wamss notes anxiety disorders

Question 1

panic attack criteria

Answer 1

Abrupt surge of intense fear or discomfort that reaches peak within minutes with 4 or more of the following Sx:
- Palpitations, pounding heart, ↑ HR
- Sweating
- Trembling, shaking
- Sensation of SOB
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Dizzy, unsteady, lightheaded, faint
- Chills or heat sensations
- Paraesthesia
- Derealisation or depersonalisation
- Fear of losing control or going crazy
- Fear of dying

Question 2

generalised anxiety disorder

Answer 2

Excessive worry & feelings of apprehension about everyday events with Sx of muscle & psychic tension causing significant clinical distress/impairment

Question 3

epidemiology of generalised anxiety disorder

Answer 3

3%

Question 4

classification of generalised anxiety disorder

Answer 4

Excessive & Anxiety and Worry occurring more days than not for at least 6 months about a
number of events or activities
Pt finds it difficult to control the worry
Associated with 3 or more of the following:
- Worry
- Anxiety
- Tension in Muscles
- Concentration difficulty or mind going blank
- Hyperarousal (irritability)
- Energy loss
- Restlessness
- Sleep Disturbances

Question 5

pathophysiology of generalised anxiety disorder

Answer 5

Hyper-responsive amygdala to anxiety ques
Multiple NTs: NA, Serotonin, Dopamine, GABA

Question 6

risk factors of generalised anxiety disorder

Answer 6

• Trauma or stress (parental death, war, family dysfunction)
• Childhood stress
• Excessive caffeine use or stimulant use
• Prolonged benzodiazepine use can worsen

Question 7

screening for generalised anxiety disorder

Answer 7

In the last 4 weeks…
About how often did you feel nervous?
About how often did you feel so nervous that nothing could calm you down?
How often did you feel restless of fidgety?
How often did you feel so restless you could sit still?

Question 8

DDx of generalised anxiety disorder

Answer 8

• Other anxiety disorders or mental disorders
• Substance use
• Arrhythmias
• Hyperthyroidism
• Asthma
• Pheochromocytoma

Question 9

treatment of generalised anxiety disorder

Answer 9

Symptomatic Management
- B-blockers (atenolol)
First Line:
- SSRI
- SNRI venlafaxine & duloxetine
Second Line:
- TCA
- Buspirone
Third Line:
- Long term benzodiazepines

Question 10

non-pharmacological management of generalised anxiety disorder

Answer 10

CBT, relaxation techniques, contingency planning, cognitive methods, psychotherapy

Question 11

short term management of generalised anxiety disorder

Answer 11

Benzodiazepines – diazepam
Tx for up to 2 weeks followed by gradual reduction in dose to 0 within 6 weeks - Lorazepam

Question 12

doses of generalised anxiety medication

Answer 12

Question 13

prognosis of generalised anxiety disorder

Answer 13

Full recovery poor
Remission rates low -30% 3yrs
70% residual Sx 6yr

Question 14

social anxiety disorder

Answer 14

Marked fear or anxiety about social situations in which the pt is being exposed to possible scrutiny by others, >
6months
Pt fears they will act in a way or show anxiety Sx that will be negatively evaluated
Social situations almost always provoke fear or anxiety
Social situations are avoided

Question 15

specific phobia

Answer 15

Marked fear or anxiety about a specific object or situation
Almost always provokes fear or anxiety
Is actively avoided
More than 6/12
Causes significant clinical distress or impairment in functioning

Question 16

panic disorder

Answer 16

Recurrent unexplained Panic Attacks in which the onset is not associated with a situational trigger
Classification the same a Panic Attack

Question 17

separation anxiety disorder

Answer 17

Developmentally inappropriate fear or anxiety concerning separation from those to whom the individual is
attached

Question 18

selective mutism

Answer 18

Constant failure to speak in situations where there is an expectation for speaking despite speaking in other
situations (school)
Not attributed to a lack of knowledge or comfort with the language

Question 19

agoraphobia

Answer 19

Fear or anxiety about 2 or more of:
- Using public transport
- Being in open spaces
- Being in closed places
- Standing in line or being in a crowd
- Being outside the home alone
Pt fears or avoids these situations due because escape may be difficult in the event of developing panic like Sx
Fear & anxiety is out of proportion to the actual danger

Question 20

anxiety disorders due to another medical condition

Answer 20

• Pheochromocytoma
• Diabetes
• Temporal lobe epilepsy
• Hyperthyroidism
• Carcinoid
• Alcohol Withdrawal
• Arrhythmias