OCD, PTSD, GAD, Drug SE & Somatisation Flashcards
Define somatisation
Disorders with multiple, recurring & changing physical symptoms that are not fully explained by other medical, neuro, psychiatric disorders
What are the causes of somatisation?
Chronic/acute emotional/psychological stress or conflict
Emotional processing deficit
Social, cultural, family taboos
What are risk factors for somatisation?
Female Alexithymia IBS Chronic pain Hx sexual/physical abuse (PTSD) Hx of unstable childhood Antisocial personality disorder Hx of trauma Neuroticism Pre poor dr-pt relationship
How is somatisation characterised?
- > 2y of multiple, variable physical symptoms w/no underlying cause: Inconsistent Ex findings, False sensory findings, Hoover’s sign
-Refusal to accept Dr’s reassurance
-Impairment of social function- adjusting lifestyle to anticipate illness
-Symptoms not intentionally produced: Hx vague/odd/ dramatic
Other:
Emotional processing problems: Inability to be aware of emotions or tendency to suppress/avoid emotions
Multiple illness behaviours: Avoiding perceived environmental triggers
How is somatisation investigated?
Often see multiple Dr’s in different specialities
Nature of illness- Pt usually undergone multiple investigations w/ -ve outcomes
Lab tests to rule out organic cause
Extensive Hx & Ex
How is somatisation managed?
Psychotherapy: Short course CBT Mindfulness therapy Psychiatric consultation Graded physical exercise Antidepressants: Duloxetine
What is defined as a generalised anxiety disorder?
At least 6months of excessive worry, apprehension, prominent tension about everyday issues that is disproportionate to any inherent risk causing distress or impairment
What is pathophysiology of a generalised anxiety disorder?
Increased levels of arousal
Overactivity of ascending noradrenergic neurones w/enhanced response to nerve stimuli by excessive activity of 5-HT neurones
Changes in cerebral blood flow in response to stress & hyper vigilance
How is GAD managed?
Stepped care model:
1) Educate & monitor, sleep hygiene
2) Low intensity psychological support, guided self-help
3) 2 interventions failed, CBT/ drug treatment, Applied relaxation
4) SSRI/Venlafaxine
Other:
Beta blockers (Propanolol): Autonomic peripheral symptoms (palpitations, tremor)
Diazepam: 2-10mg, rapid anxiolysis (only in very short term e.g flying)
What is a phobia?
Intense fears of specific objects or situations that are triggered upon actual or anticipated exposure to phobic stimuli.
How can phobias be managed?
CBT w/ gradual exposure
Benzos (Lorazepam)
Education & monitoring
In OCD what are obsessions & compulsions defined as?
O: Unwanted, recurrent, disturbing, intrusive thoughts, images, impulses generally seen as excessive/irrational/ego-alien
C: Repetitive useless behaviours & mental acts that neutralise obsessions & reduce emotional distress. Function is to prevent some objectively unlikely event (often harm/danger)
Thoughts have significance & meaning so cannot be dismissed.
What are the risk factors for OCD?
PANDAS
Pregnancy
Fhx
What are the signs & symptoms of OCD?
Person hears impulsion as self (they know they are their own thoughts not thoughts externally inserted) Simultaneous anxiety Obsessions Compulsions Tic disorder Poor motor co-ordination Schizotypal personality disorder
How is OCD investigated?
Hx & Ex:
-Do you wash/clean a lot?
-Do you check things a lot?
-Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
-Do your daily activities take a long time to finish?
-Are you concerned about putting things in a special order/are you upset by mess?
SCID
Tale-Brown Obsessive Compulsive Scale
Diagnosis: Ruminations arise/persist in absence of depressive episode
How is OCD managed?
CBT
ERP exposure & response prevention (to stimulus): Learning how to cope with tension
Mass practise: Pt forced to repeat their rituals
Thought-stopping: Blocking undesired thoughts
Pharmacotherapy:
SSRI: Fluoxetine/Sertraline, TCA: Clomipramine
Psychosurgery: Cingulotom