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Anxiety and Obsessive Compulsive Disorders (Specific Phobia (Criteria…
Anxiety and Obsessive Compulsive Disorders
Specific Phobia
Criteria
Marked fear or anxiety about specific object or situation that almost always provokes immediate fear, actively avoided, disproportionate to actual danger
4 sub types - 1. blood/injection/injury, 2. situational, 3. animals and insects, 4. natural environemnts
Treatment: exposure therapy
Aetiology
Direct experience, experiencing false alarm, observing someone experiencing fear (modelling), verbal instruction to avoid fear, social/cultural determinants
Social Anxiety Disorder
Criteria: marked fear or anxiety about exposure to possible scrutiny by others - anxiety about being evaluated negatively, trigger situations are avoided, almost always provoke fear/anxiety, disproportionate to actual threat, 3-13% prevalence
Aetiology: generalised biological/evolutionary vulnerability, social situation associated with panic, real social trauma (e.g. bullying), belief that social evaluation can be dangerous (e.g. parents obsession with other's opinions)
Treatment: exposure therapy, cognitive therapy, tricyclic anti-deps, MAO inhibitors, d-cycloserine (antibiotic) + CBT is effective
Panic Disorder
Criteria
Recurrent unexpected panic attacks, 4 or more panic symptoms, at least 1 of the attacks followed by one or both of the following - 1. worry about further attacks or 2. significant maladaptive behavioural changes, triggered by fear of having an attack, not triggered by anything in particular
Methods to avoid panic attacks: drug/alcohol use/abuse, enduring fear, avoiding places that might produce similar physiological symptoms like sweating, hard to breathe, etc
Prevalence is ~5%, early adulthood onset, 60% experience nocturnal attacks - wake up during attack (from delta wave (deepest) sleep), sleep terrors, isolated sleep paralysis
Aetiology: Locus ceruleus, major source of norepinephrine - activates HPA axis, triggers symp NS
Treatment: SSRIs, SNRIs, benzodiazepines, CBT most successful - exposure and panic control therapy
Agoraphobia
Criteria: marked fear or anxiety about enclosed space or places where escape might be difficult, situations are avoided, out of proportion to actual danger, almost always provokes fear/anxiety
Aetiology: genetic vulnerability (heritability 61%), fear of fear hypothesis
Treatment: exposure therapy (with a partner helps so they can stop enabling)
Generalised Anxiety Disorder
Criteria: excessive anxiety/worry occurring more days than not, about a number of events, associated with at least 3 from list of symptoms (restlessness, easily fatigued, difficulty concentrating, muscle tension, etc, tends to come back in waves
Aetiology: prevalence ~5.7%, genetic vulnerability, autonomic restrictors, unconscious sensitivity to threats
Treatment: benzodiazepines (short-term relief), psychological treatments - relaxation training, acceptance, challenging negative thoughts
OCD
Criteria
Presence of obsessions (recurrent, intrusive, persistent, unwanted thoughts/urges/image), compulsions (repetitive behaviours or mental acts that a person feels compelled to perform in response to an obsession or rigid rules) or both, require at least 1 hour per day or cause distress to be diagnosed
Commonly occurs with anxiety, depression, panic attacks, prevalence ~2%, subtypes include symmetry (things need aligning), forbidden thoughts (religious/sexual), cleaning
Aetiology: hyperactive orbitofrontal cortex, caudate nucleus, anterior cingulate gyrus, thought-action fusion (hypotheses: early experiences that some thoughts are dangerous, attitudes of excessive responsibility and guilt
Treatment: SRIs most effective, exposure, cognitive approaches, psychosurgery - lesion to cingulate bundle (only after drugs and therapy have failed)