Anxiety Disorders and OCD & Related

Question 1

describe when anxiety is abnormal

Answer 1

• elicited by inappropriate cues (or no cues)
• excessive in intensity
• excessive in duration (usually ≥ 6 months)

Question 2

describe diagnostic criteria for panic disorder

Answer 2

• recurrent and unexpected panic attacks (the exact # of attacks is not specified)
• for ≥ 1 month, the individual shows either:
  
  • fear of future panic attacks OR
  • a sig. change in behavior related to the attacks (e.g. avoidance of exertion, needing an escort)

Question 3

describe diagnostic criteria for agoraphobia

Answer 3

• ≥ 2 of these situations are feared/avoided:
  
  • using public transportation
  • being in open spaces
  • being in enclosed spaces
  • standing in line or being in a crowd
  • being outside of the home alone
• these situations are feared/avoided because of thoughts that escape might be difficult (or help might not be available) if incapacitating/embarrassing symptoms develop

Question 4

explain how agoraphobic can develop in panic disorder patients and how agoraphobia can develop without PD

Answer 4

• PD + agoraphobia
  
  • a PD pt avoids multiple situations (agoraphobia list) due to fear of not getting help during a panic attack
  • diagnosis: PD and agoraphobia
• agoraphobia can develop without PD:
  
  • an elderly person avoids multiple situations (agoraphobia list) due to fear of not being able to escape if incontinence strikes

Question 5

describe diagnostic criteria for specific phobias

Answer 5

• a phobia is an excessive, persistent and disproportional fear of an object or situation
• the fear invariably occurs when exposed to the stimulus, or the person avoids the phobic situation
• the fear causes marked distress/impairment and isn’t accounted for by a different disorder
• subtypes:
  
  • animals
  • natural environment
  • situational
  • blood-injection-injury
  • other

Question 6

describe diagnostic criteria for social anxiety disorder

Answer 6

• excessive, persistent and unrealistic fear of social situations involving possible scrutiny by others due to fear of negative evaluation
• specifiy “performance only” if the fear is restrained to speaking or performing in public
• major differential is avoidant personality disorder
  
  • SAD would have strong physical response (heart racing, sweating, terror)

Question 7

describe diagnostic criteria for generalized anxiety disorder (GAD)

Answer 7

• persistent uncontrolled anxiety about multiple events for ≥ 6 months
• accompanied by symptoms such as:
  
  • restless, on edge
  • decreased conc.
  • muscle tension
  • fatigued
  • irritability
  • insomnia

Question 8

describe diagnostic criteria for separation anxiety disorder

Answer 8

• developmentally inappropriate and excessive anxiety concerning separation from major attachment figure
• person experiences marked distress (mental and physical) about:
  
  • anticipated or actual separation
  • losing or harm befalling major attachment figure or self that leads to separation
  • going out (to school, work, sleeping away) because of separation fears

Question 9

describe diagnostic critera for selective mutism

Answer 9

• refusal to speak in specific situations despite fluent speech in other contexts
  
  • written communication and social play may also be affected
  • refusal to speak is anxiety-based
• symptoms persist for ≥ 1 months (not the first month of school)
• not due to lack of language knowledge or a communication disorder (e.g. stuttering)

Question 10

explain differentials of the anxiety disorders

Answer 10

• anxiety disorders due to another medical condition
  
  • hyperthyroidism
• substance-induced anxiety disorders
  
  • caffeine, sedative withdrawal

Question 11

explain the development of anxiety problems

Answer 11

largely learned through classical conditioning (learning through association)

• specific phobia: the phobic object was once associated with a fear-producing stimulus
  
  • a boy fears dogs because he was bitten by one
• panic disorder: physical symptoms of anxiety have been associated with the full fear response
  
  • a physical symptom alone now triggers a full fear response
  • tachycardia causes a man to feel terror, tingling, choking, fear of dying, etc.

Question 12

describe the correlates of amygdala, prefrontal cortex and hippocampus in anxiety

Answer 12

• amygdala
  
  • initiates fear response via activation of the hypothalamic-pituitary-adrenal axis
• prefrontal cortex
  
  • should inhibit amygdala when fear response is no longer adaptive/necessary
• hippocampus
  
  • should track the context in which a fear response is learned and help to suppress fear when in safe contexts (and facilitate fear when in unsafe contexts)

Question 13

describe the role of CBT in treatment of anxiety

Answer 13

• cognitive-behavioral therapy
  
  • a type of psychotherapy involving:
    
    • modifying one’s thoughts to change emotion (cognitive aspect of CBT)
    • using exposure techniques to extinguish the emotion (behavioral aspect of CBT)

Question 14

describe medications that can be used to treat anxiety

Answer 14

• anxiolytic medications
  
  • typically try CBT first
  1. benzodiazepines
     
     • GABA agonists
     • recommended for short-term use only due to addiction potential
  2. antidepressants
     
     • monoamine agonists

Question 15

give a summary of anxiety disorders and their triggers

Answer 15

Question 16

describe diagnostic criteria for obsessive-compulsive disorder (ODC)

Answer 16

• recurrent obsessions or compulsions:
  
  • obsessions: intrusive recurrent thoughts, urges or images that increase distress
    
    • can be of delusional intensity
      
      • add specifier: OCD with absent insight (delusional beliefs)
  • compulsions: repetitive behaviors/mental acts that are performed to decrease distress
    
    • compulsions aren’t always logically related to the obsession
• obsessions/compulsions are time consuming or distressful/disruptive
• symptoms are not explained by another disorder (weight preoccupation in eating disorders)

Question 17

describe neuroanatomical explanation for OCD

Answer 17

• cortico-striato-thalamo-cortical (CSTC) circuit overactivity
• serotonin deficiency

Question 18

describe standard OCD treatment

Answer 18

1. behavioral therpay (exposure and response prevention, ERP)
   
   • expose patient to obsession without allowing patient to engage in compulsion
   • exposure can be in vivo (live) or imaginal
2. medications
   
   • antidepressants that selectively increase serotonin (SSRIs)

Question 19

describe how psychosurgery could help treat OCD

Answer 19

interrupt CSTC circuitry

• psychosurgery: surgical (or radiation) lesions of either of the following regions:
  
  • ant. cingulate gyrus (cingulotomy)
  • ant. limb of the internal capsule (capsulotomy)

Question 20

describe how deep brain stimulation can treat OCD

Answer 20

interrupt CSTC circuitry

• deep brain stimulation: electrical impulses are delivered by an indwelling brain electrode attached to an implanted thoracic pacemaker

Question 21

describe diagnostic criteria for body dysmorphic disorder (BDD)

Answer 21

• preoccupation with a perceived flaw in physical appearance (flaw is minimal/non-observable)
• repetitive behaviors or mental acts are performed in response to the appearance concerns
• the preoccupation is not better accounted for by an eating disorder
• the preoccupation in BDD must case functional impairment (e.g. sequestering oneself) – otherwise, the preoccupation may be considered normal vanity

Question 22

describe hoarding disorder (HD), excoriation disorder and trichotillomania

Answer 22

• hoarding disorder (HD): accumulation of possessions in living areas that compromises their intended use
• excoriation disorder: recurrent unwanted skin picking causing lesions
• trichotillomania: recurrent unwanted pulling out of one’s hair

Question 23

summarize OCD & related disorders

Answer 23