Anxiety, OCD, Trauma, Stressor-related disorders

Question 1

What are the risk factors for OCD?

Answer 1

• Cortico-striato-thalamo-cortical circuit’s abnormalities
• Sexual abuse, bullying in early life
• Streptococcal infection, stress, unhealthy lifestyle

Question 2

What is the prevalence of OCD?

Answer 2

2-3% of population
*females more than male
*50% have suicidal ideas

Question 3

What is the diagnostic criteria for OCD?

Answer 3

• Obsession & Compulsion (one or both)
• Time-consuming
• Impaired function or distress (significant)
• Not caused by substance or other mental illness

Question 4

What are the patterns of OCD?

Answer 4

Obsession > Compulsion
- Safety > Frequent checking
- Contamination > Washing or cleaning
- Symmetry > Counting or order

Question 5

Tx for OCD?

Answer 5

• Psychotherapy (CBT, Exposure & response prevention*)
• SSRI

Question 6

Body dysmorphic disorder:

Answer 6

• Perceive part of body as a defect (nose, hair, skin)
• Dx: must cause impairment in function
• Tx: CBT, SSRI (if needed)

Question 7

Hoarding disorder

Answer 7

HOLDING disorder
- accumulate items (can’t throw them away)
- Tx: CBT

Question 8

Trichotillomania

Answer 8

تشد الشعر
- Pulling the hair > lead to Alopecia
- R/O fungal causes of hair loss
- Tx: CBT, SSRI (if needed)

Question 9

Excoriation (skin)

Answer 9

Skin picking leading to lesions
Tx: CBT + SSRI (if needed)

Question 10

What are the diagnostic criteria for PTSD?

Answer 10

T - trauma (exposure)
R - re-exposure (nightmares, flashbacks..)
A - avoidance (of trigger)
U - inability to function
M- month (at least)
A - arousal symptoms (2 or more)
-
N - negative symptoms (2 or more)

Question 11

What is the characteristic of Acute Stress Disorder?

Answer 11

Trauma occurred < 1 month
symptoms < 1 month

Question 12

What are the negative symptoms of PTSD?

Answer 12

• Dissociative amnesia (memory gaps)
• Negative feeling and emotions (fear, horror, guilt)
• Anhedonia (loss of interest)
• Feeling of detachment
• Inability to experience positive emotions

Question 13

What are the symptoms of increased arousal?

Answer 13

• High alertness
• Irritability/anger
• Impaired concentration
• Insomnia (don’t wanna dream)
• Exaggerated startle response

Question 14

What is the recovery rate for PTSD patients?

Answer 14

50% of patients recover within 3 months

Question 15

What is the treatment for PTSD?

Answer 15

First line: SSRI or SNRI +/- alpha-1 receptor antagonist (this one target nightmares and paranoia)
+ CBT + Supportive therapy

Question 16

What is the characteristic of adjustment disorder?

Answer 16

• Develop of emotional or behavioral symptoms within 3 months in response to life stress.
• Cause marked distress or impairment in function
• S&S resolve within 6 months after stressor has terminated
• Tx: Supportive psychotherapy + group therapy

Question 17

Criteria of panic disorder:

Answer 17

• Recurrent of panic attacks
• 4 symptoms at least
• No identifiable trigger
• 1 month of worrying of re-experiencing a panic attack in the future

Question 18

What is the prevalence of panic disorder?

Answer 18

4% of population

Question 19

What are the risk factors of panic disorder?

Answer 19

• Genetics (1 degree relative)
• Stressors
• Childhood physical or sexual abuse

Question 20

What investigation to do in panic disorder? (acute)

Answer 20

• ECG & Troponin > R/O ACS
• TSH > R/O hyperthyroidism
• Respiratory examination > R/O asthma attack or lung disease

Question 21

What is the management for Panic disorder?

Answer 21

Acute attack: Benzodiazepines (Xanax)
Tx: SSRI + CBT
* SSRI takes a month to work so give benzo until it works + watch for benzo addiction and tolerance

Question 22

What are the criteria for GAD?

Answer 22

• Anxiety
• Persistent > 6 months
• Excessive
  + Somatic symptoms (3 or more):
• Fatigue
• Decreased concentration
• Restlessness
• Tense muscles
• Insomnia
  + Impairment in function + not due to substance use

Question 23

What is the management of GAD?

Answer 23

First line: SSRI or SNRI + CBT
2nd line: buspirone or benzo

Question 24

What are the diagnostic criteria of agoraphobia?

Answer 24

• intense fear > 6 months
  + 2 or more of:
• public transportation
• being in open spaces
• standing in line
• being outside of home alone
• basically afraid they would panic without finding escape

Question 25

Tx of agoraphobia

Answer 25

• CBT + SSRI

Question 26

What is a well known risk factor for panic attacks?

Answer 26

Smoking

Question 27

Specific phobia vs Social anxiety disorder:

Answer 27

Specific phobia: specific trigger (bugs) > CBT with exposure is Tx
Social anxiety: performances.. etc > CBT + SSRI + BB (at time of performance)

Question 28

What is the characteristic of selective mutism?

Answer 28

• Failure to speak in specific situations without medical cause (typically in kids)
• • symptoms of anxiety > 1 month
    Tx: CBT + Family therapy + SSRI for anxiety

Question 29

What is the criteria for separation anxiety disorder?

Answer 29

• S&S > 1 month in kids and 6 months in adults
  3 or more of:
• Separation > extreme distress
• Worry about loss or harm to attached person
• Cant be alone, leave home or sleep alone
• Complaint of physical symptoms when separation occurs
• Nightmares of separation
• Cause marked social, academic dysfunction

Question 30

What is the treatment of separation anxiety disorder?

Answer 30

CBT + Family therapy