Anxiety et al Flashcards
What is the best psychotherapy for OCD?
Behavioral therapy involving exposure and response prevention
What is the best pharmacotherapy for OCD?
SSRI (fluoxetine, sertraline, and fluvoxamine) => adolescents
- Clomipramine => adolescents
What is the lifetime prevalence of OCD?
2-3%; accounts for 10% of outpatient psychiatric clinic visits
What is the mean age of presentation of OCD?
20yo with male adolescents being more affected than female (but same in adult population)
What is PANDAS?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections => group of disorders including OCD, that have been demonstrated to occur after streptococcal infection
Which disorders are associated with OCD?
- MDD
- Social phobia
- Generalized anxiety disorder
- Alcohol use disorders
- Specific phobias
- Panic disorders
- Eating disorders
- Tics and Tourette’s
What neurotransmitter imbalances are seen in anxiety?
- Increased norepinephrine
- Decreased GABA and serotonin
What are medical causes of anxiety disorders?
- Hyperthyroidism
- Vitamin B12 deficiency
- Hypoxia
- Neurological disorders (epilepsy, brain tumors, multiple sclerosis cerebrovascular disease)
- Cardiovascular disease
- Anemia
- Pheochromocytoma
- Hypoglycemia
What are medication/substance induced anxiety disorders?
- Caffeine intake/withdrawal
- Amphetamines
- Alcohol and sedative withdrawal
- Mercury or arsenic toxicity
- Organophosphate or benzene toxicity
- Penicillin/ Sulfonamides
- Sympathomimetics
- Antidepressants
What is the minimum criteria for a panic disorder?
At least one attack with at least one month of the following:
- persistent concern about having additional attacks
- worry about the implication of the attack (losing control or “going crazy”)
- a significant change in behavior related to the attacks
What neurotransmitter differences are seen in anxiety disorders?
- increase norepinephrine
- decrease serotonin and GABA
What is the best treatment for anxiety disorders?
SSRI (especially paroxetine and sertraline)
- use higher doses than for depression
Benzodiazepines are only for immediate relief
What proportion of patients with a phobic disorder also has major depression?
one third
How is performance anxiety successfully treated?
Beta blockers
What is systemic desensitization?
Systemic desensitization is the gradual exposure of a patient to the feared object or situation while teaching relaxation and breathing techniques
What is the flooding technique in treating anxiety?
Flooding is confronting the patient with their full fear
What is the most effective therapy for specific phobias?
Behavioral therapy is most effective and systemic desensitization is often used
- pharmacological treatment has not been found effective
What is the treatment for social anxiety?
Paroxetine (SSRI)
What is the difference between an obsession and a compulsion?
Obsession => recurrent and intrusive thought, feeling, or idea that is egodystonic. Often suppressed and are a product of the patient’s own mind
Compulsion => a conscious repetitive behavior linked to the obsession that helps to relieve anxiety caused by the obsession
What psychiatric conditions are often co-morbid with OCD?
- OCD, Tourette’s and ADHD are frequently co-morbid
What neurotransmitter abnormality is associated with OCD?
Abnormal regulation of serotonin
What is the treatment for OCD?
- SSRIs are first line (doses are higher than “normal”)
- Clomipramine is also effective
- ECT or cingulotomy is the last resort
What are the criteria for PTSD?
- Presence of a traumatic experience
- Persistent avoidance
- Hyperarousal
- Re-experiencing the traumatic event
- for at least one month
What is the treatment for PTSD?
- SSRIs
- TCAs ( imipramine, doxepin)
- MAOIs
- Anticonvulsants for flashbacks and nightmakres
What is the difference between PTSD and acute stress disorder?
- PTSD => event occurred at any time in the past AND symptoms last more than one month
- Acute stress disorder => event occurred less than a month ago AND symptoms last less than a month
What are the criteria for generalized anxiety disorder?
- Excessive anxiety and worry about daily events and activities for at least 6 months, for most days of the week
- Associated with at least 3 of the following: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
What is the treatment for GAD?
- Pharmacotherapy: SSRIs, buspirone, venlafaxine, benzodiazepines (clonazepam, diazepam)
- Psychotherapy
