treatment of anxiety disorders

Question 1

Anxiety disorders

Answer 1

Severe, excessive, persistent anxiety and irrational fears that impairs functioning with everyday living

Question 2

GAD

Answer 2

Excessive anxiety and worries > 6m

Associated with ≥3 symptoms that can cause functional impairment

Question 3

Panic Attack

Answer 3

Intense fear/discomfort with ≥4 symptoms abruptly developed and peaks in 10min, lasts no more than 20-30min

Question 4

Panic Disorder

Answer 4

≥1 recurrent unexpected panic attacks followed by ≥1m of persistent anticipatory anxiety

Question 5

Social anxiety disorder

Answer 5

Marked and persistent fear of ≥1 social situations with scrutiny that is humiliating/embarrassing for > 6m that impairs functioning

Question 6

Obsessive compulsive disorder

Answer 6

Obsessional thoughts/impulses that causes anxiety and are intrusive and inappropriate, followed by compulsive behaviours to relieve that anxiety
Recognised to be product of his own mind

Question 7

PTSD

Answer 7

Exposure to trauma
Persistently re-experienced
Effortful avoidance
Negative alterations to cognitions and mood
Trauma-related alterations in arousal and reactivity
Persistence for ≥1m

Question 8

Pathology

Answer 8

Fear circuit regulated by amygdala 
Worry circuit regulated by cortico-striatal-thalamic-cortical loop
5HT deficits 
GABA deficits 
Medical conditions 
Drug-induced

Question 9

Medical conditions associated with anxiety

Answer 9

CV: HF
Endocrine: Hyperthyroidism
Neurologic: Dementia, delirium
Pulmonary: Asthma, COPD

Question 10

Drug-induced anxiety

Answer 10

Sympathomimetics
Stimulants 
Theophylline, caffeine
Levothyroxine 
Corticosteroids 
Antidepressants 
Dopamine agonists
B-adrenergic agonists 
Drug withdrawal 
Drug intoxication

Question 11

Pharmacological treatments for GAD

Answer 11

SSRIs
Venlafaxine XR
Pregabalin

Question 12

Pharmacological treatment for Panic Disorder

Answer 12

SSRIs

TCAs

Question 13

Pharmacological treatment for OCD

Answer 13

SSRIs

Clomipramine

Question 14

Pharmacological treatment for SAD and PTSD

Answer 14

SSRIs

Question 15

Adjunctive Pharmacological therapy

Answer 15

Benzodiazepines for physical symptoms; for short term PRN treatment

Question 16

Approach to dosing

Answer 16

Low starting dose
- jitteriness in first 1-2w 
- benzodiazepine as adjunct 
Maintenance dose may be high 
Full response generally in 3m

Question 17

DDI

Answer 17

Alcohol
Other CNS depressants
Anticholinergic agents
MAOIs and SSRI/TCAs combination