(PM3B) Anxiety Disorders

Question 1

What is anxiety?

Answer 1

Prolonged or exaggerated response

To a real or imagined threat

Interferes with normal life

Cannot be attributed to any known neurological or organic dysfunction

Question 2

What percentage of the population have anxiety?

Answer 2

~15%

Question 3

Is long-term drug treatment for anxiety recommended?

Answer 3

No

Question 4

Which molecules in the blood mediate anxiety?

Answer 4

(1) Serotonin
(2) Noradrenaline
(3) Dopamine
(4) GABA

Question 5

What types of symptoms are associated with anxiety?

Answer 5

(1) Psychiatric

(2) Somatic

Question 6

What are some psychiatric symptoms of anxiety?

Answer 6

(1) Fear/ tension/ apprehension/ panic/ terror
(2) Hyper-arousal excitability + outbursts of hostility
(3) Insomnia
(4) Circling thoughts + lapses of memory
(5) Inability to concentrate + easily distracted

Question 7

What are some somatic symptoms of anxiety?

Answer 7

(1) Cardiovascular: palpitations/ increased BP/ tachycardia/ bradycardia/ flushing/ pallor
(2) Respiratory: rapid shallow breathing (hyperventilation)/ breathlessness (dyspnoea)
(3) GI: diarrhoea/ dyspepsia/ dysphagia/ churning stomach
(4) Musculoskeletal: agitation/ restlessness/ tremor/ muscle tension
(5) Metabolic: high blood glucose/ high glucocorticoids
(6) Excessive sweating/ urge to defecate or urinate

Question 8

What is dyspnoea?

Answer 8

Breathlessness

Question 9

What is hyperventilation?

Answer 9

Rapid shallow breathing

Question 10

What are some different types of anxiety disorder?

Answer 10

(1) Generalised anxiety disorder – GAD
(2) Obsessive Compulsive Disorder – OCD
(3) Post-traumatic Stress Disorder – PTSD
(4) Panic Disorder – PD
(5) Specific phobias
(6) Social phobias

Question 11

Describe the aetiology of anxiety?

Answer 11

No evidence of pathology of anxiety

OCD may be partially due to disturbed circuits

Some evidence for a genetic factor in some anxiety disorders – e.g. OCD

Question 12

What are the treatment aims for anxiety therapy?

Answer 12

(1) Discover + remove cause
(2) Assess severity of anxiety response
(3) Relieve distress
(4) Implement long-term measures to prevent recurrence

Question 13

What are some of the common psychological treatments for anxiety?

Answer 13

(1) Counselling
(2) Cognitive Behavioural Therapy (CBT)
(3) Exposure therapy
(4) Mindfulness + relaxation therapy

Question 14

What is the phramacological treatment for acute anxiety?

Answer 14

Benzodiazepines

e.g. lorazepam/ diazepam/ alprazolam

Fast-acting relief

Question 15

What is the usual first line treatment for most anxiety disorders?

Answer 15

(1) SSRIs – selective serotonin reuptake inhibitors

Recommended for long-term therapy

Question 16

When is pregabalin indicated for treatment?

Answer 16

(1) Epilepsy

(2) Generalised anxiety disorder – GAD

Question 17

When are tricyclic antidepressants indicated for treatment?

Answer 17

(1) Obsessions
(2) Phobias
e. g. clomipramine

Question 18

When is bus-irons indicated for treatment?

Answer 18

(1) Generalised anxiety disorder – GAD

(2) Acute anxiety

Question 19

When are beta-blockers indicated for treatment?

Answer 19

Treatment of somatic symptoms of anxiety disorder

(1) Social phobias
(2) Panic disorders

Question 20

How is generalised anxiety disorder (GAD) diagnosed?

Answer 20

(1) DSM-V
(2) ICD-10
(3) GAD-7

Question 21

What is the maximum total score using the GAD-7 assessment scale?

Answer 21

21

7x3 points for ‘nearly every day’

Question 22

Using the GAD-7 scale, what are the cut-off points for mild, moderate, and severe generalised anxiety disorder?

Answer 22

(1) Mild: 5 points
(2) Moderate: 10 points
(3) Severe: 15 points

Question 23

What are the assessment criteria for GAD-7?

Answer 23

(1) Feeling afraid, as if something awful might happen
(2) Becoming easily annoyed or irritable
(3) Being so restless that it is hard to sit still
(4) Trouble relaxing
(5) Worrying too much about different things
(6) Not being able to stop or control worrying
(7) Feeling nervous, anxious, or on edge

Question 24

What are the stepped escalations of therapy for GAD?

Answer 24

(1) All known and suspected presentations of GAD
(2) Diagnosed GAD that has not improved after education and active monitoring in primary care
(3) GAD with an inadequate response to step 2 interventions or marked functional impairment
(4) Complex treatment-refractory GAD and very marked functional impairment, such as self-neglect or a high risk of self-harm

Question 25

What is usually the most beneficial and effective treatment for GAD?

Answer 25

Cognitive Behavioural Therapy – CBT

Question 26

What is the first line pharmacological treatment for GAD?

Answer 26

SSRIs – e.g. sertraline

12 weeks then reassess

Question 27

What is a recommended alternative to SSRIs for first line pharmacological treatment of GAD?

Answer 27

SNRIs