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Anxieties Flashcards

1
Q

What is the prevalence of OCD?

A

1-3%

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2
Q

What is an important factor in maintaining OCD symptoms?

A

Relief of anxiety

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3
Q

What are poor prognostic factors for OCD?

A
  • symptoms involving the need for symmetry and exactness
  • presence of hopelessness and hallucinations
  • family history of OCD
  • continuous, episodic course
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4
Q

What are good prognostic factors for OCD?

A

Predominance of phobic ruminative ideas in the absence of compulsions

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5
Q

What is the most common and prevalent obsession?

A

Fear of contamination

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6
Q

What is the most common and prevalent compulsion?

A

Checking

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7
Q

What is the least prevalent obsession?

A

Sexual or aggressive thoughts

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8
Q

What is the least prevalent compulsion?

A

Counting

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9
Q

What are the common biochemical changes identified in patients with PTSD?

A

Lower basal cortisol level and elevated levels of corticotrophin releasing hormone

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10
Q

Prevalence of GAD?

A

3.1%

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11
Q

Number of people suffering from mixed anxiety and depression at any given time in the UK?

A

9 in 100

9%

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12
Q

Does YBOCS rate obsessive personality traits?

A

No

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13
Q

What can increase the placebo effect in anxious patients?

A

Capsules instead of tablets

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14
Q

Highest prevalence anxiety disorder according to NPMS?

A

Mixed anxiety and depression

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15
Q

Highest prevalence anxiety disoder according to ECA and NCS?

ECA was community based survey carried out in the USA using using the Diagnostic Interview Schedule

A

Phobia (12.5%)

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16
Q

Mean age for GAD diagnosis?

A

30 (“vague”)

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17
Q

Mean age for agoraphobia diagnosis?

A

25 (“shelter”

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18
Q

Mean age for OCD diagnosis?

A

20 (“sex, violence, religion)

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19
Q

Mean age for social phobia diagnosis?

A

15 (“people”)

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20
Q

Mean age for specific phobia diagnosis?

A

10 (“natural events”)

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21
Q

M:F ratio OCD

A

1:1

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22
Q

Which area of the brain has been implicated in OCD?

A

Hypometabolism of basal ganglia stuctures

Hypermetabolism in the orbitofrontal gyrus

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23
Q

What are the OCD spectrum disorders?

A
  1. Somatic preoccupation - BDD, hypochondriasis or anorexia
  2. Neurological disorders - Tourettes, Sydenhams and ASD
  3. Impulse control disorders - paraphilias, kleptomania, pathological gambling
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24
Q

whats the treatmen for OCD?

A

mild to moderate severity:

  1. Self help
  2. CBT with ERP
  3. SSRIs+/- CBT

severe:

  1. SSRIs +/- CBT
  2. For non-responders switch to a different SSRI or Clomipramine
  3. Antispychotic augmentation after 3 month trial of maximum dose of SSRI
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25
Q

Whats the NNT for OCD with SSRIs?

A

6-12

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26
Q

What is the point prevalence of PTSD?

A

1%

27
Q

Which trauma do men develop PTSD more than womeb?

A

Rape

28
Q

Factors associated with PTSD

A

Pre-trauatic factors:
prev psych disorder, female gender, external locus of control, low SES, ethnic minority, PD

Peritraumatic factors:
high severity of trauma, perceived threat to life, peritraumatic dissociation

Post traumatic factors:
percieved lack of social support, subsequent life stress, physical illness

29
Q

Protective factors for PTSD

A

High IQ

High SES

30
Q

Neurobiological feautures of PTSD

A

hippocampus and amygdala abnormalities

low corticsol sevels

31
Q

Clinic features of PTSD

A
  1. intrusion
  2. avoidance
  3. negative alterations in cognitions and mood
  4. alterations in arousal and reactivity
32
Q

What is the lifetime prevalence of PTSD?

A
  1. 6% men

9. 7% women

33
Q

Which mesaures are likely to be beneficial to prevent PTSD?

A

Multiple session CBT

34
Q

Which mesaures are unlikely to be beneficial to prevent PTSD?

A

Single session debriefing

Supportive counselling

35
Q

What’s the management of PTSD?

A
  • Watchful waiting where symptoms are mild and have been present for less than 4 weeks after the trauma
  • non benzo sleeper after 4 consecutive nights w/o sleep

Symptoms present within 3 months of trauma:
-trauma focused CBT

Symptoms present for more than 3 months after trauma:

  • trauma focused CBT or EMDR
  • alternative psychotherapy if onen fails
  • consider medication after -> paroxetine, mirtazapine (amitryptilineand phenelzine for sepcialist use)
36
Q

Prevalence of GAD

A

point - 2-3%

lifetime - 5%

37
Q

Risk factors for GAD

A 
female
high number of life events
first degree relative with GAD
Exposure to civilian trauma
bullying or victimisation
38
Q

What score on Hamilton scale for anxiety signifies recovery?

A

7 (treatment response is 50% reduction in baseline score)

39
Q

What are the acute treatment options for GAD?

A
  1. Mild GAD - Education and active monitoring
  2. Mild GAD with no response to step 1 - Low-intensity psychological interventions -> 1. individual non-facilitated self-help (based on CBT) 2. individual guided self-helppsychoeducational groups (based on CBT)
  3. Those with marked functional impairment or those who have not responded to step 2 - Individual high-intensity CBT or applied relaxation or drug treatment
  4. Those with very marked functional impairment, those with no response to step 3, or those with self-neglect, risks of self-harm or suicide, or significant co-morbidity - complex drug and/or psychological treatment regimens; input from multi-agency teams, crisis services, day hospitals or inpatient care

Medications for acute GAD
SSRIS - escitalopram, paroxetine, setraline
TCAs - imipramine
Venlafaxine, duloxetine, buspirone

40
Q

What are the treatment options for relapse prevention in GAD?

A

Paroxetine, escitalopram, CBT, venlafaxine , Pregabalin

41
Q

What re adjunctive options for non response to treatment in GAD?

A

Low dose Olanzapine/Risperidon

42
Q

Which herbal treatments appear to be effective in GAD?

A

Kava (piper methysticum)

43
Q

What adverse effect has kava been assocuaed with?

A

Allergy

Fatal hepatotoxicity

44
Q

Whats the point prevalence of social phobia?

A

2.8%

45
Q

What’s the treatment for social phobia?

A

CBT and SSRIs
Phenelzine second line
SSRI + clonazepam/gabapentin/pregabalin third line

46
Q

Point prevalence of panic disorder?

A

0.9%

47
Q

ICD10 definition of panic disorder

A

recurrent, unpredictable panic attacks with sudden onset of palpitations, chest pain, choking sensations, dizziness, feelings of unreality, fear of dying, losing control or going mad

48
Q

NICE guidelines for panic disorder

A

CBT, self help
SSRIs first line medication
If no improvement after 12 weeks of SSRI then imipramine or clomipramine

49
Q

Factors that may predispose to BDD

A

low self esteem
critical parents and SOs
early childhood trauma
unconscious displacement of emotional conflict

50
Q

Treatment of BDD

A

High dose SSRIs for long duration

CBT

51
Q

How often should follow up be done in patients with GAD started on SSRIs and why?

A

For patients under the age of 30 years who are prescribed SSRIs, NICE recommend warning them of the increased risk of suicidal thinking and self-harm. Weekly follow-up is recommended for the first month

52
Q

How long should medication continue for if it is successful in GAD?

A

If medication is successful it is recommended that it continue for at least 1 year

53
Q

How long should medication continue for if it is successful in panic disorder?

A

6 months

54
Q

What is flooding therapy?

A

used in the treatment of phobias. It is very different to systematic desensitisation in that it encourages people to directly confront the phobia and remain until the anxiety is gone (a process called habituation)

55
Q

Panic with agoraphobia M:F ratio

A

1:3

56
Q

Panic without agoraphobia M:F ratio

A

1:2

57
Q

Generalised anxiety disorder M:F ratio

A

1:2

58
Q

Specific phobia M:F ratio

A

1:2

59
Q

Prevalence of anxiety disorders according to Steel at al?

A

1 in 15

60
Q

According to data from the National psychiatric morbidity survey, in which condition do females and males show similar rates?

A

Panic disorder

61
Q

% of people with specific phobia who experience at least one other psychiatric disorder in their lifetime

A

80%

62
Q

The average duration of illness at the time of initial evaluation of Generalized Anxiety Disorder is around

A

20 years

63
Q

Which medication is not licenced for obsessive compulsive disorder?

A

Citalopram

MB (16 decks)

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