Anxiety + insomnia

What are the key differences between GAD and phobias?

GAD is a constant feeling of anxiety, while phobias are often triggered by external situations or objects.

What conditions can mimic the symptoms of anxiety?

hypothyroidism, substance misuse, and alcohol withdrawal can mimic anxiety symptoms.

What is the GAD-2 screening tool, and what score indicates further investigation?

GAD-2 is a two-question tool assessing nervousness and uncontrollable worrying. A score of 3 or more indicates the need for further investigation using GAD-7.

What is the first-line pharmacological treatment for GAD?

SSRIs (e.g., sertraline) are first-line for moderate-severe GAD.

How long does it take for sertraline to show full effect in anxiety?

Sertraline may take 8-12 weeks to show full effect in anxiety, longer than in depression.

What is the mechanism of action of pregabalin?

Pregabalin is a voltage-gated calcium channel blocker.

When are benzodiazepines used in anxiety?

Benzodiazepines are used short-term in severe anxiety states (crisis) but are not recommended for panic disorder or social anxiety.

What are the withdrawal symptoms of benzodiazepines?

Withdrawal symptoms include irritability, increased anxiety, panic attacks, sweating, nausea, and headaches.

What is the Heimberg model for social anxiety?

The Heimberg model involves exposure therapy, gradually exposing individuals to social situations that cause anxiety.

What is the Clark and Wells model for social anxiety?

The Clark and Wells model focuses on education and feedback to break down barriers to confidence in social situations.

What are the key characteristics of chronic insomnia?

• Chronic insomnia involves difficulty initiating or maintaining sleep

• poor sleep despite adequate opportunity

• daytime consequences like tiredness and cognitive impairment.

What is the first-line treatment for insomnia?

Non-pharmacological treatments like sleep hygiene and CBT-I (Cognitive Behavioral Therapy for Insomnia) are first-line.

What are the risks of long-term benzodiazepine use in the elderly?

Risks include falls, cognitive impairment, and a 50% increased risk of hip fractures.

What is the difference between short-acting and long-acting benzodiazepines?

• Short-acting benzodiazepines (e.g., temazepam) are used for difficulty falling asleep

• long-acting ones (e.g., nitrazepam) are used for frequent nighttime awakenings but carry a higher risk of next-day sedation.

What is the Sleepio app, and how does it help with insomnia?

Sleepio is a digital CBT-I program recommended by NICE for insomnia. It provides a six-week self-help program based on CBT principles.

What are the risks of Z-drugs like zolpidem?

Risks include tolerance, dependence, rebound insomnia, and neuropsychiatric reactions. Zolpidem can work within 15 minutes but has a high risk of addiction.

How does alcohol affect sleep?

Alcohol interferes with REM sleep, leading to more time spent in REM and less in slow-wave sleep (non-REM 3 and 4), resulting in poorer sleep quality.

What are the key considerations when prescribing hypnotics for insomnia?

Hypnotics should be used for the shortest time possible (2-4 weeks), at the lowest effective dose, and only for severe insomnia. Non-pharmacological options should be tried first.