Generalised Anxiety Disorder (GAD)

•    Definition:

o    Excessive, pervasive worry about multiple events/activities, ≥6 months

•    Symptoms:

o    Autonomic hyperarousal: palpitations, tremor, sweating

o    Restlessness, muscle tension, sleep disturbance, fatigue, difficulty concentrating

•    Key points:

o    Gradual onset, often chronic course

•    Treatment:

o    First-line: CBT

o    SSRIs (e.g., sertraline)

o    Pregabalin may be considered second-line

o    Short-term benzodiazepines only if severe crisis (avoid long-term due to dependence)

Panic Disorder

•    Definition:

o    Recurrent, unexpected panic attacks with sudden intense fear/discomfort

•    Symptoms (during attacks):

o    Palpitations, chest pain, choking sensation, dizziness, depersonalisation, fear of dying or losing control

•    Diagnosis:

o    Rule out cardiac (e.g., arrhythmia, ACS), endocrine (e.g., pheochromocytoma, hyperthyroidism)

•    Treatment:

o    CBT (exposure and cognitive restructuring)

o    SSRIs first-line; avoid benzodiazepines long-term

o    Breathing retraining to reduce hyperventilation

Phobic Disorders

•    Types:

o    Social anxiety disorder (social phobia): fear of scrutiny or embarrassment

o    Agoraphobia: fear of open or crowded places, often coexists with panic disorder

o    Specific phobias: e.g., spiders, heights, flying

•    Treatment:

o    Exposure (systematic desensitisation): most effective

o    CBT

o    SSRIs useful in severe social anxiety

Post-Traumatic Stress Disorder (PTSD)

•    Criteria:

o    Symptoms start ≥1 month after trauma (before 1 month = acute stress reaction)

o    Core clusters:

    Re-experiencing (flashbacks, nightmares)

    Avoidance of reminders

    Negative mood/cognitions

    Hyperarousal (irritability, exaggerated startle, insomnia)

•    Treatment:

o    Trauma-focused CBT

o    EMDR (eye movement desensitisation and reprocessing)

o    SSRIs (e.g., sertraline, paroxetine)

o    Prazosin for severe nightmares (off-label)

Acute Stress Reaction

•    Timing:

o    Onset within minutes to hours after trauma; resolves within days to weeks

•    Symptoms:

o    Emotional numbing, detachment, dissociation, autonomic arousal

•    Treatment:

o    Supportive, reassurance, watchful waiting

o    Avoid formal debriefing sessions (may worsen outcomes)

Adjustment Disorder

•    Definition:

o    Emotional or behavioural symptoms occurring within 3 months of an identifiable stressor

•    Course:

o    Usually resolves within 6 months once stressor is removed

•    Treatment:

o    Supportive psychotherapy

o    Address underlying stressor

o    Short-term pharmacotherapy rarely needed

Extra Revision Pearls

•    Agoraphobia without panic is rare; usually secondary to panic disorder

•    Hyperventilation may cause respiratory alkalosis → paraesthesia and light-headedness

•    Avoid benzodiazepines in PTSD (risk of dependence, worsen avoidance behaviours)

•    SSRIs may transiently worsen anxiety at initiation → warn patients

•    Prazosin can help PTSD-related nightmares

•    Beta-blockers (e.g., propranolol) sometimes used for performance anxiety