Anxiety, Phobias, OCD Flashcards
What is the definition of panic disorder?
Recurrent attacks of severe anxiety which are not restricted to any particular situation or set of circumstances and are therefore unpredictable.
What is the typical onset of panic disorder?
Adolescence to mid-30’s
What are some clinical features of panic disorder?
Sudden onset palpitations, chest pain, choking sensation, dizziness and feeling of unreality
Secondary fear of dying, losing control or going mad
What is the management of panic disorder?
1) Self-help
2) CBT or SSRI if long standing or no benefit from CBT
3) Consider tricyclics (clomipramine, desipramine) if no improvement after 12 weeks
What drugs should be avoided in panic disorder?
Benzodiazepines or sedating antihistamines
Propanolol, buspirone, buproprion
How long should drug treatment for panic disorder be continued?
6 months
What are the three types of phobias?
Agoraphobia
Social phobia
Specific phobia
What is agoraphobia?
Fears of leaving home, entering shops, crowds and public places, travelling alone
Results in avoidance of phobic situation
What are some clinical features of agoraphobia?
Others do shopping (for or with patient)
Drinking alcohol to overcome fear
Go shopping at night when quiet
Internet shopping
What is the management of agoraphobia?
1) Self-help
2) CBT or SSRI if long standing or no benefit from CBT
3) Consider tricyclics (eg clomipramine, desipramine) if no improvement after 12 weeks
What are some common specific phobias?
Animals
Heights
Thunder
Flying
Exposure to blood
Injections
Do people with phobias have insight into their condition?
Yes
They recognise that the fear is excessive or unreasonable
What is the management of specific phobia?
Exposure therapy
- Graded/systemic desensitisation
- Add CBT if necessary
SSRIs/SNRIs if required
What is social phobia/social anxiety disorder?
Persistent fear of one or more social or performance situations in which person is exposed to unfamiliar people or to possible scrutiny by others
What is the pathophysiology of phobias?
Increased bilateral activation of amygdala and related limbic areas that normalises on successful treatment
What are some clinical features of social phobia?
Blushing or shaking
Fear of vomiting
Urgency or fear of micturition or defecation
Can result in poor performance at school, work, social life
What is the management of social phobia?
1) Individual CBT
2) SSRI (escitalopram or sertraline)- review at 12 weeks
3) SSRI plus CBT
4) Alternative SSRI (fluvoxamine or paroxetine) or SNRI (venlafaxine)
5) MAOI (moclebemide)
What is the definition of obsessive compulsive disorder (OCD)?
Common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (’obsessions’) and/or behaviours (’compulsions’) that the patient feels the urge to repeat over and over
What is the mean age of onset for OCD?
20
What is the diagnostic criteria for OCD?
Obsessional symptoms or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and interference with activities
Obsessions must be individuals own thoughts
Resistance must be present
Rituals are not pleasant
Obsessional thoughts/images/impulses must be repetitive
What is the management of OCD?
1) CBT and ERP (low intensity)
2) More intensive psychological intervention or SSRI (consider dose increase after 4-6 weeks)
3) SSRI plus CBT and ERP
4) Clomipramine (tricyclic)
5) Augmentation with antipsychotic or clomipramine plus citalopram
