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)
Investigations for OCD
Bloods: FBC, TSH (organic causes); Rating Scale: Yale Brown OCD
Education and self-help
PACES: What rating scale can be used for OCD?
Yale Brown OCD
PACES: OCD screening questions
Do you wash or clean a lot?
Is there any thought that keeps bothering you that you would like to get rid of?
Do your daily activities take a long time to finish?
Are you concerned about putting things in a special order or are you very upset by a mess?
Do these problems trouble you?
What does OCD have the same treatment as?
body dysmorphic disorder
Management of OCD
1st line is CBT with Exposure and Response Therapy (ERP) - Exposes patients to obsessive thought/images and they have to respond with non-compulsive behaviour
2nd line is SSRI (fluoxetine) - Continue SSRI treatment for at least 12 months after remission of symptoms
3rd line is Clomipramine (TCA) or an alternative SSRI after 12 weeks if SSRI not effective
SEs of TCA
Thrombocytopenia, Cardiac effects (increased HR, increased QT, arrhythmia), anticholinergic (“can’t see, can’t pee, can’t spit, can’t shit), Sexual dysfunction
1st line management for OCD
CBT with exposure and response therapy (ERP)
How long should SSRI treatment be continued for in OCD?
At least 12 months after remission of symptomsW
When should Clomipramine (TCA) or an alternative SSRI be considered in OCD?
If first SSRI (fluox) is ineffective after 12 weeks
