Anxiety Disorders: GAD and OCD

Question 1

Generalized Anxiety Disorder

Answer 1

A. excessive anxiety and worry occurring more days than not for >6 months about a number of events/activities
B. individual finds it difficult to control the worry
C. 3 or more of following
1. restlessness, keyed up, on edge
2. being easily fatigued
3. difficulty concentrating or mind going blank
4. irritability
5. muscle tension
6. sleep disturbance
D. cause clinically significant impairment/distress in important settings
E. ruled out physiological cause
F. ruled out other mental disorder

Question 2

Resulting Behaviors of GAD

Answer 2

=reassurance seeking behavior
=subtle avoidance behaviors
-procrastination, checking, calling loved ones
=difficulty making decisions
-worry that they made the wrong decision after it’s made

Question 3

1. Prevalence of GAD
2. level of impairment
3. comorbidity

Answer 3

1. one year: 3%, lifetime 5.7%
   twice as common in women than men
2. functioning is not as impaired as with some other disorders
   frequent medical complaints –> vague, persistent somatic complaints
3. other anxiety disorders
   depression - lots of overlap
   -someone with depression and GAD will have worse impairment than someone with only GAD

Question 4

Tripartite model of depression and anxiety

Answer 4

1. anxious arousal: keyed up, restless, muscle tension
2. high negative affect: anger, fear, distress
3. low positive affect: inability to find pleasure in things

1 + 2 –> anxiety
-still able to find joy, brighten to good news, and then go back to worrying
2 + 3 –> depression
-psychomotor retardation, lethargic, not keyed up

Question 5

Etiology according to Psychodynamic Theory of GAD

Answer 5

• largely discounted

- unconscious conflict between ego and id, not adequately dealt with bc of poor defense mechanisms

Question 6

Etiology of GAD

Answer 6

=numerous uncontrollable unpredictable life events
-abuse, sick sibling, insecure job
-lack of control
=low tolerance for uncertainty
=intrusive over controlling parenting style
=biased attention toward threatening stimuli
=biased interpretation of ambiguous stimuli
=modest genetic heritability
=deficiency in GABA, excess CRH
-GABA inhibits anxiety
-CRH leads to excess cortisol

Question 7

What people with GAD thinks worrying does

Answer 7

=helps avoid catastrophe
-gives control, superstitious quality 
=helps avoid deeper emotional topics 
-distract yourself --> worry about financial health because you are unhappy with job 
=helps cope and prepare

Question 8

What worrying actually does

Answer 8

• greater sense of danger and anxiety
• more negative intrusive thoughts
• paradoxical increase in thoughts that you are trying to avoid

Question 9

Treatment for GAD

Answer 9

=medication

=Cognitive Behavioral Therapy

Question 10

GAD medication

Answer 10

=medication tends not to be too effective
=Benzodiazepine
-sedating
-interact with other drugs, ex alcohol - makes you drunker
-addicting, tolerance
-rebound –> return to same level when you get off them
=SSRIs
-antidepressants can be effective
-delayed effect, 4-6 weeks
-rebound
-sexual side effects

Question 11

CBT for GAD

Answer 11

=aimed at reducing distorted cognition and information processing
=cognitive restructuring
=minimizing catastrophizing over minor events
=muscle relaxation

Question 12

Obsessive Compulsive Disorder

Answer 12

A. presence of obsessions which the individual attempts to neutralize with compulsions that reduce anxiety
B. they are time consuming and cause clinically significant impairment
C. ruled out physiological cause
D. ruled out other mental disorder

Question 13

Obsessions

Answer 13

• recurrent unwanted disturbing thoughts
• feel intrusive, foreign
• attempts to avoid them lead to to anxiety

Question 14

Compulsions

Answer 14

• repeated, ritualistic behaviors or mental acts that people feel they must perform to reduce distress caused by obsessions
• obsessions and compulsions are not always clearly linked - ex touching an object repeatedly because it is associated with calming down violent thoughts

Question 15

OCD in the media / actual level of impairment

Answer 15

• used for comic relief

- in reality one of the most impairing because of the time it takes up

Question 16

Common OCD Themes across cultures and ages

Answer 16

=dirt - handwashing, contamination
=acting out - violent, aggressive, sexual
-mental rituals - counting, repeating
-orderliness, symmetry, arranging
-pathological doubt –> forgetting something, stove off, door locked
-compulsion is checking

Question 17

1. Prevalence of OCD
2. age of onset
3. comorbidity

Answer 17

1. -one year: 1.2%
   - lifetime: 2.3%
   - little or no sex differences
2. -onset in children or early adulthood
   - more common in boys when onset is in childhood
   - early onset is worse prognosis, will have worse symptoms
3. highly comorbid
   - phobias, GAD, depression

Question 18

Etiology (not biological) of OCD

Answer 18

=Learned Behavior 
=evolutionary preparedness
-germs are bad, you want to avoid them 
=effort to suppress  
=inflated sense of responsibility 
=biased attention toward disturbing material

Question 19

OCD as Learned Behavior

Answer 19

internal/external stimulus –> obsession distress and anxiety –> ritualized behavior temporary relief from anxiety (reinforces behavior)
-continue going back to ritual because anxiety relief is only temporary

Question 20

OCD efforts to suppress

Answer 20

-people who ruminate on weird thoughts instead of letting them go

Question 21

OCD inflated sense of responsibility

Answer 21

• people who equate having a thought with acting on it, think having a bad thought is the moral equivalent of doing it
• most people recognize that everyone has weird thoughts

Question 22

Etiology (biological) of OCD

Answer 22

=most genetic of any disorder
=structural abnormalities in the brain
-overactivation of orbital frontal cortex - area responsible for primitive urges
-dysfunction in communication with other brain parts
-urges that should stay in orbital frontal cortex leak through to consciousness
=NT abnormalities
-serotonin - increased levels and sensitivity
-GABA, glutamate, dopamine - a little related

Question 23

Treatment of OCD

Answer 23

=exposure and response prevention - gold standard
=medication
=neurosurgery
-destroy brain tissues in implicated areas
-used only for very severe untreatable cases

Question 24

OCD: exposure and response prevention

Answer 24

• develop hierarchy - start with easier tasks

- evoke obsession (anxiety) and then prevent compulsion –> eventually anxiety subsides and association is broken

Question 25

Medication OCD

Answer 25

• mild to moderately effective
• ocd does not respond to a wide range of medication like other disorders
• respond best to those which affect serotonin system
• relapse rates are high after medication is stopped