Anxiety and OCD Overview

Anxiety and OCD Lecture Notes

• Anxiety: A universal human experience characterized by feelings of apprehension, unease, uncertainty, or dread, resulting from a real or perceived threat. It differs from fear, which is a reaction to a specific danger.

Levels of Anxiety

• Mild Anxiety: Normal and necessary for survival. Helps focus attention and problem-solving.

• Moderate Anxiety: Focus narrows, selective attention increases, but thinking is less clear.

• Severe Anxiety: Perception is greatly reduced; individuals may feel overwhelmed and have difficulty concentrating.

• Panic: The most extreme level. Individuals may be unable to process the environment, experiencing dissociation, confusion, or terror.

Anxiety Disorders

1. Generalized Anxiety Disorder (GAD)

• Symptoms: Chronic, excessive worry about various life domains for at least 6 months, along with physical symptoms like restlessness, muscle tension, fatigue, and irritability.

• Interventions:

  • Psychotherapy (CBT)
  • Pharmacotherapy (SSRIs, SNRIs, occasionally benzodiazepines for short-term relief)
  • Lifestyle modifications (exercise, sleep hygiene, relaxation techniques)

2. Panic Disorder

• Symptoms: Recurrent, unexpected panic attacks marked by intense fear or discomfort, physical symptoms including chest pain, dizziness, palpitations, shortness of breath, and feelings of impending doom.

• Interventions:

  • CBT (particularly with exposure therapy)
  • Pharmacotherapy (SSRIs and benzodiazepines)
  • Patient education on the physical effects of anxiety to reduce fear during an attack.

3. Phobias

• Specific Phobia: Fear of specific objects or situations (e.g., heights, flying).

• Social Anxiety Disorder (Social Phobia): Fear of social situations where there is potential scrutiny by others. Leads to avoidance of social events.

• Agoraphobia: Fear of open spaces or situations where escape might be difficult, like public transportation or crowded places.

• Interventions:

  • Systematic desensitization (gradual exposure)
  • CBT (to reframe irrational fears)
  • 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 performed in response to obsessions (e.g., excessive handwashing, checking).

• Diagnostic Criteria (DSM-5):

  • Presence of obsessions, compulsions, or both.
  • Symptoms are time-consuming (more than 1 hour per day) or cause significant distress or impairment.
  • Symptoms are not attributable to substance use or other medical conditions.

• 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) to expose patients to feared situations without allowing compulsions.
  • SSRIs are first-line medications.

Other Disorders

• Body Dysmorphic Disorder (BDD): Preoccupation with an imagined or exaggerated defect in appearance, leading to excessive grooming, mirror checking, or seeking cosmetic surgery.
• Hoarding Disorder: Difficulty discarding possessions, regardless of value, leading to clutter disrupting living spaces and daily functioning.
• Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking Disorder): Repeated pulling of hair or picking of skin, leading to noticeable hair loss or skin lesions.
  • Interventions include CBT focusing on habit-reversal techniques and medications like SSRIs to reduce compulsive urges

Neurobiology

• Amygdala: Central in processing fear and anxiety, hyperactivity linked to anxiety disorders.
• Prefrontal Cortex: Regulates amygdala's response to anxiety, role in OCD.
• Neurotransmitters:
  • Serotonin: Dysregulation linked to OCD and anxiety.
  • Norepinephrine: Involved in the "fight or flight" response.
  • GABA: Primary inhibitory neurotransmitter, reduced activity linked to heightened anxiety.

Course and Prognosis

• OCD is a chronic condition with waxing and waning symptoms.
• Early treatment (CBT and/or medication) improves long-term outcomes.
• Partial remission (50-60%) is common with treatment.

Differential Diagnosis

• OCPD: General preoccupation with orderliness and control, lacks intrusive obsessions and compulsions.
• Other Anxiety Disorders: (e.g., generalized anxiety disorder, specific phobias) with excessive worry, unlike repetitive behaviors in OCD.
• Tic Disorders: Some individuals with OCD may also have tics (e.g., Tourette's syndrome).