Anxiety and OCD Flashcards
1
Q
what are the two classes of anxiety ?
A
- physiological
- pathological
2
Q
what is physiological anxiety ?
A
- anticipation of a stressful events
- acts as a stimulus to help us prepare of an event
‘useful anxiety’
3
Q
what can physiological anxiety do ?
what is an example of this ?
A
increase alertness and focus on ‘threat’
e.g. exam stress
4
Q
give an example of when physiological anxiety becomes pathological ?
A
stressing so much for an exam that you can’t sleep or it affects performance
5
Q
what is pathological anxiety ?
A
- where anxiety is out of proportion to the threat
- or anxiety without a threat
6
Q
what are some problems with pathological anxiety ?
A
- can interfere with day to day activities
- can be disabling
7
Q
what are 5 examples of pathological anxiety ?
A
- panic attacks
- phobias
- OCD
- PTSD
- genralised anxiety disorder
8
Q
what is a short definition of Generalized Anxiety Disorder ?
A
ongoing and no reason or focus of the anxiety/ chronic worry
9
Q
what is a short definition of panic attacks ?
A
- marked physical symptoms of anxiety
10
Q
what a short definition of phobia ?
A
irrational fear of specific things
11
Q
what is a short definition of OCD ?
A
obsessive and compulsive behaviours
12
Q
what is a short definition of social anxiety disorder ?
A
phobia of social interactions
13
Q
what is a short definition of PTSD ?
A
recall of past stressful events
14
Q
what are psychological symptoms of pathological anxiety ?
A
- fearful anticipation
- congitive disturbance
- irritability
- minor depressive symptoms
15
Q
what are some phsyical symptoms of pathological disorders ?
A
- sympathetic arousal (e..g high HR, sweating etc.)
- hyperventilation
- sleep disturbance
- increased muscle tension
16
Q
what do we see in many types of anxiety disorders ?
A
physiological and psychological symptoms
17
Q
what is the life time prevelance of anxiety ?
A
20-30%
number of people who will experience an anxiety disorder at some time in their life
18
Q
how many adults in a given year have an anxiety disorder ?
A
10-20% of adults
19
Q
what is the global market cost of GAD medication ?
A
$7 billio
20
Q
why is anxiety so common ?
A
physiological anxiety from ancestors (for survival) has transferred inot normal life (as our biology hasn’t changed)
21
Q
what are the 2 types of treatments for anxiety ?
A
- anxiolytic drugs
- psychological therapy
22
Q
what are 5 types of anxiolytic drugs that can be used to treat anxiety ?
A
- beta blockers
- antidepressants
- pregabalin
- buspiron
- benzodiazepines
23
Q
what does NICE recommend for the first line treatment of anxiety disorders ?
A
psychological therapies first, drugs as second line
24
Q
what is the DSM-5 criteria for diagnosing GAD ?
A
- excessive worry/anxiety for most of the time > 6 months
- worry about a number of different things
- cannot control worry
- at least three of: restlessness, fatigue, poor concentration, irritable, sleep probelms
- symptoms have to result in poor functioning, cannot be manged by patient and are not due to drugs or other psychiatric conditions
rare to get a full resolution of GAD
25
what is the difference between DSM and ICD criteria for GAD ?
DSM-5 is stricter than ICD-II, fewer diagnosed in US compared to countries that don't used DSM-5
26
what are the statistics for GAD / where does it normally present?
- around 2-4% of population in a year
- more common in women
- higher in middle age
27
what is the etiology for GAD ?
- twin studies show a 30% heritability (no one gene, but links to 5HT and MA transmission genes)
- risk factors: childhood trauma, other health conditions (e.g. stroke or heart attack)
28
what genes have been linked to GAD ?
genes involved in serotonergic and monoamine transmission
29
what are 2 risk factors for GAD ?
- childhood trauma
- other health conditions e.g. stroke or heart attack
30
what is the potential neurobiology behind GAD ?
- dysfunction of the maygdala, medial prefrontal cortex and insular cortex
- all involved in memory, decision making and emotiona reaction, fear and threat
31
where can we find the insular cortex ?
between temporal and parietal lobe
## Footnote
sometimes seen as part of temporal, sometimes as its own structure
32
what is the NICE recommendation for GAD ?
4 step approach
- education: may in itself improve symptoms
- individual or group self- or guided-help (based on CBT)
- drug therapy or high intensity CBT
- combinations of drugs or drugs + psychological interventions
## Footnote
use next step if previous step doesn't work
33
where are benzodiazepines used in GAD ?
only for short terms use
34
what type of drugs can be used to treat GAD ?
- SSRIs
- SNRIs
- pregabalin
- (BDZ)
35
aside from helping with anxiety, what can pregabalin also be used for ?
anticonvulsant
36
what are the mechanisms of Buspirone?
partial agonist at 5HT1A receptors
37
where are 5HT1A receptors found?
pre and post synaptically
38
what are the actions of 5HT1A receptors pre-synapticaly ?
- act as inhibitory autoreceptors in serotonergic synapses
- and heteroreceptors in other synapse types
39
what does buspirone do ?
modulates the release of 5HT and other neurotransmitters
40
in what kind of anxiety disorder is Busprone often used ?
GAD (and some other anxiety disorders)
41
what is the main advantage of Buspirone ?
unlike benzodiazepines, it does not produce pronouned sedation and has mild side effects
42
what are some potential limitations of Buspirone ?
potential for discontinuation syndrome, but some research suggests no withdrawl effects
43
what are panic attacks and related diagnosis of panic disorder ?
involve episodes of intense anxiety with a sudden onset over a few minutes including both physical and psychological symptoms
44
what do the physical symptoms of panic attacks include ?
- high levels of sympathetic activation e.g. high HR, trembling, sweating, chest pain
- parasthesia (pins and needles)
45
what do the psychological symptoms of panic attacks include ?
- depersonalization
- derealization
- fear of losing control or of dying
46
what is depersonalization ?
seperated from yourself
47
what is derealization ?
seperated from reality
48
when can panic attacks occur ?
- due to other anxiety dsorders e.g. phobias (not just panic disorder)
- physical conditions e.g. hyperthydrodism
49
what are some of the DSM-5 criteria for being diagnosed as having had a panic attack ?
must experience 4 out of 13 symptoms
e.g.
- palpitations, pounding heart
- sweating
- trembling
- shortness of breath
- chest pain
- dizzy, unsteady, light-headed
- paresthesias
- derealization
- fear of dyig
- fear of losing control
- fear of going crazy
- nausea
- chills or heat sensations
50
what is panic disorder ?
recurrent panic attacks AND
- a period of at least a month in which there is persisten anxiety about having a panic attack
and/or
- changed behaviour aimed at avoiding panic attacks e.g. avoiding social situations
## Footnote
you can have multiple panic attacks and not have panic disorder
51
what are the NICE recommendations for mild-moderate panic disorder ?
- low intensity psychological interventions
- e.g. self-help, support groups
52
what are the NICE recommendations for moderate-severe panic disorder ?
- CBT
(or if not effective)
- SSRI or SNRI
(if not effective)
- trycyclic AD
53
when are Beta blockers used for ?
not on NICE guidelines, but are sometimes used in anxiety disorders
- short term
- low dose along-side SSRIs
- or on an as needed basis for particular situations
54
what are two examples of situations beta blockers can be used for ?
- for particular triggers e.g. phobias
- performance anxiety
55
what is the main beta blocker used in treating anxiety ?
propranolol
56
what are the mechanisms of action for beta blockers like propranolol ?
- B1 adrenoceptor antagonist
57
what are the effects of beta blockers like propranolol?
- mask symptoms of sympathetic activation
- reduce physical effects of panic attacks
## Footnote
reducing sympathetic activation can reduce psychological symptoms
58
what is a phobia ?
unreasonable fear of a specific object or situation
59
what are some examples of phobias ?
- heights
- enclosed spaces
- spiders
- blood
60
what are some syptoms produced by phobias ?
- intense fear or panic (when confronted with phobia or even thinking about it)
- knowing reaction is out of proportion, but not being able to control it
- trying to avoid object/situation
- marked impact on functioning when confronted with phobia
61
What is the diagnostic criteria for 'specific phobia' in the DSM-5?
When the phobia causes significant impairment.
62
What is the primary treatment suggested for specific phobias according to the NHS website?
CBT with exposure therapy.
63
What does NICE say about computerized CBT for treating specific phobias?
Should not routinely be offered.
64
Name some types of antidepressants that might be used for treating specific phobias.
* SSRIs
* SNRIs
* Tricyclic antidepressants
* Moclobemide
65
What short-term medications are mentioned for treating specific phobias?
* Benzodiazepines
* Beta blockers
66
True or False: Avoidance of phobias always leads to a significant impact on life.
False
67
Fill in the blank: The treatment normally offered for specific phobias is _______.
[CBT with exposure therapy]
68
What is a common coping mechanism for individuals with phobias?
Avoidance.
69
what is social anxiety disorder ?
- social phobia
- fear of social siutations
- most commone type of anxiety disorder
70
what is the lifetime prevelance for social anxiety disorder ?
12%
71
what is the DSM-5 criteria for diagnosis for social anxiety disorder ?
- Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
- The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
- social situations almost always provoke fear or anxiety.
- social situations are avoided or endured with intense fear or anxiety.
- fear or anxiety is out of proportion to the actual threat
- fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
- fear, anxiety, or avoidance causes clinically significant distress or impairment in functioning.
symptoms have lasted > 6 months and are not better explained by another condition.
72
what is the NICE recommendations for first line treatment for social anxiety disorder ?
specialised CBT (more individual rather than group therap)
73
what do NICE recommend as a second-line treatment if CBT is ineffective for social anxiety disorder?
- SSRI in addition to further CBT
or
- SNRI or MAOIs as second or third line drug classes
74
what was the old classification for OCD compared to the new ?
OLD: grouped with anxiety disorders
NEW: own specific class of 'obsessive-compulsive and related disorders
## Footnote
there were also changes to diagnostic criteria in DSM-5
75
what does OCD stand for and why?
obsessive compulsive disorder
- obsessions and compulsions are the two main types of symptoms
76
what are obsessions in ODC ?
intrusive/disturbing thoughts
- usually have a particular theme e.g. sexual or violent or hygine
77
what drives compulsions in OCD?
the obsessions
78
what are complusions in OCD ?
repetitive, involuntary activities to provide temporary relief from obsessions
e.g. checking, counting, touching, or arranging things
## Footnote
people with OCD know their compulsions are not logical, which can be distrubing for them
79
what is pure O OCD, and what is another name for it ?
most problems arise from the intrustive thoughts, compulsions are hidden or a minor problem
- obsession dominant OCD
80
what can antidepressants be used for in OCD ?
to reduce frequency of episodes
81
what are the potential causes of OCD ?
( neurobiology largely unkown)
- genetic (50% ish) and epigenetic (childhood trauma)
82
what can potentially trigger OCD ?
atypical antipsychotics
## Footnote
can happen in people who didn't have it prior
83
what is trichotillomania ?
compusive pulling out of hair
## Footnote
can reuslt in bald patches
84
what is dermatillomania ?
compulsive picking at the skin
| common in people with contaminiation obsessions in OCD
## Footnote
can result in scaring
85
what are trichotillomania and dermatillomania classified as ?
body-focussed repetitive behaviours
86
why do trichotillomani and dermatillomania have their own classification in the DSM ?
can have these conditions/ compulsions without having obsessions
## Footnote
but have been linked to OCD
87
what are the NICE guideliness for treating mild impairement OCD ?
low intensity psychological interventions (<10h) e.g. CBT incorperating ERP (exposure response preventation)
88
what are the NICE guidelines for moderate impairement OCD ?
SSRIs OR more intense CBT inc. ERP
89
what are the NICE guideliness for serve impairement OCD ?
SSRIs AND more intense CBT inc. ERP
90
what is Exposure Response Preventation ?
you expose the person to what they are fearful of in a controlled way and gradually help the overcome their fear
91
what anxiety disorders is ERP often used in?
- OCD
- PTSD
- phobias
- social anxiety disorder
92
what is important to note about the NICE guideliness with ERP ?
not the extreme version of ERP, but CBT with ELEMENTS of ERP
93
what brain regions are suggested to play a role in OCD ?
- orbitofrontal cortex
- basal ganglia
- cingulate cortex
94
what part of the cingulate cortex may play a role in OCD and how ?
- anterior
- shows hyperativity
95
what is a psychosurgical technique that is used to treat OCD as a last resort ?
cingulotomy
96
what can a cingulotomy be used to treat ?
- OCD
- intractable pain
- depression
97
what is a cingulotomy ?
- severing connections to cingulate cortex
- done with aid of MRI scans
- either with electrodes or gamma knife
98
what are the benefits of a cingulotomy ?
- around 40% of people with OCD who undergo this surgery experience benefit
- quick recovery (few days)
- relatively few people experience serious side effects
99
what is PTSD ?
post traumatic stress disorder
100
when can someone develope PTSD ?
following any kind of trauma e.g. combat, sexual assult, terrorist attack, accidents
## Footnote
many potential triggers
101
what is the prevelance rate of PTSD in the US?
7% experience at some point in their life
102
what are the symptoms of PTSD ?
## Footnote
(6 points)
- hypervigilance
- aggression
- flashbacks to trauma
- cognitive problems
- intrusive thoughts and memories
- nightmares
103
what is the outcome of the symptoms of PTSD ?
they are extremely distressing and debilitating
- higher suicide rate (9.8x the general population)
104
what are episodes of PTSD often triggered by ?
specific triggers that are connected, if only lossely, to the origional trauma
## Footnote
e.g. if you lived in a war zone, a plane flying over head might trigger this
105
Im what group is PTSD prevelance rates the highest ?
rape survivors
106
what brain regions are involved in the development of PTSD ?
- reductions in volume of hippocampus and prefrontal cortex
- the amygdala becomes hyperresponsive (results in excessive threat responses to non-threatening stimuli)
107
what is the role of the amygdala ?
emotional processing and the acquisition of fear behaviours
108
how are changes in the HPA axis linked to PTSD ?
- people with PTSD have lower plasma cortisol levels
- greater response to dexamethasone suppression test than control
## Footnote
opposite to people with depression
109
what was surprising about the lowered cortisol levels in patients with PTSD, and what did this suggest ?
- would expect stress to increase cortisol
- but suggested that low cortisol after a traumatic event results in increased noradrenergic signalling in CNS and periphery
110
what do low levels of cortisol after a traumatic event link to in PTSD patients?
- increase release of NA by neurons in locus coeruleus
- results in 'over-consolidation' of fearful memories about trauma
111
whhat is an acute stress reaction ?
symptoms are similar to PTSD, but occur in immediate aftermath of trauma
## Footnote
before PTSD developed
112
what can be done to reduce that rate at which people develop PTSD ?
in people who experience acute stress reaction, CBT given in the month following the trauma can reduce the rate of develoment of PTSD and leson the symptoms of those who do develop it
113
what are the NICE recommendations for PTSD ?
(does not recommend drug treatments)
- established PTSD: CBT (EDMR for non-combat trauma)
- is patient prefers drug therapy: SSRIs or SNRIs instead of CBT
114
what is EMDR and when is it used ?
eye movement desensitization and reprocessing
- can be used to non-combat trauma in PTSD
115
what is offered as a drug treatment for PTSD with psychotic symptoms, and what is an example ?
atypical antipsychotic e.g. risperidone
116
what anxiety disorder is pregabalin licenced for ?
generalized anxiety disorder
## Footnote
also for epilepsy and neuropathic pain
117
what is the life time prevelance of anxiety disorders in the US ?
~30%
