Anxiety ii Flashcards
DSM-V definition of OCD
A: the presence of obsessions and compulsions.
B: these obsessions and compulsions must be either time consuming, cause siginificant distress, are not substance induced, and not better explained as symptoms of something else
what is an obsession?
recurrent/persistent thoughts, urges, or images. Intrusive and unwanted: sometimes called ego dystonic. cause person anxiety and stress. Patient trues to ignore/suppress these thoughts or try to neutrualize them (undoing ego defense mechanism)
what is a compulsion?
repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that must be strictly adhered to. a compulsion typically undoes or reduces anxiety. stopping compulsion often increases anxiety
comorbidities to OCD
1/3 have major depression. up to 2/3rds of people with tourette’s syndrome are diagnosed with OCD. suicide risk is high
treatment for OCD (therapy)
CBT: as effective as pharm therapy, with longer lasting effects. exposure and response prevention. Acceptance and commitment therapy for obsessions.
treatment for OCD (pharm)
1st line: SSRIs ( need higher dose than for MDD)
2nd line: clomipramine (a TCA) (high side effects)
3rd line: antipsychotics, other antidepressants
benzodiazepine sedatives dont work.
differential diagnoses for OCD
tourette’s disorder. temporal lobe epilepsy. OCD personality disorder. these people generally have insight into their behavior.
DSM-V criterion A of PTSD
exposure to actual or threatened traumatic event. must have symptoms for more than 1 month. must cause significant distress/impairment. symptoms must not be the result of a substance or other medical condition.
Modes of exposure in PTSD
directly experiencing events, witnessing events happening to others, learning that a family member/friend experienced such an event, directly experiencing repeated/extreme exposure to horrific details of an event
DSM-V criterion B of PTSD
> 1 intrusion symptom associated with the event. reliving of events. distressing memories or nightmares/dreams of the event. dissociate reactions during which the patient feels and/or acts as if the events are recurring. psychological distress from exposure to internal or external cues that resemble the event. psychological reactions to external cues
DSM-V criterion C of PTSD
avoidance of stimuli associated with the traumatic events. avoid memories/thoughts/feelings. avoid external reminders that may arouse memories. avoid interpersonal connectivity
DSM-V criterion D of PTSD
negative changes in cognition and mood associated with the event. >2 of the following: inability to remember important part of event due to dissociative amnesia or repression. persistent exaggerated beliefs/expectations of oneself, others , the world. distortion of thoughts and memories of the event, causing self blame. negative emotional state, decreased interest in daily activities. feeling of detachment. inability to experience positive emotions
DSM-V criterion E of PTSD
alterations in arousal/reactivity. >2 of the following: irritable behavior/angry outbursts, expressed as verbal or physical aggression towards others. reckless behavior. hypervigilance. exaggerated startle response. problems with concentration, sleep disturbances
Acute stress disorder
criteria B-D must persist for 3 days to 1 month after exposure. a precursor to PTSD. best time to treat!
co-morbidities of PTSD/ASD
depressive disorders, substance related disorders, other anxiety disorders, bipolar disorders, personality disorders.
