Psychiatry
Anxiety Disorders
Anxiety disorders for MBBS and NEET-PG: generalised anxiety, panic disorder, phobias, social anxiety and OCD, with SSRIs, CBT and benzodiazepine cautions, mapped to NMC codes PS8.
MedNext Academy | 3 min read
Anxiety Disorders
Anxiety disorders for MBBS and NEET-PG: generalised anxiety, panic disorder, phobias, social anxiety and OCD, with SSRIs, CBT and benzodiazepine cautions, mapped to NMC codes PS8.
This chapter covers the anxiety disorders, from generalised anxiety and panic to phobias, social anxiety and obsessive-compulsive disorder. It sets out their clinical features, the physical mimics that must be excluded, and the first-line role of SSRIs and cognitive behavioural therapy with the limited place of benzodiazepines.
High-yield: Anxiety Disorders
- Anxiety disorders feature excessive fear or worry with physical symptoms such as palpitations, sweating, tremor and breathlessness.
- Generalised anxiety disorder is persistent, free-floating worry about everyday matters lasting most days for at least six months.
- A panic attack is an abrupt surge of intense fear peaking within minutes, with palpitations, chest tightness, choking and a fear of dying or losing control.
- Panic disorder is recurrent unexpected panic attacks with persistent worry about further attacks.
- Agoraphobia is fear of situations where escape is difficult, and it often complicates panic disorder.
- A specific phobia is a marked fear of a particular object or situation, treated effectively with graded exposure.
- Social anxiety disorder is a persistent fear of scrutiny and embarrassment in social situations.
- Obsessive-compulsive disorder involves intrusive obsessions and repetitive compulsions performed to reduce the anxiety they cause.
- In obsessive-compulsive disorder the person recognises the thoughts as their own and often as excessive, unlike the delusions of psychosis.
- Selective serotonin reuptake inhibitors are first-line pharmacological treatment across most anxiety disorders and obsessive-compulsive disorder.
- Cognitive behavioural therapy, including exposure and response prevention for obsessive-compulsive disorder, is a core evidence-based treatment.
- Benzodiazepines relieve anxiety quickly but are limited to short-term use because of dependence and tolerance.
- Beta blockers such as propranolol reduce the physical symptoms of performance anxiety.
- Thyrotoxicosis, phaeochromocytoma, arrhythmia and substance use must be excluded before diagnosing a primary anxiety disorder.
Anxiety disorders and treatment
- **Generalised anxiety:** Persistent free-floating worry for at least six months. SSRIs and CBT.
- **Panic disorder:** Recurrent unexpected panic attacks, often with agoraphobia. SSRIs and CBT.
- **Obsessive-compulsive disorder:** Obsessions and compulsions. SSRIs and exposure with response prevention.
- **Benzodiazepines:** Rapid relief but short-term only due to dependence.
NMC competencies in this chapter
- **PS8.1:** Clinical features of anxiety disorders
- **PS8.2:** Indications and interpretation of investigations in anxiety
- **PS8.3:** Treatment of anxiety disorders including behavioural methods
- **PS8.4:** Family education in anxiety disorders
- **PS8.5:** Pharmacological basis and side effects of anxiolytics
- **PS8.6:** Conditions for specialist referral in anxiety
- **PS8.7:** Obsessive-compulsive disorder and its management
Frequently Asked Questions
What is the difference between a panic attack and panic disorder?
A panic attack is a single abrupt surge of intense fear peaking within minutes, while panic disorder is recurrent unexpected panic attacks with ongoing worry about having further attacks.
How is obsessive-compulsive disorder treated?
First-line treatment is a selective serotonin reuptake inhibitor together with cognitive behavioural therapy using exposure and response prevention. The person recognises the thoughts as their own, unlike a delusion.
Why are benzodiazepines used only short-term?
Benzodiazepines relieve anxiety quickly but cause tolerance and dependence with continued use, so they are limited to short courses while longer-term treatments take effect.
Which physical illnesses mimic anxiety?
Thyrotoxicosis, phaeochromocytoma, cardiac arrhythmia and substance use or withdrawal can all mimic anxiety and should be excluded before diagnosing a primary anxiety disorder.
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