CM: Anxiety and OCDs

Question 1

When does normal anxiety become pathological?

Answer 1

when it exceeds certain intensity, duration, or is inappropriate for the situation

Question 2

What is the psychoanalytic theory of anxiety?

Answer 2

conflicts between Id and the Superego - anxiety signals Ego to keep Id repressed

Question 3

What are the behavioral theories of anxiety?

Answer 3

cognitive distortion (overestimates threat or underestimates ability to deal with it)
conditioned response

Question 4

What major medical conditions can cause anxiety disorders?

Answer 4

hyperthyroidism, hypothyroidism, hypoparathyroidism, b12 def, pheo, MS, postencephalitic complications, epilepsy, cardiomyopathy, hypoglycemia, anemia

Question 5

What are substances/meds that can cause anxiety disorders?

Answer 5

amphetamines, cocaine, LSD, amyl nitrate, alcohol withdrawal
initiation of asthma meds, steroids, antidepressants, withdrawal of barbiturates or benzos
caffeine, decongestants, ephedra

Question 6

What is panic disorder?

Answer 6

recurrent and UNEXPECTED panic attacks: episodes of intense fear or discomfort that start abruptly, accelerate rapidly, and usually last 10-20 min
attacks lead to concern/worry about implications or complications and change in behavior to avoid attacks
anticipatory anxiety about next attacks –> avoidance
usual rule-outs apply

Question 7

What are symptoms of panic attacks?

Answer 7

cardio-pulm: palpitations, chest pain, SOB
GI: choking, nausea, ab discomfort
autonomic: sweating, shaking, chills, dizziness
psychological: fear of losing control, going crazy, dying
depersonalization and derealization

Question 8

What is important to remember about panic attacks?

Answer 8

they can occur in a variety of anxiety disorders, presence of panic attacks alone not sufficient to diagnose panic disorder

Question 9

What are phobias?

Answer 9

irrational fear of object or situation that leads to its avoidance, anticipation, and endurance with high degree of distress
pts recognize fear is excessive but feels out of their control

Question 10

What is agoraphobia?

Answer 10

fear of places and situations in which escape might be difficult or embarrassing (crossing bridge, public transport, enclosed spaces, standing in line, leaving house alone), fear help won’t be there if panic symptoms
often comorbid w panic disorder
leads to avoidance or endurance w distress

Question 11

What is the general treatment of panic disorder?

Answer 11

most antidepressants, potent benzos
CBT - misinterpretation of bodily sensations, education about panic attacks
behavioral therapy - relaxation training, deep breathing

Question 12

What is social anxiety disorder?

Answer 12

fear of one or more social situations in which person might feel scrutinized, humiliated, or embarrassed
leads to avoidance, anticipation or endurance w distress
pts recognize fear is excessive

Question 13

What is a specifier used in social anxiety disorder?

Answer 13

w performance only - fear is restricted to speaking or performing in public

Question 14

What is the general treatment of social anxiety disorder?

Answer 14

most antidepressants and benzos
CBT - identify negative autonomic thoughts, challenging the thinking errors, formation of rational alternatives
for performance only - pre-performance meds (beta-blockers - one of few times used in psychiatric disorders)

Question 15

What is the general treatment for specific phobias?

Answer 15

exposure therapy/systematic desensitization: create hierarchy of fear inducing situations and start with least feared - use relaxation techniques to tolerate w/o anxiety, move to next situation, etc

Question 16

What is generalized anxiety disorder (GAD)?

Answer 16

chronic, excessive anxiety and worry that causes impairment or distress, present at least 6 mos
includes physical symptoms (insomnia, fatigue, restless sleep, irritability, muscle tension, reduced concentration)

Question 17

What is the general treatment of GAD?

Answer 17

anxiolytic antidepressants, benzos, buspirone (only here, not panic attacks)
cognitive, behavioral, and supportive therapies

Question 18

What is OCD?

Answer 18

obsessions and/or compulsions
recognized as excessive or unreasonable
causes impairment (time-consuming) and distress
preventing can cause panic attack

Question 19

What is the general treatment of OCD?

Answer 19

SSRIs or clopmipramine (seretonergic TCA) - may take months for beneficial effect
psychosurgery in life-threatening cases
CBT - exposure and response prevention: flooding (exposure in vivo) or implosion (exposure via mental imagery) - prevents ability to carry out compulsions

Question 20

What is body dysmorphic disorder?

Answer 20

preoccupations w having profound bodily deformity - obsessions or delusions
reality: no deformity or minor feature
causes distress or impairment
insidious onset w gradual worsening, interventions to correct defect almost always unsuccessful and can make worse - some antidepressants may help

Question 21

What is an exception to BDD?

Answer 21

should not be diagnosed if also has anorexia nervosa - preoccupation w being overweight while actually being underweight is part of eating disorder

Question 22

What is hoarding disorder?

Answer 22

difficulty discarding or parting w possessions regardless of actual value
thoughts of discarding can cause distress

Question 23

What is trichotillomania?

Answer 23

hair pulling disorder - usually repeated unsuccessful attempts to stop

Question 24

What is excoriation disorder?

Answer 24

skin picking - usually repeated unsuccessful attempts to stop

Question 25

What substances or medications can cause OCDs?

Answer 25

amphetamines or cocaine

Question 26

What medical conditions can cause OCD?

Answer 26

Sydenham’s chorea - part of rheumatic fever following Group A strep inf)
PANDAS - pediatric autoimmune neuropsychiatric disorders associated w strep inf