Anxiety, Phobias, OCD

Question 1

What is the definition of panic disorder?

Answer 1

Recurrent attacks of severe anxiety which are not restricted to any particular situation or set of circumstances and are therefore unpredictable.

Question 2

What is the typical onset of panic disorder?

Answer 2

Adolescence to mid-30’s

Question 3

What are some clinical features of panic disorder?

Answer 3

Sudden onset palpitations, chest pain, choking sensation, dizziness and feeling of unreality
Secondary fear of dying, losing control or going mad

Question 4

What is the management of panic disorder?

Answer 4

1) Self-help
2) CBT or SSRI if long standing or no benefit from CBT
3) Consider tricyclics (clomipramine, desipramine) if no improvement after 12 weeks

Question 5

What drugs should be avoided in panic disorder?

Answer 5

Benzodiazepines or sedating antihistamines
Propanolol, buspirone, buproprion

Question 6

How long should drug treatment for panic disorder be continued?

Answer 6

6 months

Question 7

What are the three types of phobias?

Answer 7

Agoraphobia
Social phobia
Specific phobia

Question 8

What is agoraphobia?

Answer 8

Fears of leaving home, entering shops, crowds and public places, travelling alone
Results in avoidance of phobic situation

Question 9

What are some clinical features of agoraphobia?

Answer 9

Others do shopping (for or with patient)
Drinking alcohol to overcome fear
Go shopping at night when quiet
Internet shopping

Question 10

What is the management of agoraphobia?

Answer 10

1) Self-help
2) CBT or SSRI if long standing or no benefit from CBT
3) Consider tricyclics (eg clomipramine, desipramine) if no improvement after 12 weeks

Question 11

What are some common specific phobias?

Answer 11

Animals
Heights
Thunder
Flying
Exposure to blood
Injections

Question 12

Do people with phobias have insight into their condition?

Answer 12

Yes
They recognise that the fear is excessive or unreasonable

Question 13

What is the management of specific phobia?

Answer 13

Exposure therapy
- Graded/systemic desensitisation
- Add CBT if necessary

SSRIs/SNRIs if required

Question 14

What is social phobia/social anxiety disorder?

Answer 14

Persistent fear of one or more social or performance situations in which person is exposed to unfamiliar people or to possible scrutiny by others

Question 15

What is the pathophysiology of phobias?

Answer 15

Increased bilateral activation of amygdala and related limbic areas that normalises on successful treatment

Question 16

What are some clinical features of social phobia?

Answer 16

Blushing or shaking
Fear of vomiting
Urgency or fear of micturition or defecation
Can result in poor performance at school, work, social life

Question 17

What is the management of social phobia?

Answer 17

1) Individual CBT
2) SSRI (escitalopram or sertraline)- review at 12 weeks
3) SSRI plus CBT
4) Alternative SSRI (fluvoxamine or paroxetine) or SNRI (venlafaxine)
5) MAOI (moclebemide)

Question 18

What is the definition of obsessive compulsive disorder (OCD)?

Answer 18

Common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (’obsessions’) and/or behaviours (’compulsions’) that the patient feels the urge to repeat over and over

Question 19

What is the mean age of onset for OCD?

Answer 19

20

Question 20

What is the diagnostic criteria for OCD?

Answer 20

Obsessional symptoms or compulsive acts must be present most days for at least 2 weeks AND be a source of distress and interference with activities
Obsessions must be individuals own thoughts
Resistance must be present
Rituals are not pleasant
Obsessional thoughts/images/impulses must be repetitive

Question 21

What is the management of OCD?

Answer 21

1) CBT and ERP (low intensity)
2) More intensive psychological intervention or SSRI (consider dose increase after 4-6 weeks)
3) SSRI plus CBT and ERP
4) Clomipramine (tricyclic)
5) Augmentation with antipsychotic or clomipramine plus citalopram