anxiety and OCD

Question 1

disasters cause PTSD in ___% of direct victims and ___% of rescue workers

Answer 1

30-40% direct victims; 10-20% rescue workers

Question 2

Do pts with anxiety disorder warrant explicit evaluation for suicide risk?

Answer 2

yes

Question 3

what brain structures are primarily involved in fear?

Answer 3

amygdala and locus coeruleus

Question 4

what brain structures are involved in anxiety?

Answer 4

cortex (complex emotional processing), on top of fear structures

Question 5

describe the stress diathesis model:

Answer 5

stress leads to cortisol and adrenaline release, which cause shrinkage and death of hippocampal cells (mood regulation and memory consolidation), frontal-striate atrophy (anxiety), decreased glial density on PFC, release of inflammatory cytokines (leading to decreased neuronal genesis), and decreased BDNF release from astrocytes

Question 6

how does exercise help with anxiety?

Answer 6

increased BDNF, which helps with neuronal growth

Question 7

how does anxiety affect CV health?

Answer 7

inflammatory cytokines lead to endothelial dysfunction and atherosclerosis, serotonin dysfunction leads to increased platelet adhesion, cortisol leads to insulin resistance, autonomic dysfunction leads to sympathetic activation adn HTN

Question 8

what is the DSMV Dx criteria for panic disorder?

Answer 8

• both of recurrent unexpected attacks and followed by either persistent concerns about attacks or maladaptive changes in behaviour relating to attacks for >1mo
• abrupt surge of fear that peaks in minutes and includes >4 panic attack specifier sx
• r/o CVD/stroke/other medical causes

Question 9

what is agoraphobia?

Answer 9

fear in at least two situations that escape may be difficult or help may be unavailable if panic sx occur. provoking situation is avoided or endured with fear, fear is out of proportion to danger and cause functional impairment, lasting >6mo

Question 10

what are the 6 foundational sx of GAD?

Answer 10

• restlessness
• fatigue
• difficulty concentrating
• irritability
• muscle tension
• sleep disturbance

> 3 for GAD

Question 11

__% of pts with MDD has comorbid anxiety disorder

Answer 11

50%

Question 12

what are the sx of anxiety in MDD?

Answer 12

• tense
• restless
• difficulty concentrating due to worries
• fear that something awful will happen
• feeling of losing control of self

Question 13

common sx in ADHD and anxiety:

Answer 13

• worries about performance
• mind wandering
• overwhelmed/restless
• avoidance of situation due to ADHD sx
• sleep problems linked to restlessness

Question 14

what is the mainstay of pharma tx for anxiety?

Answer 14

SSRI/SNRI

Question 15

how does SSRI use in anxiety and MDD differ?

Answer 15

in anxiety: start with 1/2 MDD dose, increase over 4-6wks, aim higher target dose than MDD, wait longer for response (8-12wks)

Question 16

what is the mainstay of tx for OCD?

Answer 16

CBT, followed by SSRI