Anxiety disorders

Question 1

What are the core features of OCD?

Answer 1

Present on most days for at least 2 weeks:

1. obsessions: repetitive + distressing ideas/images/impulses that are acknowledged as originating in subject’s mind and as excessive or unreasonable AND/OR
2. compulsions: stereotyped behaviour that is not inherently enjoyable but is repeated to prevent some objectively unlikely event. Unsuccessfully resisted.

These cause distress/anxiety (worse if compulsive acts are resisted) + interfere with social or individual functioning, usually by wasting time.

Question 2

What are the Mx options for OCD?

Answer 2

1. low or high intensity psychological therapy e.g. CBT + exposure and response prevention
2. SSRI or clomipramine
3. +/- intensive inpatient therapy or supportive care if severe chronic dysfunction
4. +/- DBS

Question 3

A 23yo woman diagnosed with moderate OCD is started on paroxetine. How long for it to take effect? How long should she continue?

Answer 3

1. Delay in onset of up to 12 weeks.

2. Continue for at least 12 months following remission.

Question 4

A 33yo woman presents with fatigue + difficulty concentrating. She also mentions she feels constantly on edge and is often worries about various things (no specific trigger), at which point she feels palpitations, chest pain + difficulty breathing. This has been going on for 6/12 and has been gradually getting worse, affecting her most days now.

What is the likely diagnosis? Suggest an assessment tool you could you.

Answer 4

Generalised anxiety disorder

GAD-7

Question 5

What are the Mx options for GAD?

Answer 5

Stepped-care:

1. watchful waiting: education + monitoring
2. guided-self help or low intensity psychological support
3. anxiety Mx Txinc. relaxation training
4. CBT over 4/12
5. SSRI e.g. SERTRALINE, SNRIs
6. secondary care, crisis intervention, inpatient Mx