Other Anxiety Disorders

Question 1

What are compulsions?

Answer 1

Senseless, repeated rituals
Used as a way to reduce the distress of an obsession
Often resisted, but if chronic, patients can give in to them

Question 2

What are obsessions?

Answer 2

Stereotyped, purposeless words, ideas or phrases that come into the mind
Perceived as intrusive, nonsensical and out of character
But still as originating from themselves

Question 3

What is the treatment for OCD?

Answer 3

CBT

Clomipramine/SSRIs

Question 4

What are phobic disorders?

Answer 4

Group of disorders where anxiety is experienced only/predominantly in certain well-defined situations which are not dangerous
As a result these situations are avoided or endured with dread
Need to cause marked distress/impair ability to function to be classed as a disorder

Question 5

What are the different types of phobic disorder?

Answer 5

Social phobias
Agoraphobia
Simple phobias e.g. arachnophobia
Free-floating fear of fear

Question 6

What is the treatment for phobic disorders?

Answer 6

Elicit the exact phobic stimulus
Distinguish from paranoia (features delusions)
For panic attacks - CBT +/- SSRIs/TCAs/pregabalin/clonazepam

Question 7

What is the difference between “acute stress reaction”, “adjustment disorder” and “PTSD”?

Answer 7

An acute stress reaction is a transient condition (hours to days) where there is immediate dissociation (daze) followed my mixed emotions like confusion, anger and anxiety as a reaction to a stressful event. Usually resolves without psychiatric intervention.
Adjustment disorder is when the reaction lasts up to a month.
PTSD is when this lasts for up to 6 months.
Symptoms may be delayed for years in some.

Question 8

When does PTSD develop?

Answer 8

After an exceptionally stressful/catastrophic/life-threatening event or situation

Question 9

What are the common symptoms of PTSD?

Answer 9

Re-experiencing (flashbacks/vivid nightmares)
Autonomic arousal - may precipitate anxiety or panic attacks
Avoidance (of things associated with the event)
Hypervigilance (increased startle reaction)
Sleep disturbance
Poor concentration
Denial/suppression of the memory of the traumatic event

Question 10

What are some of the comorbid conditions often seen with PTSD?

Answer 10

Depression
Emotional numbing
Drug and alcohol abuse
Anger

Question 11

How can a child with PTSD present?

Answer 11

Re-experiencing in the form of re-enacting the experience/repetitive play/frightening dreams without recognisable content

Question 12

What is the pathophysiology of PTSD?

Answer 12

MRI implicates the anterior cingulate area

Failure to inhibit amygdala action +/- decreased amygdala threshold to fearful stimuli

Question 13

What is the non-pharmacological treatment for PTSD?

Answer 13

CBT
EMDR
Hypnotherapy
Stress management

Question 14

When is pharmacological therapy for PTSD indicated?

Answer 14

As a second line to therapy
In combination with therapy
If the patient is too distressed for therapy

Question 15

What are the pharmacological treatments for PTSD?

Answer 15

SSRIs
TCAs
Mirtazapine
MAOIs
Atypical antipsychotics

Question 16

What are the poor prognostic factors for PTSD?

Answer 16

Maladaptive coping strategies like denial
More than just a single traumatic event
Secondary problems e.g. disability, disfigurement

Question 17

What are some of the preventative measures for PTSD?

Answer 17

Rehearse teamwork
Techniques for stress inoculation (by exposure)
Desensitisation
Tight-knit groups for combatants

Question 18

What is depersonalisation?

Answer 18

A unpleasant state of disturbed perception in which people/themselves/body parts are experienced as being changed, becoming unreal, remote or automatised.
There is insight into this, so is not psychosis.
May be primary or part of another neurosis.

Question 19

What does CNS imaging show in people with depersonalisation?

Answer 19

Functional abnormalities in the sensory cortex where visual, auditory and somatosensory data integrate.

Question 20

What is derealisation?

Answer 20

Psychosensory feelings of detachment or enstrangement from the surroundings. Objects appear altered; buildings may metamorphose in size and colour. The patient has insight.

Question 21

What are dissociative disorders?

Answer 21

They are mental disorders that involve experiencing a disconnection/lack of continuity between thoughts, memories, surroundings, actions and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life.

Question 22

What are the different types of dissociation?

Answer 22

Amnesia (commonest)
Depersonalisation
Derealisation
Dissociative identity disorder (multiple personalities)
Fugue - inability to recall one’s past +/- loss of identity or formation of a new identity

Question 23

What is the treatment for dissociative disorders?

Answer 23

Exploring life stresses

Behavioural therapy +/- antidepressants