Anxiety 2

Question 1

What is an obsession?

Answer 1

1. Recurrent/persistent THOUGHTS, URGES, AND/OR IMAGES;
2. These are INTRUSIVE and UNWANTED (could be called EGO DYSTONIC and cause the person anxiety/distress)
3. Patient will try to ignore/suppress these intrusive thoughts or try to NEUTRALIZE them with a thought or action (this would be undoing ego defense mech)

Question 2

What is compulsion? Example?

Answer 2

1. Repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that ought to be strictly adhered to
2. It will typically undo or reduce anxiety (usually the obsession)
3. If you STOP the compulsion, you can dramatically INCREASE anxiety!!

Think of hand washing or counting numbers, or driving by a house and not stopping at number 3

Question 3

Over time, what can happen regarding intrusive thought, anxiety, and compulsion?

Answer 3

Normally IT, then anxiety, then compulsion; over time it’s just anxiety to compulsion

Question 4

Occurrence and prognosis of OCD?

Answer 4

O: men and women EQUALLY affected; most have onset AFTER a stressful event;

P: long, but variable course; it’s likely the HARDEST anxiety to treat (least chance of full remission)

Question 5

Comorbidities and treatment of OCD?

Answer 5

C: think MDD (1/3) and Tourette’s (MOTley crew; 2/3); SUICIDE RISK high
T: Psychotherapy (CBT is effective with long-lasting effects with Exposure and Response Prevention; also ACT, or Acceptance and Commitment Therapy for the obsessions!!!)
Pharm: try to combine with psychotherapy
1st line: SSRI with higher doses!!
2nd: clomipramine (TCA, approved for OCD)
3rd: antipsychotics, other antidepressants; benzos DO NOT work (not GABA based anxiety issue)

Question 6

DD for OCD:

Answer 6

1. Tourette’s Disorder (vocal and motor tics)
2. Temporal Lobe Epilepsy (have repetitive motor movements, which MIGHT look like compulsion)
3. OCPD: patients DON’T have insight into their behavior; they are rigid, moralistic, workaholic, list- and pattern-oriented; NO REPETITIVE DISCRETE BEHAVIORS to undo anxiety (these guys are tougher to treat)

Question 7

Definition of OCD:

Answer 7

Criterion A: presence of OBSESSIONS AND COMPULSIONS

Criterion B: O’s and C’s must be time consuming (>1h/day) or cause significant distress!! (either one)
AND are NOT substance induced or better explained as symptoms of another mental or medical disorder

Question 8

For PTSD: most common thing to cause it? Most likely thing to cause it? Fracture in car crash, likelihood of PTSD? Greatest variables associated with PTSD?

Answer 8

1. Death of a loved one (don’t have to be in presence of loved one)
2. Assault
3. 15% (think nightmares, flashback, avoidance)
4. Proximity, harm by another human, severity, repetition (Proton gun HuRtS)

Question 9

For PTSD: what is criterion A?

Answer 9

1. Exposure to actual or threatened traumatic event (Death, serious Injury, Sexual violence)
2. Symptoms have to be there for >1 month, cause significant distress/impairment, and not be the result of substance or another medical condition
3. Mode of exposure must occur as DIRECTLY experiencing event, WITNESSING event happen, LEARNING that a family member/friend experienced event, or directly experiencing REPEATED/EXTREME exposure to horrific details of an event

Question 10

PTSD: criterion B?

Answer 10

At least one intrusion symptom associated with event (maybe relive events, have memories or dreams/nightmares, flashbacks leading to lack of awareness of surroundings, pscyhological distress from cues that symbolize/resemble part of the event, and psychological reactions upon exposure to external cues)

Question 11

PTSD: criterion C?

Answer 11

Avoidance of stimuli (memories/thoughts/feelings related to event, external reminders that could arouse what I just said, avoiding INTERPERSONAL connectivity: estrangement, lack of commitment, unwilling to settle down, reclusiveness, or RULE)

Question 12

PTSD: criterion D?

Answer 12

Negative changes in cognition and mood associated with event (at least 2 of following): dissociative amnesia/repression, exaggerated beliefs/expectations of oneself, others or the world, distortion of event and what happened leading to blaming oneself or others, negative emotional state, decreased interest, detachment, can’t experience positive emotions)

Question 13

PTSD: criterion E?

Answer 13

Alterations in arousal/reactivity (>2 of the following): hypervigilant, concentration issues, sleep disturbances, irritable behavior, reckless behavior, exaggerated startle response

Question 14

Criteria for acute stress disorder?

Answer 14

A-D from PTSD;
main difference is B-D must last 3 days-1 month after exposure, for ASD (>1 month for PTSD);
precursor to PTSD;
Treat it EARLIER (earlier treatment can decrease risk of full PSTD ONSET)

Question 15

For PTSD and ASD: occurrence, prognosis, co-morbidities:

Answer 15

O: women > men

P: variable, but if you have rapid onset of symptoms, good pre-morbid functioning, and no other psychiatric co-morbidities it’s better; if you leave it alone the worse the symptoms can be; untreated, about 30% recover, but 10% worsen and 60% with mild/moderate symptoms

C: depression, substance-related disorders and other anxiety disorders make patient more vulnerable to getting PTSD

Question 16

Treat PTSD and ASD?

Answer 16

Psychotherapy: think initial support, grounding, validation of feelings; then choose if you want to relive event or seal it up and move on: THEN CBT, eye-movement desens and reprocessing (EMDR), maybe some psychodynamic psychotherapy; support groups and family therapy
Pharmacotherapy: 1st line SSRIs, 2nd line TCAs and atypical antipsychotics, 3rd line MAOi, trazodone, clonidine, propanolol, anticonvulsants
PRAZOSIN for NIGHTMARES!!!