MPCE-11,Block-02, Unit-02, Anxiety Disorder, Obsessive Compulsive Disorder

Question 1

What is general anxiety disorder? (GAD)

Answer 1

Definition:
● It includes a constant state of excessive worrying regarding futuristic endeavors.
●It is not limited to a particular trigger.
●It should cause significant dysfunction in regular life in multiple areas of a person’s life.
●The consistent habit of fearfulness about things that haven’t happened yet.
●It must persist for a minimum of six months to be diagnosed.
●May cause social, occupational Impairment

Question 2

Symptoms and Clinical Features
(Minimum Three symptoms must be there)

Answer 2

(Minimum Three symptoms must be there)

1. Restlessness:
   ●Always feeling on edge, unable to relax.
2. Being easily fatigued:
   ●Getting tired easily even with minimal work
3. Not being able to concentrate
   ●Trouble focusing on tasks.
   ●Easily Distracted.

4.Irritation:
●Easily get annoyed or angered.
●Constantly feel irritated as they cannot control their life

5. Muscle tension:
   ●Experiencing tightness or pain in muscles.

6.Sleep Disturbances:
●Difficulty in falling asleep, staying asleep, restlessness, unsatisfying sleep.

Question 3

What are Somatic Complaints related to Anxiety

Answer 3

As the sympathetic nervous system is consistently active to deal with anxiety, various hormones like adrenaline and cortisol get released and affect the human body

Somatic Complaints related to Anxiety
◇ Excessive Sweating
◇Palpitation
◇Irregular Heartbeats
◇Lump in throat
◇Upset Stomach
◇Frequent Urination
◇Rapid and Shallow breaths
◇Muscle Twitches and Tics

Question 4

Coexisting Disorders with GAD

Answer 4

GAD frequently coexists with other anxiety disorders and mood disorders, such as depression.

Question 5

AETIOLOGY (Reasons of GAD)

Answer 5

1. Biological Factor
2. Psychological Factors
   ○Psychoanalytical Approach
   ○Cognitive Behavioral Approaches

Question 6

Explain psychoanalytical approach behind Psychological factors surrounding general anxiety disorder

Answer 6

Psychoanalytical Approach
●There is always a consistent clash between ID ( unacceptable impulses, desires and anger)
● and EGO (controlling aspect of personality).
●The EGO will repress the unaccepted desires within the unconscious mind and seek expression.
●The conflict causes anxiety when repressed and not addressed.

Question 7

Explain cognitive Behavioral approach falling under psychological factors of anxiety disorder

Answer 7

Cognitive Behavioral Approaches
●When Individuals go through a series of uncontrollable negative events, and lack safety signals in life.
●The schema that “nothing in my life is under my control and it will only get worse” is created within my mind and overestimates threats.
●It gets enhanced when the individual doesn’t feel safe and supported in the surrounding environment.
●Worry and anxiety have a survival/functional aspect but as they get magnified cause dysfunction and seek maladaptive outlets it becomes General Anxiety Disorder.

Question 8

Treatment of GAD

Answer 8

○Medications
○Psychotherapy
○Progressive Muscle Relaxation (PMR)
○Addressing Cognitive Biases.
○Other Techniques may include
i)mindfulness
ii) exposure to anxiety-provoking situations in a controlled manner to reduce sensitivity over time.

Question 9

Biochemical Factors of GAD

Answer 9

Neurotransmitter Imbalances: A deficiency in Gamma-Aminobutyric Acid (GABA), a neurotransmitter that helps regulate anxiety, is linked to GAD.
Other neurotransmitters like serotonin and norepinephrine may also play a role.
This does not guarantee but increases the likelihood.
Hormonal Factors: Increased levels of cortisol, a stress hormone, and corticotropin-releasing hormone (CRH) are associated with GAD.
Excessive release of CRH creates predisposition of GAD.

Question 10

Medications for GAD?

Answer 10

Medications include:

●Benzodiazepines:
Provide immediate relief from anxiety but carry a risk of dependency.
●Buspirone: Non-habit forming, but takes a few weeks to become effective.
●Antidepressants
Often prescribed to help manage anxiety symptoms.

Question 11

Medications for GAD?

Answer 11

Medications include:

●Benzodiazepines:
Provide immediate relief from anxiety but carry a risk of dependency.
●Buspirone: Non-habit forming, but takes a few weeks to become effective.
●Antidepressants
Often prescribed to help manage anxiety symptoms.

Question 12

Cognitive Distortions

Answer 12

1. Cognitive distortions
   ○These are irrational or biased ways of thinking
   ○It increases negative thought patterns .
   ○It contributes to emotional distress.
   ○They are often automatic thoughts that distort reality and reinforce negative beliefs about oneself, others, and the world.
   2.Muscular Relaxation:
   ● Progressive Muscle Relaxation (PMR)
   It is a technique designed to reduce stress and anxiety by tensing and then slowly relaxing different muscle groups in the body

●It can help alleviate physical symptoms of anxiety.

Question 13

Psychotherapy in GAD

Answer 13

Cognitive-Behavioral Therapy (CBT):
●Effective in addressing the cognitive distortions and behavioral patterns associated with GAD.
●This includes cognitive restructuring (challenging and changing negative thought patterns) and behavioral techniques to reduce anxiety.

Question 14

PMR

Answer 14

Progressive Muscle Relaxation (PMR)
●It is a muscle relaxation technique.
●It is a technique designed to reduce stress and anxiety by tensing and then slowly relaxing different muscle groups in the body.

●It can help alleviate physical symptoms of anxiety.

Question 15

Intrusive Thoughts:

Answer 15

Automatic thoughts that appear in our mind without our conscious effort.

Question 16

Definition of OCD

Answer 16

Obsessive-compulsive disorder (OCD) is a long-lasting disorder in which a person experiences uncontrollable and recurring thoughts (obsessions), engages in repetitive behaviors (compulsions), or both

Question 17

Psychiatric Definition of OBSESSION

Answer 17

●The state when Intrusive thoughts, images, impulses appearing without conscious effort.
●Often negative, irrational, unacceptable.
●The thoughts keep reappearing even when the individual doesn’t desire it and consider it irrational.

Examples:
◇Fear of contamination
◇ fear of harming oneself or others
◇religious or sexual themes
◇doubts about completing tasks correctly

Question 18

COMPULSION

Answer 18

●The obsession causes anxiety.
●To get relief from the anxiety the individual is compelled to take some action for some temporary relief.
●The relief that is achieved by compulsion is always temporary.
●As the temporary relief will not last the individual will repeat the cycle again and the pattern would be reinforced.
●The action will be conditioned with temporary relief (classical conditioning)
●As the relief is temporary the individual will keep repeating the action

Question 19

Relationship between obsession and compulsion.

Answer 19

1. The obsession is triggered by internal dialogue, obsessive thoughts that cause compulsive action.
2. The Internal dialogue or obsessive thought is often irrelevant to the present moment of individual’s life, the individual is aware of irrelevance but they cannot control the obsessive thoughts.
3. The obsession causes anxiety.
4. To get relief from the anxiety the individual is compelled to take some action for some temporary relief.
5. The relief that is achieved by compulsion is always temporary.
6. As the temporary relief will not last the individual will repeat the cycle again and the pattern would be reinforced, this action will be conditioned with temporary relief (classical conditioning)
7. As the relief is temporary the individual will keep repeating the action.

Question 20

Example of common behaviors of OCD

Answer 20

■ Excessive washing or cleaning
■ Thought would be followed by action if thought emerges the person will indulge in action of seeking temporary relief in a ritualistic way, anyhow.
□ Repeated checking, counting, arranging items in a particular order, and hoarding.

Question 21

IMPACT OF OCD

Answer 21

● It is not necessary that obsession and compulsion occur together, sometimes obsession can occur without compulsion and vice versa.

●Time-Consuming:
Obsessions and compulsions take up significant time, interfering with daily activities and responsibilities.

●Health Risks:
Excessive cleaning can cause physical harm, such as skin damage.

●Emotional Distress:
Insight into the irrational nature of these behaviors often leads to feelings of shame and decreased self-confidence.

●WHO quotes OCD as a leading cause of disability.
●As Per WHO it is one of the most difficult mental disorders to treat.
●It could require lifetime help.

Question 22

Etiology of OCD
(Set of causes of OCD)

Answer 22

1. Biological Factors:
   a) Genetics:
   Moderate genetic inheritance, with a higher incidence among relatives of those with Tourette’s syndrome or autism.
   b)Brain Abnormalities:
   ●Increased activity in specific brain regions
   ●Caudate nucleus
   ●Orbital frontal cortex
   ●Cingulate cortex
   ●Abnormalities in serotonin levels.

Question 23

What is Caudate Nucleous

Answer 23

1. The caudate nucleus is a C-shaped structure in the brain that’s involved in many higher neurological functions.
2. It’s located in the center of the brain, near the thalamus, and is made up of three parts: the head, body, and tail.

3.The caudate nucleus plays a role in:
○Planning movement
○Learning
○Memory
○Reward
○ Motivation
○ Emotion
○ Romantic interaction.

Question 24

Psychological causes of OCD

Answer 24

1. Psychoanalytic Theory:
   ●Links OCD to childhood experiences, particularly strict toilet training, leading to fixation on cleanliness and rituals.
2. Learning Theory:
   ●Neutral stimuli become associated with anxiety through conditioning
   ● Compulsive behaviors are reinforced because they temporarily reduce anxiety.
3. Cognitive Theory:
   Negative automatic thoughts and a tendency to merge thoughts with actions, lead to catastrophic thinking and difficulty in suppressing irrelevant information.

Question 25

Cognitive Theory as cause behind OCD

Answer 25

Negative automatic thoughts, often thoughts compelling actions, lead to catastrophic thinking and difficulty in suppressing unwanted thoughts and hazardous behavior.

Question 26

Behavioral Therapy as treatment of OCD?

Answer 26

Behavioral Therapy as treatment of OCD Includes:

1. Behavior Therapy:
   ●Exposure and Response Prevention (ERP):
   ~ The most effective therapy for OCD involves gradually exposing the person to their obsessions and preventing compulsive behavior
   ~ It Helps them to habituate and reduce anxiety without performing rituals.

Question 27

Medications of OCD

Answer 27

Common Medications include
~Clomipramine and fluoxetine:
They can help reduce symptoms but often need to be combined with behavioral therapy to prevent relapse.

Question 28

Challenges in Treating OCD

Answer 28

-Treatment Resistance is biggest challenge in treatment.
-OCD is challenging to treat, and even with therapy, some symptoms may persist.
-The severity can be significantly reduced, allowing individuals to lead more functional lives.

Question 29

What is full form of GABA

Answer 29

-GABA is an acronym for gamma-aminobutyric acid, a neurotransmitter in the brain that helps regulate nerve cell activity.

-Scientists also call GABA a non-protein amino acid neurotransmitter.

Question 30

Functions of GABA

Answer 30

GABA is known for producing a calming effect and is thought to play a role in controlling nerve cell hyperactivity associated with anxiety, stress, and fear.

Question 31

What are the health benefits of GABA?

Answer 31

By slowing certain brain functions, GABA is thought to be able to:

-Reduce stress.
-Relieve anxiety.
-Improve sleep.

Question 32

Coexisting Disorders of GAD:

Answer 32

GAD frequently coexists with other anxiety disorders and mood disorders, such as depression.

Question 33

PREVALENCE OF OCD

Answer 33

General Population:
Affects about 2% to 3% of people.

Onset:
Typically begins in adolescence or early adulthood but can start in childhood. Early onset cases tend to be more severe.

Gender:
Affects both men and women equally, though the specific content of obsessions and compulsions can vary.

Question 34

Clinical Features of OCD

Answer 34

-Having obsessions, compulsions or both.
-The obsessions or compulsions take up a lot of time (more than an hour per day).
-The obsessions or compulsions cause distress or affect your participation in social activities, work responsibilities or other life events.
-The symptoms aren’t caused by substances, alcohol, medications or another medical condition.
-The symptoms aren’t explained by a different mental health condition, such as generalized anxiety disorder, eating disorder or body image disorder.

Question 35

GABA neurotransmitter for a layman

Answer 35

1.GABA (Gamma-Aminobutyric Acid): A chemical messenger (neurotransmitter) in the brain.

2.Main Function: It reduces the activity of nerve cells, acting like a “calm-down” signal for the brain.

3.Psychological Role: Helps control stress, anxiety, and sleep by calming the brain when it gets overactive.

4.Low GABA Levels: Can lead to issues like anxiety, restlessness, or trouble sleeping.

4.Medications: Many anti-anxiety drugs work by increasing GABA activity, helping people feel more relaxed and balanced.