Anxiety Disorders and Obsessive-Compulsive Disorder

Question 1

Separation Anxiety Disorder criteria

Answer 1

1. Fear of separation from attachment figures
2. 3+ symptoms (distress related to separation, school avoidance, physical symptoms related to separation)
3. Symptoms 4+ weeks (children) or 6+ months (adults)
4. Distress or impairment

Question 2

Separation Anxiety Disorder etiology

Answer 2

Often develops after stressful event (divorce, death, etc.)

Question 3

Separation Anxiety Disorder treatment

Answer 3

1. CBT combined with parent training
2. Getting child back to school is primary focus if applicable

Question 4

Specific Phobia criteria

Answer 4

1. Fear of specific object or situation
2. Avoidance or endurance with distress
3. Symptoms 6+ months
4. Distress or impairment

Question 5

Specific Phobia types

Answer 5

1. Animal
2. Natural environment (lightning, heights)
3. Blood-injection-injury
4. Situational (elevators, bridges)
5. Other (vomiting, choking)

Question 6

Specific Phobia prevalence

Answer 6

Rates are 2x higher in girls than boys (depending on type)

Question 7

Specific Phobia onset

Answer 7

Usually in childhood (mean age = 10 yo)

Question 8

Mowrer’s two-factor theory and Specific Phobia

Answer 8

Combination of classical and operant conditioning:
1. Classical = onset, neutral stimuli becomes anxiety-provoking
2. Operant = maintenance, avoidance is reinforcing

Question 9

Specific Phobia treatment

Answer 9

ERP

Question 10

ERP

Answer 10

1. Can be in vivo* or in imagination
2. Can be therapist-led* or self-guided
3. Flooding or graded/graduated
4. Lower attrition with graded exposure

Question 11

Virtual reality and ERP

Answer 11

1. Some evidence that VR is similar to in vivo
2. Especially useful for heights and flying

Question 12

Treatment for blood-injection-injury phobia

Answer 12

Best when ERP is paired with tensing/relaxing muscles to prevent fainting

Question 13

Social Anxiety Disorder criteria

Answer 13

1. Fear of 1+ social situations involving exposure to scrutiny (mostly due to symptoms)
2. Avoidance or endurance with distress
3. Out of proportion
4. Symptoms 6+ months
5. Distress or impairment

Question 14

Social Anxiety Disorder treatment

Answer 14

Children:
1. CBT*
2. School-based CBT

Adults:
1. CBT and antidepressants* (SSRIs and SNRIs)
2. Evidence that guided internet-based CBT is similar to in-person CBT

Question 15

Panic Disorder criteria

Answer 15

1. Unexpected panic attacks
2. 1+ month of concern about additional attacks or effects of attack
3. Not due to medical condition

Question 16

Panic attack criteria

Answer 16

1. Intense fear or discomfort
2. Reaches peak within minutes
3. 4+ symptoms (heart palpitations, sweating, nausea, dizziness, fear of death, paresthesia)

Question 17

Panic Disorder medical condition rule-outs

Answer 17

1. Hyperthyroidism
2. Cardiac arrhythmia

Question 18

Panic Disorder treatment

Answer 18

1. Cognitive-behavioral* (interoceptive exposure with relaxation)
2. Antidepressants (imipramine) or benzodiazepines, with high relapse rates at discontinuation

Question 19

Agoraphobia criteria

Answer 19

1. Fear in 2+ situations
2. Fear or avoidance related to escape when symptomatic
3. Out of proportion
4. Fear/avoidance, need for companion, or endurance with distress almost always
5. Symptoms 6+ months
6. Distress or impairment

Question 20

Agoraphobic situations

Answer 20

1. Public transportation
2. Open spaces
3. Enclosed spaces
4. Crowds or lines
5. Being alone outside the home

Question 21

Agoraphobia treatment

Answer 21

1. In vivo ERP*
2. Usually graded, some evidence that flooding has better long-term outcomes
3. Some evidence that pairing ERP with relaxation is not more effective (key is tolerating distress)

Question 22

Generalized Anxiety Disorder criteria

Answer 22

1. Excessive worry about multiple stimuli
2. Difficult to control
3. 3+ symptoms (adults) or 1+ symptoms (children)
4. Symptoms most days for 6+ months
5. Distress or impairment

Question 23

Generalized Anxiety Disorder symptoms

Answer 23

1. Restlessness
2. Fatigue
3. Difficulty concentrating
4. Irritability
5. Muscle tension
6. Sleep disturbance

Question 24

Generalized Anxiety Disorder v. non-pathological anxiety

Answer 24

1. Uncontrollable
2. Larger number of stimuli
3. More likely to report somatic symptoms

Question 25

Generalized Anxiety Disorder worry stimuli (age)

Answer 25

Children: 1. Catastrophic events 2. Competence in sports, school Adults: 1. Health 2. Safety

Question 26

Generalized Anxiety Disorder co-morbidities

Answer 26

1. MDD* 2. Social anxiety disorder 3. Specific phobia 4. PTSD

Question 27

Generalized Anxiety Disorder etiology

Answer 27

1. Family history 2. Temperament (inhibition, neuroticism, harm avoidance) 3. Childhood trauma or chronic stress 4. Brain abnormalities

Question 28

Brain abnormalities linked to Generalized Anxiety Disorder

Answer 28

1. vlPFC and dlPFC 2. Anterior cingulate cortex 3. Posterior parietal cortex 4. Amygdala 5. Hippocampus 6. Reduced connectivity between PFC and anterior cingulate cortex/amygdala (weak control of amygdala response)

Question 29

Generalized Anxiety Disorder treatment

Answer 29

1. CBT* 2. Medications (SSRIs and SNRIs*, buspirone, benzodiazepine) 3. Some evidence for combined CBT and MI

Question 30

Obsessive-Compulsive Disorder criteria

Answer 30

1. Recurring obsessions and/or compulsions 2. Time-consuming (1+ hours per day), distress, or impairment

Question 31

Obsessions definition

Answer 31

1. Repetitive thoughts, urges, or images that are experienced as intrusive/unwanted 2. Attempts to ignore or suppress 3. Anxiety or distress

Question 32

Compulsions definition

Answer 32

1. Repetitive behaviors or mental acts 2. Response to obsession or rigid rule 3. Goal is to reduce anxiety or distress or prevent bad outcome 4. Excessive or not realistically connected to goal

Question 33

Obsessive-Compulsive Disorder specifiers

Answer 33

1. Level of insight 2. Presence of tics

Question 34

Obsessive-Compulsive Disorder prevalence (gender)

Answer 34

Males: 1. Earlier age of onset 2. Higher rates in childhood Females: 1. Slightly higher rates in adulthood

Question 35

Obsessive-Compulsive Disorder co-morbidities

Answer 35

1. Anxiety disorder* 2. Depressive or bipolar disorder 3. Impulse control disorder 4. Substance use disorder 90% have co-morbidities

Question 36

Neurotransmitter abnormality linked to Obsessive-Compulsive Disorder

Answer 36

Low serotonin

Question 37

Brain abnormalities linked to Obsessive-Compulsive Disorder

Answer 37

Hyperactive: 1. Caudate nucleus 2. Orbitofrontal cortex 3. Cingulate gyrus 4. Thalamus

Question 38

Obsessive-Compulsive Disorder treatment

Answer 38

1. ERP and medication* 2. Some evidence for CBT for OCD 3. Some evidence for ACT for OCD

Question 39

Obsessive-Compulsive Disorder medications

Answer 39

1. SSRI 2. Clomipramine Ineffective as standalone for severe symptoms

Question 40

Body Dysmorphic Disorder criteria

Answer 40

1. Preoccupation with flaw in appearance 2. Flaw not observable or minor to others 3. Compulsions related to flaw 4. Distress or impairment

Question 41

Body Dysmorphic Disorder associated symptoms

Answer 41

1. Seek to correct flaw medically 2. Ideas/delusions of reference (others are mocking them, others are noticing the flaw)