Anxiety, OCD, Trauma, Stressor-related disorders Flashcards
What are the risk factors for OCD?
- Cortico-striato-thalamo-cortical circuit’s abnormalities
- Sexual abuse, bullying in early life
- Streptococcal infection, stress, unhealthy lifestyle
What is the prevalence of OCD?
2-3% of population
*females more than male
*50% have suicidal ideas
What is the diagnostic criteria for OCD?
- Obsession & Compulsion (one or both)
- Time-consuming
- Impaired function or distress (significant)
- Not caused by substance or other mental illness
What are the patterns of OCD?
Obsession > Compulsion
- Safety > Frequent checking
- Contamination > Washing or cleaning
- Symmetry > Counting or order
Tx for OCD?
- Psychotherapy (CBT, Exposure & response prevention*)
- SSRI
Body dysmorphic disorder:
- Perceive part of body as a defect (nose, hair, skin)
- Dx: must cause impairment in function
- Tx: CBT, SSRI (if needed)
Hoarding disorder
HOLDING disorder
- accumulate items (can’t throw them away)
- Tx: CBT
Trichotillomania
تشد الشعر
- Pulling the hair > lead to Alopecia
- R/O fungal causes of hair loss
- Tx: CBT, SSRI (if needed)
Excoriation (skin)
Skin picking leading to lesions
Tx: CBT + SSRI (if needed)
What are the diagnostic criteria for PTSD?
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)
What is the characteristic of Acute Stress Disorder?
Trauma occurred < 1 month
symptoms < 1 month
What are the negative symptoms of PTSD?
- Dissociative amnesia (memory gaps)
- Negative feeling and emotions (fear, horror, guilt)
- Anhedonia (loss of interest)
- Feeling of detachment
- Inability to experience positive emotions
What are the symptoms of increased arousal?
- High alertness
- Irritability/anger
- Impaired concentration
- Insomnia (don’t wanna dream)
- Exaggerated startle response
What is the recovery rate for PTSD patients?
50% of patients recover within 3 months
What is the treatment for PTSD?
First line: SSRI or SNRI +/- alpha-1 receptor antagonist (this one target nightmares and paranoia)
+ CBT + Supportive therapy
What is the characteristic of adjustment disorder?
- 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
Criteria of panic disorder:
- Recurrent of panic attacks
- 4 symptoms at least
- No identifiable trigger
- 1 month of worrying of re-experiencing a panic attack in the future
What is the prevalence of panic disorder?
4% of population
What are the risk factors of panic disorder?
- Genetics (1 degree relative)
- Stressors
- Childhood physical or sexual abuse
What investigation to do in panic disorder? (acute)
- ECG & Troponin > R/O ACS
- TSH > R/O hyperthyroidism
- Respiratory examination > R/O asthma attack or lung disease
What is the management for Panic disorder?
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
What are the criteria for GAD?
- 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
What is the management of GAD?
First line: SSRI or SNRI + CBT
2nd line: buspirone or benzo
What are the diagnostic criteria of agoraphobia?
- 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
Tx of agoraphobia
- CBT + SSRI
What is a well known risk factor for panic attacks?
Smoking
Specific phobia vs Social anxiety disorder:
Specific phobia: specific trigger (bugs) > CBT with exposure is Tx
Social anxiety: performances.. etc > CBT + SSRI + BB (at time of performance)
What is the characteristic of selective mutism?
- Failure to speak in specific situations without medical cause (typically in kids)
- symptoms of anxiety > 1 month
Tx: CBT + Family therapy + SSRI for anxiety
- symptoms of anxiety > 1 month
What is the criteria for separation anxiety disorder?
- 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
What is the treatment of separation anxiety disorder?
CBT + Family therapy
