Anxiety Disorders Overview

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What characterizes anxiety as a disorder?

A temporary feeling of unease

A type of psychological stress that is short-lived

A prolonged or exaggerated response to a real or imagined threat (correct)

A symptom related to physical illness

What is the lifetime prevalence rate of anxiety disorders?

10%

15% (correct)

20%

Which of the following is NOT a symptom typically associated with anxiety disorders?

Somatic symptoms

Sadness

Euphoria (correct)

Sleep disturbance

What is a critical consideration for healthcare professionals when treating anxiety disorders?

The potential side effects of treatments Signup and view all the answers

Which mediators are involved in the pathophysiology of anxiety in the central nervous system?

Serotonin, noradrenaline, dopamine, and GABA Signup and view all the answers

What type of long-term treatment is generally not recommended for anxiety disorders?

Drug treatment Signup and view all the answers

When does anxiety become considered problematic?

When it interferes with normal life functioning Signup and view all the answers

What can anxiety be triggered by?

Imagined threats or stress reactions Signup and view all the answers

Which of the following is a physiological symptom of anxiety?

Elevated blood pressure Signup and view all the answers

What is a common psychological approach to treating anxiety disorders?

Exposure therapy Signup and view all the answers

Which disorder is characterized by persistent feelings of apprehension and tension?

Generalized anxiety disorder (GAD) Signup and view all the answers

What is one aim of treatment for anxiety disorders?

To assess the severity of the anxiety response Signup and view all the answers

Which type of phobia specifically relates to social situations?

Social phobia Signup and view all the answers

What might potentially contribute to the aetiology of anxiety disorders?

Genetic and environmental factors Signup and view all the answers

Which of the following is NOT a common physiological symptom of anxiety?

Euphoria Signup and view all the answers

What is the primary treatment to consider before pharmacological interventions?

Psychotherapy Signup and view all the answers

What is the appropriate action if a patient opts for a high-intensity psychological intervention but shows no improvement?

Offer drug therapy as an alternative. Signup and view all the answers

Which defines the main aspect of anxiety disorders that should be understood and discussed by health care professionals?

Symptoms and specific types of anxiety. Signup and view all the answers

What should be added to the treatment if a patient shows only partial improvement with drug therapy?

Introduce a non-pharmacological intervention. Signup and view all the answers

Which of the following is NOT a consideration that healthcare professionals make when treating anxiety disorders?

Determining the patient's physical fitness level. Signup and view all the answers

What is a significant limitation of the treatments for anxiety that should be explained to patients?

Pharmacological treatments can take time to show effects. Signup and view all the answers

What is the primary mechanism of action for benzodiazepines?

Positive allosteric modulation of GABA binding to GABA A receptors Signup and view all the answers

Which side effect is commonly associated with tricyclic antidepressants?

Dry mouth Signup and view all the answers

What is the recommended duration for benzodiazepine use in treating severe anxiety?

2-4 weeks Signup and view all the answers

What is the mechanism of action of buspirone?

5-HT1A receptor partial agonist Signup and view all the answers

Which medication is considered first-line treatment for many anxiety disorders?

SSRIs Signup and view all the answers

Which medication is appropriate for managing somatic symptoms in anxiety disorders?

Propranolol Signup and view all the answers

What is a potential risk of using long-term benzodiazepines?

Dependence Signup and view all the answers

In which anxiety disorder are SNRIs like venlafaxine considered useful?

Generalized Anxiety Disorder Signup and view all the answers

What is the purpose of the GAD-7 questionnaire?

To diagnose Generalised Anxiety Disorder and assess symptom severity Signup and view all the answers

What is typically considered the first line of drug treatment for GAD?

SSRIs like sertraline Signup and view all the answers

Which step in the treatment of GAD involves low-intensity psychological interventions?

Step 2 Signup and view all the answers

What should be recommended as the first line of treatment for GAD in pregnant individuals?

Psychological interventions Signup and view all the answers

What score would indicate severe anxiety according to the GAD-7?

15 Signup and view all the answers

What is NOT part of the GAD-7 questionnaire's assessment questions?

Experiencing hallucinations Signup and view all the answers

For treatment-refractory GAD, what might be involved in the care process?

Input from multi-agency teams and crisis services Signup and view all the answers

What is a key characteristic of Generalized Anxiety Disorder (GAD) as defined by the DSM-V?

Presence of at least 3 symptoms for more than half of the days for 6 months Signup and view all the answers

Which of the following is NOT one of the criteria for diagnosing GAD according to the DSM-V?

Excessive worry about one specific event Signup and view all the answers

According to the ICD-11, which symptom is indicative of Generalized Anxiety Disorder?

Physical symptoms like heart palpitations Signup and view all the answers

Which of the following statements about the duration of symptoms in Generalized Anxiety Disorder is true?

Symptoms persist for at least several months, for more days than not. Signup and view all the answers

Which factor can NOT be considered responsible for the symptoms of GAD?

Genetic predisposition Signup and view all the answers

In GAD, what is the effect of anxiety symptoms on daily functioning?

They cause significant impairment in various areas of life. Signup and view all the answers

Which of the following is a symptom of GAD according to the ICD-11 diagnostic criteria?

Frequent gastrointestinal symptoms Signup and view all the answers

What does the DSM-V state regarding the control of worry in GAD?

Individuals find it difficult to control their worry. Signup and view all the answers

Study Notes

PM3PY2: Anxiety Disorders

The session is being recorded.
For more information, refer to the Learning Capture Student Essentials at https://bit.ly/yujaessentials.
Contact the session lead if you have concerns.
A trigger warning advises that the session contains content on mental health disorders and associated suicide risks.

Learning Outcomes

Students will be able to understand and define anxiety as a disorder.
Students will be able to describe individual symptoms of anxiety and specific types of anxiety.
Students will be able to explain the treatment (pharmacological and behavioral), side effects, and limitations associated with treatments for anxiety.
Students will be able to discuss considerations health professionals (HCPs) make in treating and advising patients with anxiety disorders.

What is Anxiety?

Anxiety serves a useful function in daily life.
Anxiety becomes problematic when the threat response is disproportionate to the actual or perceived threat, or when the threat is imagined.
Anxiety is defined as a prolonged or exaggerated response to a real or imagined threat that interferes with normal life and cannot be attributed to neurological or organic dysfunction.
Lifetime prevalence of anxiety is approximately 15%.
Symptoms include anxiety, worry, despondency, sadness, somatic symptoms (e.g., pain), sleep disturbances, and difficulties in coping with life stressors.
Anxiety is commonly seen by general practitioners (GPs).
Long-term drug treatment is not typically recommended.

Pathophysiology of Anxiety

An understanding of the sensory and reaction pathways in the central nervous system (CNS), including the limbic system, is important for understanding anxiety.
Neurotransmitters such as serotonin, noradrenaline, dopamine, and GABA in the CNS play a role in anxiety.
The peripheral nervous system (PNS) is also involved.
Symptoms can be behavioral, physiological, cognitive, or affective.

Examples of Anxiety Clinical Features

Cognitive/Psychological: Feelings of apprehension, tension, fear, panic, feeling on edge, labile mood, outbursts of hostility, irritability, circling thoughts, difficulty concentrating, and memory lapses.
Somatic/Physiological: Cardiovascular issues (palpitations, bradycardia, tachycardia, high blood pressure, flushing), respiratory issues (rapid shallow breathing, breathlessness), gastrointestinal issues (diarrhea, dyspepsia, dysphagia, churning stomach), musculoskeletal issues (agitation, restlessness, muscle tension), metabolic issues (high blood glucose and glucocorticoids), other issues (excessive sweating, urge to urinate/defecate, insomnia).

Types and Aetiology of Anxiety Disorders

Includes Generalized anxiety disorder (GAD), social phobia, specific phobias, obsessive-compulsive disorder (OCD), panic disorder (PD), and post-traumatic stress disorder (PTSD).
The underlying causes of anxiety disorders are not fully understood, but risk factors include genetics, environmental factors (including epigenetic factors), psychological factors, and developmental factors.

Treatment Aims and Prognosis

Prognosis is generally good if the external stressor can be eliminated.
Treatment aims to discover the cause, address the cause, assess severity of the anxiety response, relieve distress, and institute long-term measures to prevent recurrence (especially important in cases of chronic anxiety).

Psychological Treatments

Psychotherapy is a primary treatment approach for anxiety.
Common approaches include counseling, cognitive behavioral therapy (CBT), exposure therapy, and mindfulness and relaxation training.

Treating Anxiety Disorders: Pharmacotherapy

Treatment depends on the type of disorder.
A stepped care model (e.g. NICE guidance) is often used.
For acute anxiety, benzodiazepines (lorazepam, alprazolam, diazepam) can be used. They are positive allosteric modulators of GABA binding to GABA receptors, providing fast-acting relief, but are typically not recommended for long-term use due to potential side effects.
Benzodiazepines can have adverse side effects in overdose.

Drugs to Treat Anxiety Disorders

SSRI medications (fluoxetine, escitalopram, paroxetine, sertraline) are often a first-line treatment for many anxiety disorders.
Pregabalin is another option (Class 3 controlled substance, Schedule 3 drug).
Tricyclic antidepressants (e.g., clomipramine) and buspirone (a 5-HT1A receptor partial agonist) are also used to treat anxiety.
Beta-blockers (e.g., propranolol) are helpful for anxiety with strong somatic symptoms.

Generalized Anxiety Disorder (GAD): Diagnosis

International diagnostic criteria (DSM-V or ICD-11) can be used.
GAD is characterized by excessive anxiety and worry occurring more days than not for at least six months, concerning a number of events and activities. Individuals find it difficult to control the worry.
Associated with three or more symptoms (restlessness/nervousness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance) occurring for more days than not for the past 6 months.
Causes significant distress or impairment in social, occupational or other areas of functioning.
Not attributed to substances, other medical conditions, or other mental disorders.
The ICD-11 criteria also include marked symptoms of anxiety and worry, alongside additional characteristic symptoms (e.g. muscle tension, sympathetic autonomic overactivity).

GAD-7: Questionnaire Tool

A self-scored 7-question questionnaire can be used to assess the severity of GAD.
Scores of 5, 10, and 15 are cut-off points for mild, moderate, and severe anxiety, respectively.

Stepped Care for GAD

A stepped-care model is often used for the treatment of GAD.
Step 1: Identification and assessment, education about GAD and treatment options.
Step 2: Non-facilitated self-help for those with low functional impairment.
Step 3: Individualized high-intensity interventions (e.g., CBT, relaxation, medication) for those with marked functional impairment.
Step 4: If Step 3 is not effective, treatment is focused on self neglect and highly specialist interventions.

Drug Treatment for GAD

Sertraline is a first-line SSRI for GAD.
SNRIs are also considered alternative treatments.
Pregabalin is an option for those unable to tolerate SSRIs or SNRIs.
Benzodiazepines are used only in severe cases, typically for short-term relief.
Buspirone is a short-term medication option for specialists.

Mechanisms of Action

Different classes of drugs have specific mechanisms of action in treating anxiety disorders.

Step 3 Examples for Patient Considerations: Pharmacotherapy

Expected drug effects (time to onset, potential side effects, gradual development of anxiolytic effects).
Risk activation and potential side effects during SSRI treatment.
Importance of taking the drugs as prescribed to prevent relapse.
Monitoring for risk of suicidal ideation.
Follow-up and monitoring schedules.
Considerations for switching medications.
Important considerations for patients with high functional impairment.

Learning Outcome Recap

The learning outcomes reiterate the key concepts covered in the session.

Reference Material

Recommended textbooks (Neurological disorders and Mental Health)
Relevant NICE guidance pages for GAD
DSM-V diagnostic criteria
The ICD-11 diagnostic criteria
BNF information regarding antidepressants and anxiolytics and hypnotics

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores essential concepts related to anxiety disorders, including symptoms, treatment options, and prevalence rates. Test your knowledge on the critical aspects healthcare professionals must consider and the physiological and psychological factors involved in anxiety. Perfect for students or anyone interested in mental health.