Anxiety & OCD Flashcards
What is GAD?
Excessive worry and apprehension regarding several issues (not restricted to specific situation) for most of the time for >6 months.
Difficulty controlling symptoms.
Specific phobia
an intense or disproportionate fear of a particular object or situation, that pose little danger, but lead to anxiety and avoidance.
NOTE: Social phobia is a subtype but pertaining to social situations. This could be a general social phobia, or specific e.g. eating in public.
Agoraphobia
an intense or disproportionate fear of situations where escape may be difficult, such as crowded or open spaces. It is often associated with panic, and can lead to difficulty leaving the house.
Criteria for GAD
3+ of the following symptoms for >12 months
Restlessness
Fatigue
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance
Investigations for GAD
Full Medical and Psychiatric History
Physical Examination
Investigations for Organic Causes
What type of organic causes are the most common in GAD? Give some examples
Endocrine (Most Common)
Hyperthyroidism
Cushing’s disease
Adrenal dysfunction
Pituitary disease
Addison’s disease
Phaeochromocytoma
PACES: Lifestyle measures for GAD
Stress management techniques (e.g. deep breathing, mindfulness)
Sleep hygiene and exercise advice
Self-help groups and online resources
Social worker input
Management of GAD
STEP 1: education about GAD + active monitoring
STEP 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
STEP 3: high-intensity psychological interventions (CBT or applied relaxation) or drug treatment (sertraline)
STEP 4: highly specialist input (e.g. multi-agency teams)
Drug Treatment
1st line: Sertraline
Weekly follow-up is recommended in patients < 30 years (because of increased risk of suicidal thinking and self-harm)
Drug treatment in GAD
1st line: sertraline
2nd line: other SSRI or SNRI
3rd line: pregabalin
WARNING: do NOT routinely use benzodiazepines except for short-term management during a crisis (risk of dependency)
Follow Up: usual follow up used for SSRIs
What may beta blockers (e.g. propanolol) be used for in GAD?
Sometimes used to treat adrenergic symptoms (e.g. tremor, palpitations). IMPORTANT: consider contraindications
PACES: What screening tool may be used for GAD?
GAD-7
What are obsessions? What do they cause?
Recurrent persistent thoughts, urges or images
Intrusive and unwanted
Patient attempts to ignore but is unsuccessful
Causes distress
What are compulsions? What do they are done to relieve?
Repetitive behaviours or mental acts done to relieve obsessions
e.g. wash hands, praying, counting, repeating words
Patient feels driven to engage in compulsions in response to the obsessions
What other psych disorders does OCD usually occur along with?
Schizophrenia, Bipolar, eating disorders and Tourette
Is there insight in OCD?
Insight is present: patients will recognise that the obsessions are excessive or unreasonable but find it difficult to resist them
NOTE: Recognised as originating from their own mind (unlike psychosis)
