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Anxiety Disorders Flashcards

1
Q

When does OCD usually present?

A

Teens/20s

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2
Q

What are the most common comorbidities with OCD?

A 
Major depression
Tics
Phobias
Eating disorders
Alcohol
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3
Q

Describe the thoughts associated with OCD?

A

Obsessional thoughts
Intense impulse, thoughts or images which provoke intensity
Repetitive, intrusive, unwanted and resisted

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4
Q

Do patients have insight into their thoughts in OCD?

A

Yes - thoughts are unpleasant and unwanted but recognised as own and irrational

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5
Q

What is the most common thought had in OCD?

A

Contamination/uncleanliness

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6
Q

Describe the acts associated with OCD?

A

Internalised and ritualised consequences of obsession to remove the anxiety caused by thoughts
E.g. Washing

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7
Q

What percentage of people have only the obsessive thoughts in OCD (no actions)?

A

25%

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8
Q

What is the mainstay of therapy for OCD? What are the 2 types?

A

CBT

Exposure response prevention ERP and cognitive therapy CT

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9
Q

Describe exposure response prevention and how it is performed?

A

Graded exposure to stressful situation and prevention of compulsive response until anxiety goes away
Every day for at least 1-2 weeks, either with guided self help or direct professional contact

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10
Q

Describe how cognitive therapy is used in OCD?

A

Psychological treatment aimed at changing response to thoughts, rather than get rid of them
Often used alongside ERP or for the 25% that have only obsessional thoughts

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11
Q

What medications may be utilised in OCD? When?

A

SSRIs to help reduce the obsessions and compulsions

Often used alongside ERP/CT for moderate to severe OCD

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12
Q

What are the second line pharmacological treatment options for OCD after one SSRI?

A

Try another SSRI

Or use clomipramine - at low doses acts like SSRI

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13
Q

How long is medication recommended for in OCD and how does it help?

A

At least 12m

Reduces symptoms and prevents return of symptoms

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14
Q

What is the caveat to taking medications for OCD and how is this risk reduced?

A

50% relapse rate

Less likely if CBT also used

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15
Q

Management of OCD?

A

For mild CBT alone effective
For moderate can choose CBT (10 hours professional contact) or 3m of medication
For severe try both together

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16
Q

Options for treatment resistant OCD?

A

CT plus ERP plus medication
Polypharmacy e.g. Clomipramine plus citalopram
Antipsychotics e.g. Aripiprazole or risperidone
Treat comorbidities
DBS?

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17
Q

What is the difference between OCD and obsessive compulsive personality disorder?

A

OCD is egodystonic so causes distress

OCPD is egosyntonic so fits in with individuals personality and does not cause distress

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18
Q

Where can be targeted in surgical management of OCD?

A

Cingulate cortex ACC - can use DBS or lesions
Also ECT, VNS
Also anterior ventral capsullotomy with gamma knife

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19
Q

What is the most recent site of use for DBS in OCD?

A

VC/VS - ventral capsule ventral striatum area

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20
Q

What 3 features of anxiety make it more likely to be pathological?

A

Persistence
Frequency
Intensity

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21
Q

What is commonly comorbid with agoraphobia and how do the 2 relate chronologically?

A

Panic disorder

The agoraphobia usually develops within one year of panic disorder

22
Q

What are the 8 broad types of anxiety disorder?

A 
Phobic anxiety disorder
Stress reaction
Generalised anxiety disorder
Obsessive compulsive disorder
Somatoform disorders
Dissociative disorders
Mixed anxiety and depressive disorders
Neuraesthenia
23
Q

4 types of phobic anxiety disorder?

A

Agoraphobia
Panic disorder
Social phobia
Specific phobias

24
Q

3 types of stress reaction disorders?

A

Acute stress reactions

Chronic stress reactions - PTSD and adjustment disorder

25
5 somatoform disorders?
``` Hyperchondriasis Somatisation disorder Conversion disorder Body dysmorphic disorder Pain disorder ```
26
Types of dissociative disorders?
Depersonalisation Derealisation Dissociative fugue Dissociative identity disorder
27
What is feared in agoraphobia?
Open spaces (agora = market) Crowds Feeling trapped Travelling alone
28
3 therapies useful for agoraphobia?
Cognitive behavioural therapy Behavioural therapy Rational-emotive therapy
29
When does agoraphobia usually present?
Age 18-35
30
What characterises panic disorder?
Paroxysmal panic attacks with physical and emotional symptoms
31
What is often comorbid with panic disorder?
Agoraphobia | As well as suicide, depression and substance abuse
32
Describe social phobia?
Incapacitating anxiety in situations of social evaluation leading to symptoms and subsequent escape/avoidance
33
What is the best psychological therapy for phobias?
Systematic desensitisation (exposure)
34
When do acute stress reactions occur?
Sx develop over minutes to hours following acute often unexpected life event
35
Symptoms of acute stress reaction? How long do they last?
Low mood, irritability, emotional fluctuance, poor sleep, poor concentration, isolation etc. Usually settle over few hours if not days-few weeks
36
What is situational anxiety?
Like an acute stress reaction but occurring before the event
37
How are chronic stress reactions divided up?
Whether the event was 'life threatening' or not | So PTSD it was, adjustment disorder it wasn't
38
Symptoms of PTSD?
Recurring thoughts, flashbacks, images, dreams relating to event and subsequent distress Hypervigilance Avoidance of possible triggers Emotional blunting and avoidance/detachment from others Depressive Sx including anhedonia, pessimism, poor concentration
39
What is adjustment disorder?
Chronic stress reaction following a relatively common life event e.g. Divorce, house move Mixed often depressive Sx develop within days-weeks after stressor (but within 1m) and can last upwards of 6m
40
What is generalised anxiety disorder?
Anxiety present most days for long period of time, often no identifiable triggers
41
Symptoms of anxiety disorder (non-physical)?
``` Restlessness/ feeling of being on edge Tiring easily Poor sleep Difficulty concentration Irritability Muscle tension ```
42
What is somatisation disorder?
Multiple symptoms from different organ systems, usually developing in early adulthood
43
What disorder is characterised by multiple different organ systems resulting in Sx over a long period of time, with no organic basis?
Somatisation disorder
44
What is hyperchondriasis?
Acknowledgement that symptoms are minor but belief that they are due to serious underlying cause e.g. Headache is brain tumour
45
What is conversion disorder?
Present with Sx suggestive of serious underlying neurological disease e.g. Blindness, paresis, deafness Often quickly developing in response to stressful situation
46
What is body dysmorphic disorder?
Repeated concern about appearance and belief that there is a physical defect that no one else can see, or a small imperfection is made enormous
47
What is a dissociative fugue?
Travel to a new location during temporary depersonalisation before assuming new identity and new life, often with preceding severe amnesia Usually lasts few days, can be longer
48
What is the proper name for multiple personality disorder?
Dissociative identity disorder
49
What are the 2 types of neuraesthenia? What often accompanies both?
Massive physical fatigue after mental exertion Physical exhaustion, aches/pains and inability to relax after minimal effort Often accompanied by anxiety/depressive symptoms, sleep disturbances and general physical malaise
50
What is buspirone?
Anxiolytic psychotropic often used for GAD
51
What role may benzodiazepines play in anxiety management?
Rx of acute or severe anxiety reactions
52
What caveat does antidepressant e.g. SSRI use for anxiety have?
May worsen before get better, and may take up to 2-4 weeks to begin having effect

Psych Y5 (13 decks)

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