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Year 2 Medicine > Anxiety Disorders: Clinical Picture > Flashcards

Anxiety Disorders: Clinical Picture Flashcards

1
Q

Epidemiology - Anxiety Disorders v Bipolar v Schizophrenia

  • Schizophrenia and bipolar around …%, whereas anxiety disorders are more …
A
  • Schizophrenia and bipolar around 1%, whereas anxiety disorders are more common
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2
Q

Clinical picture of Acute Stress Reaction

  • Acute stress reaction lasts hours to … days
  • A response to exceptionally … events (physical/psychological)
  • Initial daze
  • Mixed and usually … picture
  • Individual v…
A
  • Acute stress reaction lasts hours to 3 days
  • A response to exceptionally stressful events (physical/psychological)
  • Initial daze
  • Mixed and usually changing picture
  • Individual vulnerability
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3
Q

Acute stress reaction lasts … to … days

A

Acute stress reaction lasts hours to 3 days

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4
Q

Typical symptoms of Acute Stress

  • Feelings of being … or …
  • Insomnia
  • R…
  • Poor C…
  • Autonomic arousal
  • Anger/anxiety/depression
  • W…
A
  • Feelings of being numb or dazed
  • Insomnia
  • Restlessness
  • Poor concentration
  • Autonomic arousal
  • Anger/anxiety/depression
  • Withdrawal
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5
Q

Typical symptoms of Acute Stress

  • Feelings of being numb or dazed
  • I…
  • R…
  • Poor concentration
  • … arousal
  • a../a…/d…
  • Withdrawal
A
  • Feelings of being numb or dazed
  • Insomnia
  • Restlessness
  • Poor concentration
  • Autonomic arousal
  • Anger/anxiety/depression
  • Withdrawal
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6
Q

List the 7 typical symptoms of acute stress

A
  • Feelings of being numb or dazed
  • Insomnia
  • Restlessness
  • Poor concentration
  • Autonomic arousal
  • Anger/anxiety/depression
  • Withdrawal
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7
Q

ADJUSTMENT DISORDER

  • Wide range of … or … symptoms
  • Stressor not necessarily … …
  • Out of … to stressor
  • Lasts up to … months
A
  • Wide range of emotional or behavioural symptoms
  • Stressor not necessarily life threatening
  • Out of proportion to stressor
  • Lasts up to 6 months
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8
Q

PTSD

  • Response to exceptionally … or … event
    • … experienced ,witnessed … event that involved actual or threatened … or serious … …. or threat to physically … of self or others.
    • … response involved intense …, h… or horror …
A
  • Response to exceptionally threatening or catastrophic event
  • … experienced ,witnessed … event that involved actual or threatened death or serious injury …. or threat to physical integrity of self or others.
  • … response involved intense fear, helplessness or horror …
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9
Q

PTSD symptoms

  • Re-… flashbacks/nightmares
  • Numbness/detachment
  • A…
  • Hypervigilance/startle
  • I…
  • Anxiety/depression
A
  • Re-experiencing flashbacks/nightmares
  • Numbness/detachment
  • Avoidance
  • Hypervigilance/startle
  • Insomnia
  • Anxiety/depression
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10
Q

PTSD symptoms

  • Re-experiencing f…/n…
  • N../D…
  • Avoidance
  • H…/s…
  • Insomnia
  • a…/d…
A
  • Re-experiencing flashbacks/nightmares
  • Numbness/detachment
  • Avoidance
  • Hypervigilance/startle
  • Insomnia
  • Anxiety/depression
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11
Q

List 6 PTSD symptoms

A
  • Re-experiencing flashbacks/nightmares
  • Numbness/detachment
  • Avoidance
  • Hypervigilance/startle
  • Insomnia
  • Anxiety/depression
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12
Q

PTSD course

  • Usually … onset
  • Most recover within … year
  • Rape victims
    • –…% at 2 weeks
    • –65% at 1 month
    • –42% at 6 months
A
  • Usually immediate onset
  • Most recover within 1 year
  • Rape victims
    • –94% at 2 weeks
    • –65% at 1 month
    • –42% at 6 months
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13
Q

PTSD course

  • Usually … onset
  • Most recover within 1 year
  • Rape victims
    • –94% at 2 weeks
    • –….% at 1 month
    • –…% at 6 months
A
  • Usually immediate onset
  • Most recover within 1 year
  • Rape victims
    • –94% at 2 weeks
    • –65% at 1 month
    • –42% at 6 months
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14
Q

Clinical Picture of GAD

  • Symptoms are …
  • Symptoms are not restricted to or strongly predominating in any particular set of circumstances
  • Characteristic features:
    • –Worry & a…
    • –h… & motor tension (restless / trembling)
    • –Autonomic … (sweating / palpitations / dry mouth / epigastric discomfort / dizziness)
A
  • Symptoms are persistent
  • Symptoms are not restricted to or strongly predominating in any particular set of circumstances
  • Characteristic features:
    • –Worry & apprehension
    • –Headache & motor tension (restless / trembling)
    • –Autonomic hyperactivity (sweating / palpitations / dry mouth / epigastric discomfort / dizziness)
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15
Q

Psychological Symptoms of GAD

  • f… anticipation
  • Irritability
  • Sensitivity to …
  • Restlessness
  • Poor …
  • … thoughts
A
  • Fearful anticipation
  • Irritability
  • Sensitivity to noise
  • Restlessness
  • Poor concentration
  • Worrying thoughts
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16
Q

Psychological Symptoms of GAD

  • Fearful anticipation
  • I…
  • S… to noise
  • R…
  • Poor …
  • Worrying thoughts
A
  • Fearful anticipation
  • Irritability
  • Sensitivity to noise
  • Restlessness
  • Poor concentration
  • Worrying thoughts
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17
Q

List the 6 symptoms of GAD

A
  • Fearful anticipation
  • Irritability
  • Sensitivity to noise
  • Restlessness
  • Poor concentration
  • Worrying thoughts
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18
Q

Additional symptoms of GAD

  • Sleep disturbances
    • –Insomnia, night …
  • S…
  • De…
  • F… with details
A
  • Sleep disturbances
    • –Insomnia, night terrors
  • Sadness
  • Depersonalisation
  • Fixation with details
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19
Q

Epidemiology of GAD

  • Lifetime prevalence: –8.9% (ICD-10 criteria)1
  • … > …
  • Estimated to be …x higher in patients in primary care clinics (indicated increased use of health care services)
  • High level of co-morbidity (~ …%), especially simple phobias, social phobia, panic disorder & depression
A
  • Lifetime prevalence: –8.9% (ICD-10 criteria)1
  • Women > men
  • Estimated to be 3x higher in patients in primary care clinics (indicated increased use of health care services)
  • High level of co-morbidity (~ 70%), especially simple phobias, social phobia, panic disorder & depression
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20
Q

Epidemiology of GAD

  • Lifetime prevalence: –…% (ICD-10 criteria)1
  • Women > men
  • Estimated to be 3x higher in patients in … care clinics (indicated increased use of health care services)
  • High level of co-morbidity (~ 70%), especially simple …, social …, … disorder & depression
A
  • Lifetime prevalence: –8.9% (ICD-10 criteria)1
  • Women > men
  • Estimated to be 3x higher in patients in primary care clinics (indicated increased use of health care services)
  • High level of co-morbidity (~ 70%), especially simple phobias, social phobia, panic disorder & depression
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21
Q

Aetiology of GAD - Genetic Predisposition

  • … fold increase in 1st degree relatives1
    • –….% in relatives of GAD sufferers
    • –3.5% in relatives of controls
  • Monozygotic = dizygotic
  • Shared heritability for GAD and mood disorders
  • In summary: Genetic factors play a modest role
A
  • Five fold increase in 1st degree relatives1
    • –19.5% in relatives of GAD sufferers
    • –3.5% in relatives of controls
  • Monozygotic = dizygotic
  • Shared heritability for GAD and mood disorders
  • In summary: Genetic factors play a modest role
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22
Q

Aetiology of GAD - Genetic Predisposition

  • Five fold increase in … degree relatives1
    • –19.5% in relatives of GAD sufferers
    • –…% in relatives of controls
  • Monozygotic = dizygotic
  • Shared heritability for GAD and mood disorders
  • In summary: Genetic factors play a modest role
A
  • Five fold increase in 1st degree relatives1
    • –19.5% in relatives of GAD sufferers
    • –3.5% in relatives of controls
  • Monozygotic = dizygotic
  • Shared heritability for GAD and mood disorders
  • In summary: Genetic factors play a modest role
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23
Q

Aetiology of GAD - Association with life events

  • Several studies found an association with stressful / traumatic life events
  • The experience of even one very important unexpected negative event was associated with a …x ↑ in GAD in men and women
A
  • Several studies found an association with stressful / traumatic life events
  • The experience of even one very important unexpected negative event was associated with a 3x ↑ in GAD in men and women
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24
Q

Aetiology of GAD - Early environmental factors

  • Impact on development of anxiety and other negative emotions
  • … theory:
    • Parents or other consistent caregivers serve important function in a child’s development
    • They provide a protective and secure base from which the child can operate
    • Disruption leads to anxious … and …
    • Severe … leads to withdrawal and depression
A
  • Impact on development of anxiety and other negative emotions
  • Attachment theory:
    • Parents or other consistent caregivers serve important function in a child’s development
    • They provide a protective and secure base from which the child can operate
    • Disruption leads to anxious apprehension and dependency
    • Severe disruption leads to withdrawal and depression
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25
Q

Aetiology of GAD - Early environmental factors

  • Impact on development of anxiety and other negative emotions
  • Attachment theory:
    • … or other consistent … serve important function in a child’s development
    • They provide a … and secure base from which the child can operate
    • … leads to anxious apprehension and dependency
    • Severe disruption leads to … and …
A
  • Impact on development of anxiety and other negative emotions
  • Attachment theory:
    • Parents or other consistent caregivers serve important function in a child’s development
    • They provide a protective and secure base from which the child can operate
    • Disruption leads to anxious apprehension and dependency
    • Severe disruption leads to withdrawal and depression
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26
Q

Aetiology of GAD - Parenting 1

  • A healthy parent–child relationship fosters a sense of control over events.
    • … to child’s efforts at engagement
    • … of the child to explore and manipulate the environment.
  • A lack of … & … leads to a general perception of personal inefficacy which may predispose to … emotional states
  • … coupled with a lack of warmth and responsiveness toward the child could lead to …
A
  • A healthy parent–child relationship fosters a sense of control over events.
    • Responsiveness to child’s efforts at engagement
    • Encouragement of the child to explore and manipulate the environment.
  • A lack of warmth & encouragement leads to a general perception of personal inefficacy which may predispose to negative emotional states
  • Overprotection coupled with a lack of warmth and responsiveness toward the child could lead to anxiety
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27
Q

Aetiology of GAD - Parenting 2

  • Mothers of anxious preschool children were:
    • More … and …
    • … responsive to their children
  • Compared to controls, adults who rated their parenting as more protective and less caring:
    • Had … trait anxiety scores
    • Met … criteria for GAD & panic disorder
A
  • Mothers of anxious preschool children were:
    • More critical and intrusive
    • Less responsive to their children
  • Compared to controls, adults who rated their parenting as more protective and less caring:
    • Had higher trait anxiety scores
    • Met more criteria for GAD & panic disorder
28
Q

Aetiology of GAD - Parenting 3

  • One hypothesis is that the relationship of these early parenting experiences to the subsequent development of anxiety or depression is mediated by the early formation of cognitive … best described as a sense of … regarding future events in one’s life
A
  • One hypothesis is that the relationship of these early parenting experiences to the subsequent development of anxiety or depression is mediated by the early formation of cognitive vulnerability best described as a sense of uncontrollability regarding future events in one’s life
29
Q

Clinical picture of panic

  • …: Fear of losing control, going mad, fainting, dying, derealisation, depersonalisation.
  • …: Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes
A
  • Psychic: Fear of losing control, going mad, fainting, dying, derealisation, depersonalisation.
  • Somatic: Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes
30
Q

Clinical picture of panic

  • Psychic: Fear of losing …, going …, fainting, d…, derealisation, depersonalisation.
  • Somatic: pa…, tachy…, s…, t…, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, di…, faintness, paraesthesia, chills/flushes
A
  • Psychic: Fear of losing control, going mad, fainting, dying, derealisation, depersonalisation.
  • Somatic: Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes
31
Q

Somatic symptoms of panic:

A
  • Palpitations, tachycardia, sweating, trembling, dyspnoea, choking, chest pain, nausea, ‘butterflies’, urgency, dizziness, faintness, paraesthesia, chills/flushes
32
Q

Psychological symptoms of panic:

A
  • Fear of losing control, going mad, fainting, dying, derealisation, depersonalisation.
33
Q

Panic Differential Dx

  • Endocrine
    • –…glycaemia
    • –Phaeocromocytoma
    • –Carci…
  • Cardiovascular
    • –Arrythmia
  • Respiratory
    • –A…
  • Drugs
  • Neurological
    • –S…
    • –Vestibular
A
  • Endocrine
    • –Hypoglycaemia
    • –Phaeocromocytoma
    • –Carcinoid
  • Cardiovascular
    • –Arrythmia
  • Respiratory
    • –Asthma
  • Drugs
  • Neurological
    • –Seizures
    • –Vestibular
34
Q

Panic Differential Dx

  • Endocrine
    • –Hypo…
    • –Phaeocromocytoma
    • –Carcinoid
  • Cardiovascular
    • –A…
  • Respiratory
    • –Asthma
  • D…
  • Neurological
    • –Seizures
    • –V…
A
  • Endocrine
    • –Hypoglycaemia
    • –Phaeocromocytoma
    • –Carcinoid
  • Cardiovascular
    • –Arrythmia
  • Respiratory
    • –Asthma
  • Drugs
  • Neurological
    • –Seizures
    • –Vestibular
35
Q

Clinical Picture of Agoraphobia

  • Anxiety in specific context:
    • Away from …
    • In …
    • In situations they cannot easily …
  • Presents with anxiety symptoms & … …
  • Anxious cognitions about … and loss of … are common
  • … is common
A
  • Anxiety in specific context:
    • Away from home
    • In crowds
    • In situations they cannot easily leave
  • Presents with anxiety symptoms & panic attacks
  • Anxious cognitions about fainting and loss of control are common
  • Avoidance is common
36
Q

Epidemiology of Panic - General Info

  • Panic attacks: ..-…% of the population
  • Panic disorder:
    • 1.5-2.5% lifetime prevalence
  • Onset has two peaks: …-… & 45-54
A
  • Panic attacks: 7-9% of the population
  • Panic disorder:
    • 1.5-2.5% lifetime prevalence
  • Onset has two peaks: 15-24 & 45-54
37
Q

Epidemiology of Panic - General Info

  • Panic attacks: 7-9% of the population
  • Panic disorder:
    • …-…% lifetime prevalence
  • Onset has two peaks: 15-24 & ..-…
A
  • Panic attacks: 7-9% of the population
  • Panic disorder:
    • 1.5-2.5% lifetime prevalence
  • Onset has two peaks: 15-24 & 45-54
38
Q

Aetiology of Panic - Genetic Predisposition

  • Increased risk in 1st degree relatives ~ … fold
  • Increased concordance in all but one monozygotic twin study
  • Modest … suggested by family & twin studies
  • At least 50% environmental influences
A
  • Increased risk in 1st degree relatives ~ 7 fold
  • Increased concordance in all but one monozygotic twin study
  • Modest inheritability suggested by family & twin studies
  • At least 50% environmental influences
39
Q

Aetiology of Panic - Genetic Predisposition

  • Increased risk in 1st degree relatives ~ 7 fold
  • Increased concordance in all but one monozygotic twin study
  • Modest inheritability suggested by family & twin studies
  • At least …% environmental influences
A
  • Increased risk in 1st degree relatives ~ 7 fold
  • Increased concordance in all but one monozygotic twin study
  • Modest inheritability suggested by family & twin studies
  • At least 50% environmental influences
40
Q

Aetiology of Panic - Environmental Factors

  • Precipitating events in ..-..% of cases
    • S… / loss
    • Relationship difficulties
    • New …
  • Traumatic early life events
    • … parental separation
    • Traumatic childhood event – … fold increase
    • Early sexual abuse (<5 years of age)
A
  • Precipitating events in 60-96% of cases
    • Separation / loss
    • Relationship difficulties
    • New responsibilities
  • Traumatic early life events
    • Early parental separation
    • Traumatic childhood event – 3 fold increase
    • Early sexual abuse (<5 years of age)
41
Q

Aetiology of Panic - Environmental Factors

  • Precipitating events in 60-96% of cases
    • Separation / loss
    • … difficulties
    • New responsibilities
  • Traumatic early life events
    • Early parental …
    • Traumatic childhood event – 3 fold increase
    • Early … abuse (
A
  • Precipitating events in 60-96% of cases
    • Separation / loss
    • Relationship difficulties
    • New responsibilities
  • Traumatic early life events
    • Early parental separation
    • Traumatic childhood event – 3 fold increase
    • Early sexual abuse (<5 years of age)
42
Q

Aetiology of Panic - Biological Models

  • Panic attacks may be triggered in the locus …
    • –↑ firing associated with ↑ … etc
  • … agents (yohimbine & isoproterenol) stimulate attacks in sufferers
  • SSRIs are effective but contradictory findings regarding the role of serotonin
A
  • Panic attacks may be triggered in the locus coeruleus
    • –↑ firing associated with ↑ CO2 etc
  • Noradrenergic agents (yohimbine & isoproterenol) stimulate attacks in sufferers
  • SSRIs are effective but contradictory findings regarding the role of serotonin
43
Q

Aetiology of Panic - Biological Models

  • Panic attacks may be triggered in the … coeruleus
    • –↑ firing associated with ↑ CO2 etc
  • Noradrenergic agents (yohimbine & isoproterenol) … attacks in sufferers
  • … are effective but contradictory findings regarding the role of serotonin
A
  • Panic attacks may be triggered in the locus coeruleus
    • –↑ firing associated with ↑ CO2 etc
  • Noradrenergic agents (yohimbine & isoproterenol) stimulate attacks in sufferers
  • SSRIs are effective but contradictory findings regarding the role of serotonin
44
Q

… causes panic attacks in animals & … causes attacks in panic disorder patients

A

Cholecystokinin causes panic attacks in animals & pentagastrin causes attacks in panic disorder patients

45
Q

Clinical Picture of Specific Phobias

  • … anxiety in the presence of one or more particular objects or situations
  • Characterised by adding the name of the … (e.g. Spider Phobia)
  • Avoid jargon (e.g. Arachnophobia)
A
  • Inappropriate anxiety in the presence of one or more particular objects or situations
  • Characterised by adding the name of the stimulus (e.g. Spider Phobia)
  • Avoid jargon (e.g. Arachnophobia)
46
Q

Specific Phobias - Subtypes

  • B…, I…, injury – a specific case?
  • A.. & I…
  • Aspects of the … environment (e.g. heights)
  • S.. (e.g. flying)
  • Other (e.g. dental/medical procedures, choking, etc.).
A
  • Blood, injection, injury – a specific case?
  • Animals & Insects
  • Aspects of the natural environment (e.g. heights)
  • Situational (e.g. flying)
  • Other (e.g. dental/medical procedures, choking, etc.).
47
Q

Specific Phobias - Responses

  • Individuals with blood–injection–injury phobias exhibit a … anxiety reaction:
    • Initial short-lived sympathetic arousal
    • Followed by … arousal
    • May result in … syncope
    • The subjective experience tends to … and … rather than pure apprehension
  • In other subtypes, exposure to the phobic stimulus evokes intense anxiety that may meet the criteria for a situationally bound … …
  • There is extreme apprehension and desire to escape or avoid the phobic stimulus
A
  • Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction:
    • Initial short-lived sympathetic arousal
    • Followed by parasympathetic arousal
    • May result in vasovagal syncope
    • The subjective experience tends to disgust and repulsion rather than pure apprehension
  • In other subtypes, exposure to the phobic stimulus evokes intense anxiety that may meet the criteria for a situationally bound panic attack
  • There is extreme apprehension and desire to escape or avoid the phobic stimulus
48
Q

Specific Phobias - Responses

  • Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction:
    • Initial short-lived … arousal
    • Followed by … arousal
    • May result in vasovagal …
    • The subjective experience tends to disgust and repulsion rather than pure …
  • In other subtypes, exposure to the phobic stimulus evokes intense anxiety that may meet the criteria for a situationally bound panic attack
  • There is extreme …. and desire to escape or … the phobic stimulus
A
  • Individuals with blood–injection–injury phobias exhibit a biphasic anxiety reaction:
    • Initial short-lived sympathetic arousal
    • Followed by parasympathetic arousal
    • May result in vasovagal syncope
    • The subjective experience tends to disgust and repulsion rather than pure apprehension
  • In other subtypes, exposure to the phobic stimulus evokes intense anxiety that may meet the criteria for a situationally bound panic attack
  • There is extreme apprehension and desire to escape or avoid the phobic stimulus
49
Q

Aetiology of Specific Phobias - Genetics

  • All Specific Phobias: evidence for genetic transmission
    • …% of 1st degree relatives affected
  • Animal phobias:
    • monozygotic …%
    • Dizygotic 11%
A
  • All Specific Phobias: evidence for genetic transmission
    • 31% of 1st degree relatives affected
  • Animal phobias:
    • monozygotic 26%
    • Dizygotic 11%
50
Q

Aetiology of Specific Phobias - Psychological Theories

  • … approach: Symptoms related to unresolved unconscious conflicts
  • … conditioning: phobias are learned through association of negative experience with an object or situation
  • Marks’ ‘…’ theory maintains that commonly feared objects are those that historically threatened the survival of the individual or the species
  • Large number of studies suggest that phobias may be acquired via … learning
A
  • Psychoanalytic approach: Symptoms related to unresolved unconscious conflicts
  • Classical conditioning: phobias are learned through association of negative experience with an object or situation
  • Marks’ ‘preparedness’ theory maintains that commonly feared objects are those that historically threatened the survival of the individual or the species
  • Large number of studies suggest that phobias may be acquired via observational learning
51
Q

Aetiology of Specific Phobias - Psychological Theories

  • Psychoanalytic approach: Symptoms related to unresolved … conflicts
  • Classical conditioning: phobias are learned through … of … experience with an object or situation
  • Marks’ ‘preparedness’ theory maintains that commonly feared objects are those that historically threatened the … of the individual or the species
  • Large number of studies suggest that phobias may be acquired via … learning
A
  • Psychoanalytic approach: Symptoms related to unresolved unconscious conflicts
  • Classical conditioning: phobias are learned through association of negative experience with an object or situation
  • Marks’ ‘preparedness’ theory maintains that commonly feared objects are those that historically threatened the survival of the individual or the species
  • Large number of studies suggest that phobias may be acquired via observational learning
52
Q

Clinical Picture of Social Phobia

  • Inappropriate anxiety in:
    • Situations where the person is …
    • Situations where there is potential for …
  • Leads to … of trigger situations
    • Eating in public
    • Dinner parties
    • Committees, seminars, public speaking
A
  • Inappropriate anxiety in:
    • Situations where the person is observed
    • Situations where there is potential for criticism
  • Leads to avoidance of trigger situations
    • Eating in public
    • Dinner parties
    • Committees, seminars, public speaking
53
Q

Clinical Picture of Social Phobia

  • Inappropriate anxiety in:
    • Situations where the person is observed
    • Situations where there is potential for criticism
  • Leads to avoidance of trigger situations
    • … in public
    • … parties
    • Committees, S…, public …
A
  • Inappropriate anxiety in:
    • Situations where the person is observed
    • Situations where there is potential for criticism
  • Leads to avoidance of trigger situations
    • Eating in public
    • Dinner parties
    • Committees, seminars, public speaking
54
Q

Symptoms of Social Phobia

  • … anxiety
  • Feeling …
  • B…
  • T… (observed writing is a problem)
  • Relieved by A… (potential for abuse)
A
  • Anticipatory anxiety
  • Feeling anxious
  • Blushing
  • Trembling (observed writing is a problem)
  • Relieved by alcohol (potential for abuse)
55
Q

List the 5 symptoms of social phobia

A
  • Anticipatory anxiety
  • Feeling anxious
  • Blushing
  • Trembling (observed writing is a problem)
  • Relieved by alcohol (potential for abuse)
56
Q

Aetiology of Social Phobia

  • Both genetics and environmental factors contribute, with genetics contributing < … of the variance in the transmission
  • …% of relatives of probands vs 5% of relatives of controls
  • Monozygotic … dizygotic
A
  • Both genetics and environmental factors contribute, with genetics contributing < ⅓ of the variance in the transmission
  • 16% of relatives of probands vs 5% of relatives of controls
  • Monozygotic > dizygotic
57
Q

Clinical Picture of OCD 1

  • Obsessional thoughts / images
    • Words, ideas, beliefs and/or images
    • Recognised as …
    • Intrude … into the mind
    • They are …
  • … reduce anxiety
  • Cleaning/checking
  • … – ‘just right’
A
  • Obsessional thoughts / images
    • Words, ideas, beliefs and/or images
    • Recognised as own
    • Intrude forcibly into the mind
    • They are resisted
  • Compulsions reduce anxiety
  • Cleaning/checking
  • Precision – ‘just right’
58
Q

Clinical Picture of OCD 1

  • …. thoughts / images
    • Words, ideas, b… and/or i…
    • Recognised as own
    • Intrude forcibly into the mind
    • They are resisted
  • Compulsions reduce …
  • c…/c…
  • Precision – ‘just …’
A
  • Obsessional thoughts / images
    • Words, ideas, beliefs and/or images
    • Recognised as own
    • Intrude forcibly into the mind
    • They are resisted
  • Compulsions reduce anxiety
  • Cleaning/checking
  • Precision – ‘just right’
59
Q

Epidemiology of OCD - 2

  • … = …
    • Some reports suggest a slight … predominance
  • During adolescence, … > ….
  • Mean age of onset is ~ 20 years of age.
  • Prevalence 2-3%
A
  • Men = women
    • Some reports suggest a slight female predominance
  • During adolescence, boys > girls.
  • Mean age of onset is ~ 20 years of age.
  • Prevalence 2-3%
60
Q

Epidemiology of OCD - 2

  • Men = women
    • Some reports suggest a slight female predominance
  • During adolescence, … > ….
  • Mean age of onset is ~ … years of age.
  • Prevalence …-…%
A
  • Men = women
    • Some reports suggest a slight female predominance
  • During adolescence, boys > girls.
  • Mean age of onset is ~ 20 years of age.
  • Prevalence 2-3%
61
Q

OCD Co-morbidity

  • Major depressive episode: ~…% lifetime prevalence
  • ↑ lifetime risk for:
    • –… disorders
    • –… phobia
    • –… phobia
    • –panic disorder
    • –… disorders
    • –Schizophrenia
    • –tic disorders (~ …% in juvenile OCD)
  • ↑ prevalence of Tourette’s syndrome in relatives
  • Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD
A
  • Major depressive episode: ~67% lifetime prevalence
  • ↑ lifetime risk for:
    • –alcohol disorders
    • –social phobia
    • –specific phobia
    • –panic disorder
    • –eating disorders
    • –Schizophrenia
    • –tic disorders (~ 40% in juvenile OCD)
  • ↑ prevalence of Tourette’s syndrome in relatives
  • Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD
62
Q

OCD Co-morbidity

  • Major depressive episode: ~67% lifetime prevalence
  • ↑ lifetime risk for:
    • –alcohol disorders
    • –social phobia
    • –specific phobia
    • –… disorder
    • –… disorders
    • –s…
    • –… disorders (~ 40% in juvenile OCD)
  • ↑ prevalence of … syndrome in relatives
  • Unclear relationship between OCD & obsessive–compulsive …. … (OCPD), but it appears that OCPD is not a prominent risk factor for OCD
A
  • Major depressive episode: ~67% lifetime prevalence
  • ↑ lifetime risk for:
    • –alcohol disorders
    • –social phobia
    • –specific phobia
    • –panic disorder
    • –eating disorders
    • –Schizophrenia
    • –tic disorders (~ 40% in juvenile OCD)
  • ↑ prevalence of Tourette’s syndrome in relatives
  • Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD
63
Q

OCD Co-morbidity

  • Major … episode: ~…% lifetime prevalence
  • ↑ lifetime risk for:
    • –… disorders
    • –… phobia
    • –… phobia
    • –panic disorder
    • –eating disorders
    • –Schizophrenia
    • –tic disorders (~ 40% in juvenile OCD)
  • ↑ prevalence of Tourette’s syndrome in relatives
  • Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD
A
  • Major depressive episode: ~67% lifetime prevalence
  • ↑ lifetime risk for:
    • –alcohol disorders
    • –social phobia
    • –specific phobia
    • –panic disorder
    • –eating disorders
    • –Schizophrenia
    • –tic disorders (~ 40% in juvenile OCD)
  • ↑ prevalence of Tourette’s syndrome in relatives
  • Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD
64
Q

OCD Co-morbidity

  • Major depressive episode: ~67% lifetime prevalence
  • ↑ lifetime risk for:
    • –alcohol disorders
    • –social phobia
    • –specific phobia
    • –… disorder
    • –… disorders
    • –…
    • –… disorders (~ 40% in juvenile OCD)
  • ↑ prevalence of … syndrome in relatives
  • Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD
A
  • Major depressive episode: ~67% lifetime prevalence
  • ↑ lifetime risk for:
    • –alcohol disorders
    • –social phobia
    • –specific phobia
    • –panic disorder
    • –eating disorders
    • –Schizophrenia
    • –tic disorders (~ 40% in juvenile OCD)
  • ↑ prevalence of Tourette’s syndrome in relatives
  • Unclear relationship between OCD & obsessive–compulsive personality disorder (OCPD), but it appears that OCPD is not a prominent risk factor for OCD
65
Q

Aetiology of OCD - Genetics

  • …zygotic >> …zygotic
  • …-degree relatives of patients with …-onset OCD have a higher than expected incidence of OCD
A
  • Monozygotic >> dizygotic
  • First-degree relatives of patients with childhood-onset OCD have a higher than expected incidence of OCD
66
Q

Summary - Anxiety Disorders

  • Anxiety disorders are …
  • They represent an … of a normal response which conferred an … advantage
  • There is a vast overlap between the …
  • They represent a … failure, not a … weakness
A
  • Anxiety disorders are common
  • They represent an exaggeration of a normal response which conferred an evolutionary advantage
  • There is a vast overlap between the categories
  • They represent a biological failure, not a psychological weakness

Year 2 Medicine (162 decks)

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