Anxiety, Phobias, OCD Flashcards
Phobia anxiety disorders (PAD) can present in a similar way to generalised anxiety disorder (GAD). But which of the following is key to distinguishing between GAD and PAD?
1 - anxiety occurs to a very specific stimulus
2 - avoidance of the specific stimulus causing anxiety
3 - anticipatory anxiety to stimulus
4 - all of the above
4 - all of the above
What is a phobia?
1 - fear specific to childhood
2 - fear of a traumatic event
3 - overwhelming and debilitating fear of a specific object/ situation etc…
3 - overwhelming and debilitating fear of a specific object/ situation etc…
- more pronounced than fears
There are 3 categories of Phobia anxiety disorders (PAD). Which of the following is NOT one of these categories?
1 - specific phobia
2 - diurnal phobia
3 - agoraphobia
4 - social phobia
2 - diurnal phobia
In specific phobias patients are inappropriately anxious to a specific object or situation. Patients will go out of their way to avoid this object or situation. When do specific phobias generally occur when?
1 - from birth
2 - childhood
3 - puberty
4 - adulthood
2 - childhood
- then continue into adulthood
In patients with phobia, they have an unrealistic response to a specific stimulus, which can be anything, including specific locations or venues. Why is this important clinically?
- can significantly impair patients life and ADL
- for example if hospitals are the patients phobia, how will they get treated?
- patients anticipate the phobia and experience huge anxiety
What is anticipatory anxiety?
1 - patient expresses anxiety if someone mentions phobia
2 - patient anticipates phobia and becomes severely anxious
3 - patient becomes anxious seeing phobia
2 - patient anticipates phobia and becomes severely anxious
Which 2 of the following are the main features of a specific phobia in line with the ICD-11?
1 - reduced physical symptoms
2 - excessive fear/anxiety associated with specific phobia all the time
3 - phobic object is avoided at all costs for fear of excessive anxiety
4 - fear of obscure objects
2 - excessive fear/anxiety associated with specific phobia all the time
3 - phobic object is avoided at all costs for fear of excessive anxiety
In order to be diagnosed with a specific phobia, the phobia must have a significant impact on the patients employment and life in general and last how long?
1 - 1 week
2 - 3 weeks
3 - 2-3 months
4 - >6 months
3 - 2-3 months
- several months
What % of patients with a specific phobia will meet the criteria for another psychiatric condition?
1 - 8%
2 - 28%
3 - 48%
4 - 83%
4 - 83%
Do patients with specific phobias always present immediately?
- no
- often manage it
- BUT if they have to face their phobia for some reason, they may come for help
Blood injury phobias are a serious problem. There is said to be a biphasic (means 2 responses) anxiety reaction in patients, what is this?
1 - 2 consecutive stimulations of the sympathetic system
2 - 2 consecutive stimulations of the para-sympathetic system
3 - stimulation of the sympathetic and then para-sympathetic system
4 - stimulation of the para-sympathetic and then sympathetic system
3 - stimulation of the sympathetic and then para-sympathetic system
- initial reaction = sympathetic arousal (tachycardia)
- second reaction = parasympathetic arousal (fainting)
How is classical conditioning associated with developing phobias?
- experience an encounter with a specific event or object
- patient attends hospital and has bad reaction to medication. This enforces a learned behaviour with a negative experience
- patient will then associate coming into hospital with similar responses
- leads to avoidance, making it difficult to eliminate the phobia
How does the “Biological preparedness” hypothesis contribute to phobias?
1 - following an initial fear of something that persists and develops into a phobia
2 - developing a phobia from birth
3 - developing a phobia based on survival and what we should be scared of
3 - developing a phobia based on survival and what we should be scared of
- we know we should run from bears and lions
Which of the following are suitable psychological treatment approaches in a patient with a specific phobia?
1 - self help books
2 - group computerised CBT
3 - individual CBT
4 - all of the above
4 - all of the above
- this is generally sufficient for most patients and no medications are required
What group of medications are the 1st line treatment for patients with specific phobias?
1 - antipsychotics
2 - antiepileptics
3 - anti-depressants
4 - benzodiazepines
3 - anti-depressants
- SSRIs = Citalopram, Fluoxetine, Sertraline are 1st choice
- can try tricyclics = Amitriptyline
Anti-depressants are the 1st line drug for patients with specific phobias, either SSRIs or tricyclic anti-depressants. If these are successful, how long following recovery should they be provided for?
1 - stop when patient feels better
2 - 2 weeks
3 - 2 months
4 - 6 months
4 - 6 months
Anti-depressants are the 1st line drug for patients with specific phobias, either SSRIs or tricyclic anti-depressants. If at least 2 of these have been tried, but have been unsuccessful, which 2 classes of medication can be prescribed?
1 - anti-epileptics
2 - benzodiazepines
3 - non-benzodiazepines
4 - anti-psychotics
2 - benzodiazepines
- Diazepam, Lorazepam, Chlordiazepoxide
3 - non-benzodiazepines
- must use with caution due to high risk of dependence
Social anxiety disorder, also known as social phobia relates to an acute attack of anxiety in a public space, subsequently anxiety occurs in similar places. Which of the following are principle features of social anxiety?
1 - specific concerns about being observed critically
2 - situations, such as public speaking or eating
3 - anticipatory anxiety
4 - avoidance of social interactions causing anxiety
5 - symptoms of general anxiety
6 - drugs and alcohol used to relieve anxiety
7 - low self esteem and perfectionism
8 - all of the above
8 - all of the above
In order to be diagnosed with a social anxiety the patient must have a significant impact on the patients employment and life in general and last how long?
1 - 1 week
2 - 3 weeks
3 - 2-3 months
4 - >6 months
3 - 2-3 months
- according to the ICD-11, it must last several months
What % of patients with social anxiety will meet the criteria for another psychiatric condition?
1 - 8%
2 - 28%
3 - 48%
4 - 80%
4 - 80%
- most common are PTSD, depression or alcohol use disorders
Which of the following are common differentials for social anxiety?
1 - generalised anxiety disorder
2 - depressive disorder
3 - schizophrenia
4 - panic disorder with agoraphobia
5 - all of the above
5 - all of the above
When is the initial social anxiety likely to have begin in patients, adulthood or adolescence?
- adolescence
- awkward time when this can occur, also may be influenced by parents own social anxiety
When trying to treat a patient we should 1st do a mini social phobia inventory (Mini-SPIN). What is then the 1st line of treatment for social anxiety patients?
1 - self help books
2 - group computerised CBT
3 - individual CBT
4 - all of the above
4 - all of the above
- individual CBT should be tried 1st though
In a patient with social anxiety who has tried psychological treatment, which has not worked, we can try medication. What group of medications are the 1st line treatment for patients with social anxiety disorder?
1 - antipsychotics
2 - antiepileptics
3 - anti-depressants
4 - benzodiazepines
3 - anti-depressants
- SSRIs = Citalopram, Fluoxetine, Sertraline are 1st choice
- can try tricyclics = Amitriptyline
In a patient with social anxiety who has tried psychological and pharmacological treatment in isolation, what is the 3rd line treatment for patients with social anxiety disorder?
1 - antipsychotics with benzodiazepines
2 - antiepileptics with anti-depressants
3 - anti-depressants with CBT
4 - benzodiazepines with CBT
3 - anti-depressants with CBT
AVOID benzodiazepines due to risk of dependence
Which of the following aspects are included in the definition of Obsessive compulsive disorder (OCD)?
1 - obsessions
2 - compulsions
3 - innate drive to complete something
4 - specific rules must be followed to avoid an imagined dreaded event
5 - all of the above
5 - all of the above
- a person has compulsive behaviours
Obsessive compulsive disorder (OCD) is the 4th most common psychiatric disorder and is often chronic. Is it an untreatable condition?
- no
- effective treatment is available
What are obsessions ?
1 - behaviours and thoughts
2 - recurrent thoughts and impulses
3 - behaviours relation to thoughts
2 - recurrent thoughts and impulses
What are compulsions, also referred to as obsessional rituals?
1 - behaviours and thoughts
2 - recurrent thoughts and impulses
3 - repeated senseless activities
3 - repeated senseless activities
- can be physical (touching every window before leaving the house) or mental (counting)
Why do patients with OCD perform the compulsions (obsessional rituals)?
1 - makes them more stressed
2 - increases obsessions
3 - relieves stress
4 - internal voice commanding it
3 - relieves stress
- only for a brief period
- BUT it may also be followed by doubts if it was done correctly
To be diagnosed with OCD in accordance to the ICD-11 criteria, does the patient need to have insight into their OCD?
- yes
- patient must be aware that their OCD is unreasonable and excessive and for it to interfere with their daily lives
When is the initial OCD likely to have begin in patients, older age or younger?
- younger
- typically teens and early 20s
What % of patients with OCD remember symptoms from when they were children?
1 - 5-10%
2 - 20-30%
3 - 30-50%
4 - >65%
3 - 30-50%
- earlier OCD starts the worse the outcomes
- OCD interferes with childs development
Do OCD symptoms typically present with an acute or gradual onset?
- gradual
- generally seen as a chronic condition
What % of all individuals with OCD will also experience Tourette Syndrome or another primary tic disorder during their lifetime?
1 - 3%
2 - 10%
3 - 30%
4 - 60%
3 - 30%
Which 2 of the following conditions is OCD often associated with?
1 - depression
2 - dementia
3 - bipolar disorder
4 - anxiety
1 - depression
4 - anxiety
- has also been shown to increase risk of substance abuse and body dysmorphic disorder
Which of the following are common co-morbidities associated with OCD?
1 - depression (70%)
2 - eating disorder
3 - anxiety
4 - body dysmorphia
5 - excessive alcohol use
6 - all of the above
6 - all of the above
Which of the following is NOT a common differential for OCD?
1 - anxiety disorder
2 - phobias
3 - eurythmia
4 - depressive disorder
5 - schizophrenia
6 - organic cerebral disorder
3 - eurythmia
- normal, healthy mood
To be diagnosed with OCD in accordance to the ICD-11 criteria, how much time in a day must the OCD take up?
1 - 1 hour/day
2 - 3 hours/day
3 - 10 hours/day
4 - all day
1 - 1 hour/day
Are compulsions (actions) in isolation from obsessions (thoughts)?
- no
- obsessions typically lead to compulsions
- obsessions lead to compulsions
In patients with OCD there is evidence of a brain disorder linked with neurobiological factors. What part of the brain has this been shown in?
1 - cerebellum
2 - basal ganglia
3 - hypothalamus
4 - frontal cortex
3 - hypothalamus
- also in the head of the caudate, involved in execution of movement, but also in learning, memory, reward, motivation, emotion, and romantic interaction.
If a 1st degree relative has OCD, what is the increased risk of developing OCD?
1 - x2 fold
2 - x6 fold
3 - x10 fold
4 - x25 fold
3 - x10 fold
What % of patients with OCD generally go into remission when treated appropriately within 1 year?
1 - 16%
2 - 20%
3 - 33%
4 - 66%
4 - 66%
- the last 3rd generally have partial or complete remission lasting for months to years
In a patient with OCD who has mild functional impairment, what would be the 1st line treatment?
1 - ECT
2 - anti-depressants
3 - CBT
4 - group therapy
3 - CBT
- will include exposure with response prevention
In a patient with OCD who has moderate functional impairment, which 2 of the following would be the 1st line treatment?
1 - chronic ECT
2 - anti-depressants
3 - full course of CBT
4 - group therapy
2 - anti-depressants
- SSRI inhibitors
OR
3 - full course of CBT
In a patient with OCD who has severe functional impairment, which 2 of the following would be the 1st line treatment?
1 - chronic ECT
2 - anti-depressants
3 - full course of CBT
4 - group therapy
2 - anti-depressants
WITH
3 - full course of CBT
- if patient is resistant then try atypical antipsychotics
- if high risk, hospitalisation may be required
