Flashcards in OCD and such Deck (89):
1
What is fear?
the physical and mental response to an *imminent* threat
2
What is anxiety?
The anticipation of threat in the *future*
3
Anxiety or fear: threat is known
Fear
4
Anxiety or fear: desire to escape
Fear
5
Anxiety or fear: desire to avoid
Anxiety
6
Anxiety or fear: muscle tension and vigilance
Anxiety
7
Anxiety or fear: fight/flight/freeze response
Fear
8
True or false: both anxiety and fear can occur as part of anxiety disorders
True
9
What is the most common category of mental disorders?
Anxiety disorders
10
What is the prevalence of anxiety disorders every year?
18%
11
Are anxiety disorders more common in women or men?
Women
12
True or false: anxiety disorders tend to develop in adulthood
False--childhood
13
What is the classic course of GAD?
Chronic, waxing and waning course
14
What does avoidance lead to? Exposure?
Avoidance - Anxiety
Exposure - Extinction
15
What is the lifetime prevalence of anxiety disorders in women? Men?
Women = 30%
Men = 19%
16
What are the comorbidities of anxiety disorders?
Depression and substance abuse
17
What are the 4 criteria for specific phobias?
-Marked fear or anxiety about a specific object
-Exposure to the phobic stimulus provokes immediate fear
-The phobic object is avoided
-Fear is out of proportion to the actual danger
18
How long do phobias last for, (to meet the criteria)?
6 months
19
True or false: most people with a phobia usually do not have more than one
False--most do
20
In what age group are phobias particularly prevalent in?
Adolescents
21
True or false: excessive fears are common in young children, and often transitory--thus consider it part of normal development
True
22
What is the major difference between phobias and realistic fears?
Realistic fears are proportional to probability
23
What is the best treatment for fear?
Exposure therapy
24
What is the one exception to increased SNS with phobias?
Sight of blood
25
Is pharmacotherapy recommended for treatment of phobias? Why or why not?
No--treatment gains are not sustained
26
How long does exposure therapy have to last for?
until fear decreases
27
When is pharmacotherapy appropriate for phobias?
For one time instances (flying for one time, vs flying constantly for new job)
28
What are the criteria for social anxiety disorder? (5)
-Marked fear/anxiety of social situations
-Concern for acting in a way that is humiliating
-Exposure to social situations
-Feared situation is avoided
-Fear/anxiety is out of proportion
29
What is the time duration that is needed to diagnose social anxiety disorder?
6 months or more
30
What is the CBT treatment for social anxiety disorder?
-Correction of maladaptive thinking
-Exposure to feared social situations
31
Can CBT for social anxiety disorder be done in groups?
Yes
32
What is the pharmacotherapy for social anxiety disorder? (4)
-SSRIs/SNRIs
-Beta blockers
-MAOIs
-Benzos
33
Performance based anxiety disorders respond well to what sort of pharmacotherapy?
Beta blockers
34
What is panic disorder?
Recurrent, unexpected panic attacks (abrupt surge or intense fear or discomfort within minutes)
35
How many symptoms are needed to diagnose a panic attack?
4+
36
What is the anxiety component of panic disorders?
Persistent worry about additional attacks or their consequences, resulting in maladaptive change in behavior related to the attacks
37
Is a single episode of a panic attack diagnostic for a panic disorder?
No--need multiple
38
What is the ratio of panic attacks in females:males?
2:1
39
What is the median age at onset of panic attacks?
early 20s
40
Can panic attacks occur during sleep?
Yes--need to have one for diagnosis of panic disorder
41
There is a (__)x increase in mental disorders in first degree relatives of panic attack pts.
4-8x
42
True or false: syncopal episodes do not happen with panic attacks, and should be worked up medically
False
43
What is the first line treatment for panic attacks?
CBT and panic-focused psychodynamic psychotherapy
44
What are the pharmacotherapies for panic attacks?
-**SSRIs/SNRIs**
-TCAs
-Benzos
45
True or false: pts with panic disorders are often intensely sensitive to side effects of medications
True
46
What is agoraphobia, and what are the 5 diagnostic criteria?
Marked fear or anxiety about at least 2 of the following:
-Using public transportation
-Being in open spaces
-Being in enclosed spaces
-Standing in line or being in a crowd
-Being outside the home alone
47
What is the fear of agoraphobia usually d/t?
Not having access to help or of not being able to escape the situation
48
How long do s/sx of agoraphobia have to last for to meet the criteria for diagnosis?
6 months
49
True or false: agoraphobia often develops as a result of panic disorders
True
50
What age group is the incidence of agoraphobia the highest?
adolescence
51
What is the treatment for agoraphobia?
CBT or SSRIs
52
True or false: SSRIs are generally safe in overdose
True
53
Which type of antidepressant is more effective in the treatment in panic/agoraphobia
TCAs
54
What is the criteria for GAD? (2)
-Excessive anxiety/worry for more days than not for at least 6 months about a number of events or activities
-Difficulty controlling the worry
55
When (age wise) is the peak incidence of GAD?
Middle age
56
GAD is more common in men or women?
Women
57
True or false: GAD s/sx tend to wax and wane
True
58
What is the treatment for GAD?
-CBT
-Acceptance and commitment therapy
59
What are the components of the acceptance and commitment therapy? (3)
-Decrease avoidance
-Decrease attachment to thoughts
-Increase behavior moving towards valued goals
60
What is the pharmacotherapy for GAD?
-SSRIs/SNRIs
-Benzos (acutely)
-Buspirone
61
What is the MOA of buspirone?
serotonin 5-HT1A receptor partial agonist
62
What is the MOA of benzos?
Increases Cl channel opening frequency
63
What is the MOA of barbiturates?
Increases Cl channel opening duration
64
True or false: relapse is common in GAD in the first year after discontinuation of medication
True
65
What are obsessions?
1. Recurrent, intrusive and unwanted *thoughts*
2. Attempts are made to suppress, ignore or neutralize them with some other thought
66
What are compulsions?
1. Repetitive *behaviors* or mental acts that one feels driven to perform in response to an obsession
2. Behaviors or mental acts are aimed at preventing or reducing anxiety
67
What is characteristic of the compulsions with OCD?
The behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event/situation, but they are not connected in any realistic way with what they are designed to neutralize or prevent, or are clearly excessive
68
What are the characteristics of obsessive thoughts?
Not pleasurable or voluntary--feel intrusive and undesired
69
What is the usual level of insight with OCD?
Variable
70
What is the mean age of onset for OCD? Course?
Mean age of onset is 20
Chronic, waxing and waning but 40% are self-limited
71
What is the usual comorbidity with OCD?
-Tic disorders
-Depression
-Other anxiety disorders
72
What is the treatment for OCD?
-Behavior therapy
73
What is the pharmacotherapy for OCD?
-SSRIs/SNRIs
-Clomipramine
74
Are benzos effective for OCD?
No
75
What are the criteria for OCD?
Need to take up at least an hour of the day or cause significant distress or impairment
76
What SSRI is particularly efficacious in treating OCD?
Clomipramine
77
What is body dysmorphic disorder?
Preoccupation with a perceived defect or flaw in appearance not observed by others
-Has a performed, repetitive behavior in response
78
True or false: there is usually little insight with body dysmorphic disease?
True
79
True or false: the risk of suicide is not elevated in body dysmorphic disorder, as compared to general population
False
80
What is the treatment for body dysmorphic disorder?
-SSRIs
-CBT
81
What are the diagnostic criteria for hoarding?
-Persistent difficulty discarding/parting with things, regardless of their value
-Perceived need to save, and distress associated with discarding
82
Hoarding is more common among what age group?
Old people
83
True or false: there is a strong genetic component to hoarding
True
84
What is the treatment for hoarding?
CBT (maybe)
85
What is trichotillomania?
-Recurrent pulling out of hair for gratification
-Repeated attempts to stop
86
When does Trichotillomania usually begin?
Around puberty
87
What is the treatment for Trichotillomania?
Psychotherapy and habit reversal therapy
88
What is excoriation disorder?
-Recurrent skin picking resulting in lesions
-Repeated attempts to stop
89