Anxiety, obsessive-compulsive, and related disorders

Question 1

fear vs anxiety

Answer 1

• fear: physical and mental response to IMMINENT threat

- anxiety: anticipation of a FUTURE threat

Question 2

what are the features of a fear response?

Answer 2

• fight / flight / freeze

- desire to escape

Question 3

what are the features of an anxiety response?

Answer 3

• unknown threat, internal or vague
• muscle tension
• vigilance
• desire to avoid

Question 4

what is the A-A, E-E phenomenon with anxiety?

Answer 4

• avoidance leads to anxiety

- exposure leads to extinction

Question 5

definition: specific phobia

Answer 5

• marked fear or anxiety about a specific object or situation
• phobic object is avoided or endured with intense anxiety or distress
• fear is disproportionate and must persist for at least 6 months

Question 6

what is the treatment for specific phobia?

Answer 6

• exposure therapy (behavioral, in vivo works best)

- pharmacological (not treatment of choice)

Question 7

definition: social anxiety disorder

Answer 7

• marked fear / anxiety of social situations involving exposure to the possible scrutiny of others
• concern for acting in a way that is humiliating or embarrassing

Question 8

what is the treatment for social anxiety disorder?

Answer 8

• psychotherapy: changing what people say to themselves in their head
• exposure
• pharmacotherapy: SSRIs / SNRIs (first line), MAOIs, benzos, BBs

Question 9

definition: panic disorder

Answer 9

• recurrent unexpected panic attacks (abrupt surge of intense fear of discomfort peaking within minutes)
• persistent worry about additional attacks or their consequences
• maladaptive change in behavior related to the attacks

Question 10

what is the first line psychotherapy for panic disorder? what is the first line pharmacotherapy?

Answer 10

• cognitive behavioral therapy (CBT)

- SSRIs / SNRIs

Question 11

definition: agoraphobia

Answer 11

marked fear or anxiety about at least 2 of the following:

• public transportation
• open spaces
• enclosed spaces
• standing in line / crowd
• being outside of home alone
• fear is of not having access to help or of not being able to escape situation

Question 12

what are the psycho and pharmacotherapies for agoraphobia?

Answer 12

• psychotherapy: CBT

- pharmacotherapy: benzodiazepines, SSRIs, TCAs

Question 13

definition: generalized anxiety disorder

Answer 13

• excessive anxiety / worry for more days than not for at least 6 months about a number of events or activities
• difficulty controlling worry / anxiety
• presence of at least 3 of the following symptoms present more days than not for 6 months:
• restlessness, on edge
• easily fatigued
• difficulty concentrating or mind goes blank
• irritability
• muscle tension
• sleep disturbance

Question 14

what are the psychotherapy treatments for generalized anxiety disorder?

Answer 14

• CBT
• acceptance and commitment therapy
• pyschodynamic (addressing issues and fears)

Question 15

what are the pharmacotherapy treatments for generalized anxiety disorder?

Answer 15

• SSRIs / SNRIs
• benzos
• buspirone

Question 16

definition: 1) obsession, 2) compulsion

Answer 16

• obsession: unwanted and intrusive thought
• compulsion: repetitive behaviors or mental acts that one feels driven to perform in response to an obsession

obsessions or compulsions are time consuming (over 1 hour / day) or cause significant stress or impairment

Question 17

what is the psychotherapy for OCD?

Answer 17

exposure and response prevention

Question 18

what is the pharmacotherapy for OCD?

Answer 18

• SSRIs
• SNRIs
• clomipramine (possibly most effective but watch for side effects)