115b - Anxiety Disorders

Question 1

What is required to diagnose OCD?

Answer 1

• Presence of either obsessions or compulsions (or both)
• Individual has realized that the obsessions and/or compulsions are unreasonable (has insight)
• Symptoms are time consuming

Question 2

Which parts of the brain are important for regulating fear and anxiety states?

Answer 2

Amygdala

Also hippocampus, locus coeruleus, hypothalamic/pituitary/adrenocortical axis

Question 3

When does specific phobia usually present?

Answer 3

Bimodal onset: Childhood or early adulthood

Early onset cases are more likely to remit

Question 4

Which medications can be used to manage panic disorder?

Answer 4

• SSRIs
• Benzos (2nd line, should not be used long-term)
  
  • May serve a a bridge since SSRIs take awhile to start working

Question 5

Which parts of the DSM-5 criteria are similar for all anxiety disorders?

Answer 5

Symptoms must be:

• Persistent
• Out of proportion to the threat/danger
• Cause clinically significant distress or impariment

Question 6

Which areas of the brain have increased activity in patients with OCD?

Answer 6

• Cingulate
• Caudate
• Prefrontal cortex

Question 7

“Chronic daily worry” is a symptom of which anxiety disorder?

Answer 7

Generalized anxiety disorder

Question 8

Which anxiety disorder is most likley to benefit from surgical intervention if medical management is unsuccessful?

Answer 8

OCD

We understand more about the neural circuitry: OCD results from overactive cingulate, caudate, and prefrontal cortex

Question 9

Which neurotransmitters have a role in anxiety?

Answer 9

• GABA
  
  • Too little GABA = anxiety
• Serotinin
  
  • Too little serotonin = anxiety
• NE
  
  • Poor regulation w/Bursts of NE = anxiety

Question 10

What is the most common obsession found in OCD?

Answer 10

Uncleanliness obsessions

Question 11

In general, what is the prognosis for anxiety disorders?

Answer 11

Chronic illness, but many improve with treatment

• 80% remit or improve
  
  • 30% remit
  • 50% improve
• 20% remain significantly ill

Varies with specific disorder, setting of treatment

Question 12

What physical causes are on the ddx for panic attack?

Answer 12

• Cardiac (arrhythmia, angina)
• Endocrine (pheochromocytoma, hyperthyroid, hypoglycemia)
• Resiratory distress
• Drug withdrawal
• Seizure disorder
• Vestibular dysfunction

The point is: evaluate all possible causes so you don’t miss something!

Question 13

When does panic disorder usually onset?

Answer 13

Adolescence - 30’s

(later than other anxiety disorders)

Question 14

What is necessary to diagnose a panic disorder?

Answer 14

• Recurrent or unexpected panic attacks
• At least 1 of the attacks has been followed by 1 month+ of either:
  
  • Persistent concern about additional attacks
  • Maladaptive change in behavior related to attacks

Not everyone who has had a panic attack has a panic disorder!

Question 15

Which treatments are most helpful for OCD?

Answer 15

• Response prevention/flooding
• TCAs, SSRIs
• Atypical antipsychotics (as an ad-junct)
• Surgical
  
  • May be helpful in refractory cases

Question 16

What is the lifetime prevalance of anxiety disorder?

Answer 16

~30%