibular

Question 15

What is the epidemiology of panic?

Answer 15

Panic attacks: 7-9% of population
Panic disorder: 1.5-2.5% lifetime prevalence
Peak onset at 15-24 & 45-54

Question 16

What is the genetic predisposition of panic?

Answer 16

Increased risk in 1st degree relatives - 7 fold
Increased concordance in all but 1 monozygotic twin study
At least 50% environmental influences

Question 17

What are some environmental factors contributing to aetiology of panic?

Answer 17

Separation / loss
Relationship difficulties
New responsibilities
Traumatic early life events: early parental separation, traumatic childhood event, early sexual abuse

Question 18

Describe the biological model of panic

Answer 18

Panic attacks triggered in locus coeruleus. Increased firing associated with increased CO2
Noradrenergic agents stimulate attacks in sufferers
SSRIs are effective
GABA has a role
Cholecystokinin causes panic attacks in animals & pentagastrin causes attacks in panic disorder patients

Question 19

What is a specific phobia?

Answer 19

Inappropriate anxiety in presence of one or more particular objects or situations
Characterised by adding name of stimulus
Avoid jargon

Question 20

What are some subtypes of specific phobias?

Answer 20

Blood, injection, injury
Animals & insects
Aspects of natural environment e.g. heights
Situational e.g. flying
Other e.g. dental / medial procedures, choking

Question 21

What is the response during a blood-injection-injury?

Answer 21

Biphasic anxiety reaction
Initial short-lived sympathetic arousal
Followed by parasympathetic arousal
May result in vasovagal syncope
Subjective experience tends to disgust & repulsion rather than pure apprehension

Question 22

What is social phobia?

Answer 22

Inappropriate anxiety in situations where person is observed & situations where there is potential for criticism
Leads to avoidance of trigger situations

Question 23

What are the symptoms of social phobia?

Answer 23

Anticipatory anxiety
Feeling anxious
Blushing
Trembling
Relieved by alcohol

Question 24

What is OCD?

Answer 24

Obsessional thoughts / images
Compulsions reduce anxiety
Cleaning / checking
Precision

Question 25

What is the epidemiology of OCD?

Answer 25

Men & women equally
During adolescence it is more common in boys
Mean onset age is 20 years
Prevalence: 2-3%

Question 26

What does OCD increase the lifetime risk of?

Answer 26

Alcohol disorders
Social phobia
Specific phobia
Panic disorder
Eating disorder
Schizophrenia
Tic disorders