Anxiety and Obsessive Compulsive Disorders

Question 1

What 3 factors make anxiety pathological?

Answer 1

1. intensity [panic attacks]
2. duration [chronic anxiety]
3. inappropriate for the situation [out of proportion to the threat, ex. phobias]

Question 2

What psychological symptoms are associated with anxiety?

What cognitive symptoms?

Answer 2

Psychological:
fear, worry, concern, apprehension, shame, doubt

Cognitive:
impaired attn, impaired learning

Question 3

What are the 2 behavioral theories of anxiety?

Answer 3

1. cognitive distortion - anxious person overestimates the threat or underestimates their ability to deal with the threat
2. conditioned response - ex. person with fractured legs is scared to stand, but physical therapist supports them as they stand. The patient gets anxious when the therapist 1asks her to stand on her own. The next day, she is anxious at the site of the therapist

Question 4

What is the biological theory of anxiety based on?

Answer 4

Dysregulation of:

1. NE
2. 5HT
3. GABA

Question 5

What are the DSM5 primary anxiety disorders?

Answer 5

1. separation anxiety disorder [child psych]
2. selective mutism [child psych]
3. panic disorder
4. agoraphobia
5. social anxiety disorder
6. specific phobia
7. GAD

Question 6

What medical conditions are associated with anxiety disorder? [10]

Answer 6

1. hyper or hypothyroidism
2. hyperparathyroidism
3. B12 deficiency
4. pheo
5. MS
6. post-encephalitic complications
7. epilepsy
8. cardiomyopathy
9. hypoglycemia
10. anemia

Question 7

What drugs of abuse are associated with secondary anxiety disorders?
Withdraw of what drug of abuse can cause it?

Answer 7

1. amphetamines
2. LSD
3. cocaine
4. amyl nitrite
5. alcohol withdraw

Question 8

What prescribed medications are associated with secondary anxiety disorder?
Withdraw of what prescribed med can also cause it?

Answer 8

1. anti-asthmatics
2. steroids
3. anti-depressants
4. withdraw of barbituates and benzodiazepines

Question 9

What OTC or herbals cause secondary anxiety?

Answer 9

1. caffeine
2. decongestants
3. ephedra

Question 10

What are the 4 main criteria of panic disorders?

Answer 10

1. RECURRENT and UNEXPECTED panic attacks
2. attacks –> concern/worry about implications and complications
3. concern/worry–> change in behavior to avoid attacks
4. anticipatory anxiety about when the next attack will occur –> avoidance of certain people/places/things

Question 11

A patients says that they have abrubtly starting attacks that last about 10-20 minutes where they have chest pain, palpitations, SOB, feeling of choking/nausea, sweating, chills, shakes, dizziness.
They feel like they are going crazy and losing control and like they might die. They don’t feel that they are real and that the surroundings become unfamiliar/unreal.
These attacks are unexpected.

What does this person have?

Answer 11

Panic attack episodes

Question 12

What is a phobia characterized by?

Answer 12

Irrational fear of an object or situation which leads to:

1. avoidance of the object/situation
2. anticipation of object/situation
3. endurance of the situation with high degree of distress [which may precipitate a panic attack]

*the patient recognizes that their fear is excessive but it feels out of their control

Question 13

What is agorophobia?

Give a few examples.

Answer 13

fear of places or situations in which escape might be difficult or embarrassing.
The person will avoid certain situations or endure them with marked distress.
1. going across a bridge
2. standing in line
3. leaving the house alone
4. public transit

Question 14

What is social anxiety disorder?

Answer 14

fear of one or more social situations in which the person might feel:

1. scrutinized
2. humiliated
3. embarrassed

Which leads to:

• avoidance
• anticipation
• endurance with high degrees of distress

*patients recognize that their fear is excessive

Question 15

What are examples of feared situations for someone with social anxiety disorder?

Answer 15

1. writing while someone watches
2. calling to make reservations
3. looking a stranger in the eye
4. talking in group discussions
5. sitting in a waiting room

Specifier of “performance only” when fear is restricted to speaking or performing in public

Question 16

What is a specific phobia?

Answer 16

Fear of a specific object or situation that leads to:
-avoidance, anticipation, endurance with high degree of distress

*patient recognizes fear as excessive

Question 17

What criteria make something generalized anxiety disorder?

Answer 17

Chronic, excessive worry that causes impairment/distress and lasts for at least 6 months.
It is CONSTANT, not episodic.

restless, irritable, muscle tension, fatigue, decreased concentration, insomnia

Question 18

What is standard treatment for a specific phobia?

Answer 18

Exposure therapy [systematic desensitization]

1. The patient makes a list of hierarchy of fear-inducing situations ranked from least to most feared.
2. start with least feared and with the assistance of a therapist use relaxation technique until they can tolerate this situation w/o anxiety.
3. move to the next fear on the list

Question 19

What psychotherapy treatment is used for GAD?

Answer 19

1. cognitive therapy to address the distortion
2. behavioral therapy such as relaxation and biofeedback
3. supportive therapy for reassurance/comfort

Question 20

What pharmacological treatments are used for GAD?

Answer 20

1. benzodiazepine
2. anxiolytic antidepressants
3. buspirone [this is the only indication for its use. do NOT use with panic attacks

Question 21

What criteria classify a disorder as OCD?

Answer 21

1. obsessions- recurrent thought that leads to anxiety
   and/OR
2. compulsions - repetitive behaviors to decrease anxiety created by the obsessions

ex.
- obsession with contamination–>compulsion hand washing
- obsession doubt–>compulsion checking/hoarding
- obsession symmetry–> compulsive straightening

Question 22

What medication categories are used to treat OCD?

Answer 22

[Medications may take 2-3 months for benefit]

1. SSRI
2. clomipramine [serotonergic TCA]

Question 23

What psychotherapies are most commonly used to treat panic disorders and OCD?

Answer 23

A. CBT with emphasis on behavioral techniques

1. exposure and response prevention = make patient 1touch doorknobs and then don’t allow them to wash their hands.
   - flooding = exposure in vivo
   - implosion = exposure via mental imagery

B. Psychosurgery - lesion to the proposed hyperactive neural circuit

Question 24

What is Body Dysmorphic Disorder?

Answer 24

When the patient has preoccupation with having a physical deformity that is so significant that it can be considered obsession or delusion.

There is NO deformity or a minor blemish.

Question 25

Is anorexia nervosa considered a body dysmorphic disorder?

Answer 25

According to DSM5, no.

Question 26

Describe the onset and progession of body dysmorphic disorder. What doctors do these people tend to see first?

Answer 26

It is insidious and gradually worsening.

They see derm and plastics first but NO medical interventions should be done as this will make things worse

Question 27

What substances can lead to OCD?

Answer 27

1. amphetamines [Meth]
2. cocaine

obsession, compulsion, skin picking, hair pulling, repetitive behaviors

Question 28

What medical conditions can cause OCD?

Answer 28

1. sydenham’s chorea - neurologic manifestation of group A strep infection
2. PANDAS - pediatric autoimmune neuropsychiatric disorders associated with streptococcus