Return to Scenario ListShow Learning Points most relevant to Phase 1:

Anxiety disorder

Clinical Discipline(s)/Organ System(s)
Psychiatry/Health Psychology, General Practice
Progress Test Topic(s)
Mental health
You are attached to a psychiatry outpatient clinic where a 50 year old South African married businessman sees the Consultant Psychiatrist you are shadowing complaining of feeling uptight, tense and questions whether he is heading for a 'nervous breakdown'. On three occasions in the past month, he thought that he was having a heart attack because of sharp chest pains and shortness of breath. Twice he went to the Emergency Department (ED) for treatment. Blood investigations and an ECG were normal and he was sent home both times with reassurance. On the last occasion the ED doctor thought that he was having a panic attack and suggested that he visit your outpatient clinic. He is fearful of having another similar episode. His mother gave him a tranquilizer (he has the name 'Ativan' written on a piece of paper which he shows you) and says that it made him calm and relaxed; he wants your Consultant to prescribe these for him. He also adds that he sleeps poorly. His GP diagnosed essential hypertension three years ago and he has been stabilised on a beta-blocker.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Current biopsychosocial theories of the aetiology of anxiety disorders
   - Developmental tasks in middle age
   - Concept of somatisation
   - Anxiety disorders due to more common medical conditions
   - Stages of sleep and secondary insomnias
   - Classification and course of the anxiety disorders
   - Theories underlying cognitive behavioural therapy (learning theories, behaviourism, cognitive theories)
   - Pharmacology of hypnosedatives, flumazenil and antidepressant medications
Clinical and Communication Skills 
   - Elicit a comprehensive psychiatric and medical history from a patient with an anxiety disorder; consider triggers
   - Perform a mental state examination of a patient with an anxiety disorder
   - To be able to perform a risk assessment for harm to self or others with an emphasis on suicide and neglect risk
   - Differential diagnoses of generalized anxiety
   - Recognise the characteristic symptoms of panic disorder (PD), agoraphobia, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD)
   - Awareness of mind-body interactions
   - Interpret relevant investigations: electrolytes, hormonal screening, toxicology screen, imaging
   - Management of anxiety disorders including pharmacological, psychological and other non-biological methods
   - Awareness of dysfunctional coping strategies such as alcohol, hypnosedative abuse and dependence
   - Management of secondary insomnia including behavioural (sleep-hygiene) and pharmacological interventions
   - Prognosis of the various anxiety disorders
Personal and Professional Skills 
   - Non-judgemental approach to mental illness and reducing stigma
   - Demonstrate empathic interviewing
   - Social impact of mental illness
   - Role of the multi-disciplinary team in the care of patient with an anxiety disorder
   - Practice guidelines in anxiety disorders
Population Health 
   - Epidemiology of anxiety disorders, hypnosedative prescription and use
Conditions to be considered relating to this scenario
generalised anxiety disorder, depression, psychosis of any cause, hyperthyroidism, primary insomnia, irritable bowel syndrome, dysthymic disorder, alcohol-related psychosis, substance-induced anxiety disorder, panic disorder, acute stress disorder, post-traumatic stress disorder, adjustment disorder with anxious features, obsessive-compulsive personality disorder, social phobia, agoraphobia, simple phobias, hyperventilation syndrome, drug seeking behaviour
Less common but 'important not to miss'
ischaemic heart disease, encephalopathy of any cause, hypercalcaemia, phaeochromocytoma, anorexia nervosa, anaphylaxis, acute respiratory distress syndrome
personality disorder, malingering