Lecture 12: Natural history and differential diagnosis of anxiety disorders - Prof David Veale Flashcards
Name some disorders related to OCD?
Hoarding disorder
Body dysmorphic disorder
Skin picking disorder
Trichotillomania - hair pulling
Hypochondriasis
Olfactory reference disorder
Why has OCD been grouped with these related disorders in the DSM-V and ICD-11?
- Phenomenology of repetitive behaviours
- Clinical utility
- FHx and genotypes hint at validity
Outline the three basic emotion systems that have thought to be shared by old ancestors
- Soothing system
- Contented / Safe
- Not-wanting - focused on affiliation
- Safety and kindness
- Soothing
- Threat system
- Anger, anxiety, disgust
- Threat focused
- Protection and safety-seeking
- Activating/inhibiting
- Can take over when person has been stuck in loops of anxious thinking and feeling for a long time, ability to activate soothing system underdeveloped, or it is not used enough
- Drive system
- Drive/Excitement
- Inventive/resource focussed
- Activating
- Wanting, pursuing, achieving and consuming
What did Power & Dalgeish propose (1997)
Complex emotions arise out of combinations of the three emotional systems
With fight-flight-freeze-fawn a mixture of these contribute to emotions such as horror, shame, guilt, contempt, hatred/loathing and rage
What three domains can be used to guide quesitons aimed at assessing if anxiety is a problem?
Interference - how does anxiety affect your life / how does it stop you doing the things you want to do / how much time each day are you taking up worrying?
Distress - does the anxiety upset you / do you think it is a major problem
Mood - is it linked to mood - do you still worry when you’re happy?
Outline the criteria for panic attack
Specific episode of intense fear or discomfort with 4 (or more) of the following symptoms:
- Palpitations, chest tight, dizziness, unreality, hot/cold, tingling, shaking, choking, sweat
- Symptoms develop abruptly
- Symptoms reach a peak within 10 mins
Outline the DSM-V criteria for panic disorder for?
- Recurrent unexpected panic attacks
Followed by at least 1 month of:
- Fear of another panic attack or consequences (eg having a heart attack or going crazy or losing control)
- Change in behaviour because of the attacks (avoidance of exercise or unfamiliar situations)
Name some hints that indicate a panic disorder?
- Fear of immediate internal threat
- Panic attacks come out of the blue
- At last 2 panic attacks
- Worry about another attack needs to be there for a month
- Has behaviour changed because of the attack
- What is avoided
Panic disorder with agoraphobia may be present if fear in the situations is because of having a panic attack
- Are the situations avoided because of this
- Does the person need to be accompanied
- The situation can’t be better explained by social phobia, specific phobia, OCD or PTSD
How may a desert island question aid differeing depression from social phobia?
- Negative evaluation in social phobia tends to occur in situations around other people - may be absent if no one around
- For depression self esteem is internally generated and patient may still think low of themselves even if others not around
BDD - pre-occupation with perceived/exaggerated defect in physical appearance –> externals will see them as bad looking or unacceptable
Define an obsession and a compulsion?
Obsession is an unwanted intrusive thought, image, doubt, sensation or urge that causes marked distress. Respond by ignoring, suppressing or trying to neutralise
Compulsion is a repetitive behaviour or mental act in response to the obsession. Aim is to reduce distress or preventing a feared event
- Can be mental compulsions - special words, images, or numbers recreated mentally - aim to prevent harm or reduce anxiety but tend to increase both
Outline the DSM-V criteria for GAD
Excessive anxiety and worry more days than not fr at least 6 months about a number of events or activities
Hard to control the worry
At least 3 of:
- Restlessness
- Easily fatigued
- Poor concentration
- Sleep disturbance
- Muscle tension
- Irritability
Focus of worry is not confined to features of an axis I disorder
What is the duration, context of worries and controllability in GAD
At least 6 months
Worry about at least two topics
Worry is future orientated
Uncontrollable - i.e. if I gave you £100 to stop worrying could you
Not GAD if worries occur exclusively in depressive episodes, PTSD, or Psychotic disorders
For normal anxiety - may be 6 months, person may be able to control it, many people “adjust” within 6 months
For adjustment disorder - within 6 months of major stressor - appears like GAD but most people adjust
What are the 3P’s of personality disorder?
Persistent
Pervasive
Pathological
What scale can be used to screen for personality disorders?
SAPAS
Standardised assessment of personality abbreviated scale
Give some clinical factors present in PTSD?
- Exposure to threatened death, actual or threatened serious injury
- Re-experiencing (flashbacks)
- Avoidance
- Altered cognition & mood (emotional numbing)
- Arousal (hypervigilant)
Differs to acute stress reaction –> includes dissociative symptoms but resolves within 1 month of the event
Differs to adjustment disorder - PTSD symptoms but not criterion A stressor - onset within 1 months of life event and resolves within 6 months
