117b - 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
• Serotonin
  
  • 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

When does panic disorder usually onset?

Answer 12

between Adolescence - 30’s

(later than other anxiety disorders)

Question 13

What is necessary to diagnose a panic disorder?

Answer 13

• 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 14

Which treatments are most helpful for OCD?

Answer 14

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

Question 15

What is the lifetime prevalance of anxiety disorder?

Answer 15

~30%

Question 16

Definition of obsessions:

Answer 16

• Obsessions = recurrent persistent thoughts experienced as intrusive and unwanted, usually causing marked distress
  
  • patients try to ignore, suppress, or neutralize them (different than obsessive compulsive personality disorder)

Question 17

Definition of compulsions

Answer 17

• Compulsions = repetitive behaviors where the person feels driven to perform them in response to obsession; the performance is aimed at preventing or reducing anxiety or preventing a dreaded outcome; but the actions are not realistically connected w/ what they are intended to prevent

Question 18

What is OCD commonly associated with?

Answer 18

Tourette’s syndrome

Question 19

Agoraphobia DSM5 Critieria:

Answer 19

• Agoraphobia DSM5 Criteria:
  
  • marked fear/anxiety about 2 of the following: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside of the home alone
  • fear these situations b/c escape is difficult, and help isn’t available if panic symptoms were to start
  • the fear/anxiety is persistent (>6 months) and out of proportion

Question 20

Specific Phobia DSM 5 Criteria:

Answer 20

• Specific Phobia DSM5 Criteria:
  
  • marked fear or anxiety about a specific object or situation
  • the object/situation is actively avoided or is endured with intense anxiety
  • the fear is persistent (> 6 months) and causes impairment/distress

Question 21

Social Anxiety Disorder Criteria

Answer 21

• Social Anxiety Disorder DSM5 Criteria:
  
  • marked anxiety about one or more social situations where the individual is exposed to possible scrutiny of others
  • individual fears how they will show anxiety symptoms and be negatively evaluated
  • social situations are avoided or endured w/ intense fear
  • anxiety is out of proportion, persistent (> 6 months), and distressing/causing impairment

Question 22

Generalized Anxiety Disorder Criteria:

Answer 22

Generalized Anxiety Disorder DSM5 Criteria:

• excessive anxiety, more days than not, for at least 6 months about several events or activities
• difficult to control the worry
• 3 or more anxiety symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
• symptoms cause distress and impairment and are not due to use of a substance or a medical condition