Anxiety and OCD Lecture Notes

Anxiety and OCD Lecture Notes

• Anxiety is a common human experience, featuring feelings of apprehension, unease, and dread, triggered by a real or perceived threat. It's distinct from fear, which reacts to a specific danger.

Levels of Anxiety

• Mild Anxiety: A normal, necessary response for survival, enhancing focus and problem-solving abilities.
• Moderate Anxiety: Focus narrows, attention becomes selective, but clarity of thought reduces.
• Severe Anxiety: Perception significantly decreases, leading to difficulty concentrating and overwhelming feelings.
• Panic: The most intense level, characterized by a loss of ability to process the environment, causing dissociation, confusion, or terror.

Generalized Anxiety Disorder (GAD)

• Symptoms: Chronic, excessive worry across life domains for at least six months, accompanied by physical symptoms like restlessness, muscle tension, fatigue, and irritability.
• Interventions: Psychotherapy (CBT), pharmacotherapy using SSRIs, SNRIs, or occasionally benzodiazepines (short-term), and lifestyle modifications like exercise, sleep hygiene, and relaxation techniques.

Panic Disorder

• Symptoms: Recurrent, unexpected panic attacks marked by intense fear, discomfort, physical symptoms (chest pain, dizziness, palpitations, shortness of breath), and a feeling of impending doom.
• Interventions: Cognitive Behavioral Therapy (CBT), particularly with exposure therapy, pharmacotherapy using SSRIs, benzodiazepines, and patient education about the physical effects of anxiety to diminish fear during attacks.

Phobias

• Specific Phobia: Fear of specific objects or situations (e.g., heights, flying).
• Social Anxiety Disorder (Social Phobia): Fear of social situations involving potential scrutiny by others, leading to avoidance of social events.
• Agoraphobia: Fear of open spaces or situations where escape might be difficult (e.g., public transportation, crowded places).
• Interventions: Systematic desensitization (gradual exposure to the feared object/situation), CBT to modify irrational fears, and medications (SSRIs or beta-blockers, especially for performance-related anxiety).

Obsessive-Compulsive Disorder (OCD)

• Obsessions: Persistent, intrusive thoughts, urges, or images causing anxiety (e.g., fear of contamination, intrusive sexual or aggressive thoughts).
• Compulsions: Repetitive behaviors or mental acts (e.g., excessive handwashing, checking) performed in response to obsessions.
• Diagnostic Criteria (DSM-5): Obsessions, compulsions, or both, significantly impacting daily life, lasting over one hour per day, and not attributable to substance use or another medical condition.
• Common Subtypes: Contamination and cleaning, harm obsessions and checking, symmetry, order, and counting, taboo or forbidden thoughts.
• Interventions: CBT with Exposure and Response Prevention (ERP), SSRIs are first-line medications.

Body Dysmorphic Disorder (BDD)

• Symptoms: Preoccupation with an imagined or exaggerated flaw in appearance, leading to compulsive behaviors like excessive grooming, mirror checking, or seeking cosmetic surgery.
• Interventions: CBT focusing on cognitive distortions and body image issues, SSRIs to reduce obsessive thinking.

Hoarding Disorder

• Symptoms: Difficulty discarding possessions regardless of value, leading to clutter obstructing living spaces and daily functioning.
• Interventions: CBT emphasizing organizational skills and reducing acquisition, motivational interviewing for engagement in treatment.

Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking Disorder)

• Symptoms: Repeated pulling of hair or picking of skin leading to noticeable hair loss or skin lesions.
• Interventions: CBT focusing on habit-reversal techniques, medications such as SSRIs may help reduce compulsive urges.

Neurobiology of Anxiety and OCD

• Amygdala: Central to fear and anxiety processing, hyperactivity linked to anxiety disorders.
• Prefrontal Cortex: Plays a role in regulating the amygdala's response to anxiety, impaired in some OCD cases.
• Neurotransmitters: Serotonin dysregulation commonly associated with OCD and anxiety disorders. Norepinephrine plays a role in the "fight or flight" response; GABA is a primary inhibitory neurotransmitter.

Course and Prognosis

• OCD is typically chronic, with waxing and waning symptoms.
• Early treatment with CBT and/or medications improves long-term outcomes; full remission is less common.

Differential Diagnosis

• OCPD: General preoccupation with orderliness, perfectionism, and control, lacking specific intrusive obsessions and compulsions.
• Other Anxiety Disorders: Conditions like GAD or specific phobias might involve excessive worry but lack the repetitive behaviors of OCD.
• Tic Disorders: Individuals can have OCD along with tics or a diagnosis of Tourette's syndrome.

Explore the concepts of anxiety and OCD through this quiz. Learn about the different levels of anxiety, symptoms of Generalized Anxiety Disorder (GAD), and effective interventions. Test your understanding of how anxiety impacts daily life and how it can be managed.