MH

Question 1

What are the diagnostic criteria for GAD?

Answer 1

1) unrealistic and intrusive fears, worries about the future/life circumstances
2) occurring for >6 months
with >3 of:
muscle tension leading to irritability, leading to poor sleep, leading to fatigue, leading to being on edge or keyed up, leading to difficulty concentrating or mind going blank

Question 2

What are your differentials for GAD?

Answer 2

Hyperparathyroidism
normal anxiety
angina/palpitations
alcohol/cannabis withdrawal
caffeine intoxication
other drug intoxication, amphetamines
Depression

Question 3

What are the main treatment options for GAD?

Answer 3

Psycho education regarding diagnosis, reason for symptoms etc
psychotherapy/psychology - CBT
Pharmacotherapy - 1st line SSRi, 2nd line SNRI/TCA?
-access efficacy after 3 months and for at least 6 months
Improving coping skills
relaxation techniques
emergency/crisis plan
avoid aggravating substances such as caffeine

Question 4

What are the criteria for diagnosing a panic disorder?

Answer 4

Freq panic attacks followed by worry of >1 month of having another panic attack. Common with agoraphobia.
>4 more symptoms withing 10min
paraesthesias, SOB, CP, palpitations, feel like dying, tremor, sweating, lightheadedness eg.

Question 5

What are the possible organic causes of panic disorders that must be excluded?

Answer 5

Hyperparathyroidism
Hypoglycaemia
Phaeochromocytoma

Question 6

What is the management of panic disorders?

Answer 6

Psychoeducation about disorder
Relaxation techniques, timed breathing, progressive muscle relaxation
CBT to identify, evaluate and change negative thoughts
antidepressants at half starting dose
Avoid benzos

Question 7

What is Agoraphobia?

Answer 7

Anxiety condition where people avoid open or public spaces out of fear of being unable to escape as they may faint or have a panic attack and cause themselves more embarraessment

Question 8

What are the treatment options for a social phobia?

Answer 8

Propanolol 10-40mg 30min before the event

Psychotherapy, relaxation, graded exposure therapy

Question 9

What is an acute stress reaction?

Answer 9

This is when anxiety symptoms last for >3 days in response to trauma which occurred within 4 weeks. Symptoms of anxiety, hypervigilence and depression are common.
Psychotherapy, debriefing, relaxation and rarely pharmacotherapy are needed.

Question 10

What are the components that lead to a diagnosis of PTSD?

Answer 10

> 1 month after exposure
-hyperarousal phenomena such as exaggerated startle
-Persistant low mood
-Intrusive features
-avoidance of events symbolising or resembling trauma
can be acute <3/12, or chronic >6/12

Question 11

What is adjustment disorder?

Answer 11

> 3/12 but <6/12 anxiety and depressive features in excess of the what is normally expected towards a psychological stressor