Anxiety Disorders: shorter oxford

Questions and Answers

In generalized anxiety disorders, anxiety is described as intermittent rather than continuous.

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Panic disorder is characterized by anxiety that is unrelated to specific circumstances.

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Freud first suggested that anxiety symptoms should not be classified separately from mood disorders.

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The term 'anxiety neurosis' was coined by Freud in the early 20th century.

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Anxiety hysteria is associated with primarily psychological symptoms of anxiety.

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Anxiety and depression are commonly observed to occur together.

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The recognition of anxiety disorders as a separate classification occurred primarily after the early 20th century.

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Phobic anxiety disorders feature continuous anxiety rather than intermittent episodes.

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Anxiety caused by physical illness can sometimes be mistaken for generalized anxiety disorder.

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Rates of generalized anxiety disorder are higher in men than in women.

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The Adult Psychiatric Morbidity Survey indicated a 12-month prevalence of 4.4% for GAD in France.

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It is uncommon for anxious patients to withhold physical symptoms unless prompted by specific questioning.

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Diagnosis of generalized anxiety disorder requires systematic inquiries about the timing and nature of symptoms.

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The ICD-10 requires the presence of a minimum of 22 physical symptoms of anxiety for diagnosis.

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Worry is not considered a key symptom in the ICD-10 diagnostic criteria for generalized anxiety disorder.

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The duration criteria for symptoms in DSM-5 is shorter than in ICD-10 for generalized anxiety disorder.

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Comorbidity between generalized anxiety disorder and other anxiety disorders is rare.

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The diagnosis of generalized anxiety disorder cannot coincide with a diagnosis of major depression in patients.

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Anxiety symptoms can occur in nearly all psychiatric disorders.

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Misdiagnosing severe depressive disorder as generalized anxiety disorder is a common diagnostic error.

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Anxiety is considered an uncommon complaint in individuals developing dementia.

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The symptoms of drug withdrawal can sometimes be mistaken for those of anxiety.

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Thyrotoxicosis may present symptoms that can be easily distinguished from anxiety disorders.

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Freud initially proposed that the causes of anxiety neurosis were solely related to emotional conflicts.

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The first systematic medical study of phobic disorders was conducted by Le Camus in the seventeenth century.

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In the 1960s, it was observed that phobias accompanied by panic attacks responded better to behavior therapy than to imipramine.

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Agoraphobia is typically characterized by an exaggerated fear of high places.

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OCDs are classified with anxiety disorders in both ICD-10 and DSM-5.

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Generalized anxiety disorder (GAD) symptoms are generally focused around specific issues.

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Simple phobias usually begin in adolescence, while social phobia tends to begin in childhood.

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Muscle tension in GAD can result in bilateral and frontal headaches.

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Early-morning waking is a characteristic feature of generalized anxiety disorder.

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Panic disorder has been classified separately in the context of anxiety disorders due to its distinct symptoms and responses to treatment.

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Benzodiazepines are recommended as the initial treatment choice for generalized anxiety disorder due to their effectiveness.

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The anticonvulsant pregabalin is licensed for the treatment of GAD in the UK and has a similar side effect profile to SSRIs.

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Serotonin and noradrenaline reuptake inhibitors (SNRIs) are generally more well tolerated than selective serotonin reuptake inhibitors (SSRIs) in treating GAD.

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Patients with GAD who respond to medication have a reduced risk of relapse if treatment is maintained for at least 3 months.

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Duloxetine and venlafaxine are examples of SSRIs used in the treatment of generalized anxiety disorder.

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GAD has a higher concordance between dizygotic twins than monozygotic twins.

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The presence of adverse early experiences does not have a significant impact on the development of GAD in adulthood.

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Stressful life events characterized by danger are more commonly associated with the development of GAD.

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Genetic factors play a minor role in the aetiology of GAD compared to environmental influences.

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Family history of GAD is solely linked to the genetic transmission of the disorder.

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Early adversity reduces the likelihood of developing generalized anxiety disorder.

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The study by Kendler et al. (2003) indicated that stressful life events characterized by loss decreased the risk of both depression and GAD.

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Psychoanalytic theory suggests that anxiety is a result of intrapsychic conflict overwhelming the ego.

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Psychoanalytic theories have emerged from the accounts of anxious patients regarding their childhood experiences.

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Physical or sexual abuse in childhood is considered an adverse experience that can lead to GAD in adulthood.

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Cognitive biases associated with GAD include a reduced attention to potentially threatening stimuli.

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Genetic factors connected to neuroticism do not influence the occurrence of generalized anxiety disorder.

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The amygdala has no significant role in the regulation of anxiety.

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Conditioning theories provide robust support for the development of GAD.

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Worry can be used as a coping strategy for individuals predisposed to GAD.

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Cognitive behavioral theories have no link to the predisposition of GAD.

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Gamma-aminobutyric acid (GABA) receptors help increase anxiety levels in the brain.

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Psychoanalytic ideas suggest that secure relationships with parents can help children overcome anxiety.

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Patients with generalized anxiety disorder typically utilize worry as a coping strategy.

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The mean age of onset for generalized anxiety disorder is reported to be 30 years.

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Guided self-help involves minimal therapist input compared to self-help activities.

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Anxiolytic medications should rarely be prescribed for longer than 6 weeks due to dependency risks.

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Forty percent of patients diagnosed with generalized anxiety disorder in a UK study recovered after 12 years.

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Cognitive behavior therapy has shown superior outcomes compared to applied relaxation for treating generalized anxiety disorder.

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The prognosis for patients with generalized anxiety disorder is typically better when symptoms have been present for less than 6 months.

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Relaxation training is generally effective in reducing anxiety in all cases of generalized anxiety disorder.

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The average duration of illness for generalized anxiety disorder can be approximately 20 years.

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Diazepam is recommended for long-term management of generalized anxiety disorder due to low dependency risk.

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Self-help resources, such as books, can reinforce explanations of anxiety symptoms and provide cognitive behavioural techniques.

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Generalized anxiety disorder is often accompanied by physical symptoms that can easily be distinguished from other medical conditions.

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It is beneficial for healthcare practitioners to discuss treatment origins and evaluation with patients suffering from generalized anxiety disorder.

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In managing generalized anxiety disorder, identifying psychosocial factors is unnecessary if no physical symptoms are present.

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Individuals with generalized anxiety disorder may struggle with occupational and social activities due to excessive worries.

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Treatment for comorbid conditions such as depression is secondary to the treatment of generalized anxiety disorder.

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Psychiatrists tend to encounter more cases of generalized anxiety disorder at early stages than primary care providers.

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Benzodiazepines are used in the management of severe anxiety to provide rapid relief when needed.

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Exposure treatment in vivo performed better than other exposure therapies in the long term.

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Cognitive behaviour therapy is an effective structured treatment for patients with significant functional disability.

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D-cycloserine is regarded as ineffective in the treatment of specific phobias.

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Benzodiazepines can be prescribed for more than 3 weeks to manage anxiety effectively.

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The effectiveness of exposure therapy varies significantly across different specific phobias.

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Patients with specific phobia can experience anticipatory anxiety even in the absence of the feared object or situation.

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A significant strength of most studies on phobia treatment was their inclusion of dropouts in the analysis.

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D-cycloserine may facilitate fear extinction in animals but has no potential similar effect in humans.

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Individuals with phobia of blood experience initial bradycardia followed by tachycardia when faced with blood.

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Social phobia and agoraphobia are classified as separate diagnoses in DSM-5 but grouped together in ICD-10.

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Exposure in vivo is a recognized treatment for phobias, including the phobia of blood and injury.

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The presence of adverse early experiences significantly increases the likelihood of developing general anxiety disorder in adulthood.

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Phobia of choking only occurs in adults who have previously had a choking incident.

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Generalized anxiety disorder (GAD) primarily features continuous anxiety without specific triggers.

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The terms arachnophobia and acrophobia are preferred in clinical settings over simpler names like spider phobia and phobia of heights.

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People with phobias of illness often fail to recognize that their thoughts are irrational.

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The average age of onset for blood phobia is around 10 years.

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Specific phobias in adulthood often originate from stressful experiences that occur during adulthood.

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Studies have shown that specific phobias have a heritability of approximately 50%.

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Conditioning theory posits that specific phobias arise through association learning, primarily in adulthood.

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Individuals with specific phobias have shown hyperactivity in the amygdala upon presentation of the feared stimulus.

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Therapies based on exposure for specific phobias are less effective compared to relaxation therapies.

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The anterior cingulate cortex is involved more in the anticipation of phobic stimuli than in their immediate response.

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Hypochondriasis occurs when individuals are aware that their concerns about disease are irrational.

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Genetic vulnerability for phobias can be linked to the strength of fear conditioning.

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Social phobia is characterized by anxiety that is experienced in public situations where individuals feel they are being observed by others.

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Patients with social phobia exclusively avoid any situation where they might be alone.

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Generalized social phobia means an individual feels anxious in a wide range of social situations.

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In social phobia, the fear of embarrassment or criticism occurs only during specific performance activities, not during general social interactions.

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Symptoms like blushing and trembling are common complaints among individuals with social phobia.

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Alcohol misuse is less prevalent in individuals with social phobia compared to other anxiety disorders.

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The DSM-5 uses the term 'social anxiety disorder' rather than 'social phobia.'

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Cognitions of perceived critical evaluation by others in social phobia are recognized as rational concerns.

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Socially phobic individuals often engage fully in social situations to overcome their fears.

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Public speaking is a situation that might trigger specific anxiety in some individuals with social phobia.

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Increased activity in the insula is often associated with the experience of social phobia.

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Only 30% of individuals with social phobia seek treatment.

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Benzodiazepines are recommended as a long-term solution for treating social phobia.

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Dynamic psychotherapy has robust evidence supporting its effectiveness in treating social phobia.

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Cognitive behaviour therapy is the first-line psychological treatment recommended for social phobia.

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Treatment with SSRIs usually shows effects within just a few days.

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Social phobia is characterized by symptoms that can begin in adulthood and persist into later life.

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The use of beta-adrenergic blockers for social phobia has proven to be universally effective.

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Modified forms of cognitive behaviour therapy are deemed less effective than the original procedures used for social phobia.

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Escitalopram and sertraline are SSRIs recommended as first-line treatments for social phobia when medication is necessary.

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The concordance rate of social phobia in dizygotic twins is higher than that of monozygotic twins.

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Symptoms of social phobia must persist for less than three months to meet the DSM-5 criteria.

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Social phobia is associated with a higher prevalence in first-degree relatives compared to the general population.

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The rate of social phobia in community surveys is reported to be higher in men than in women.

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Cognitive factors associated with social phobia include an undue concern about negative evaluation by others.

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The diagnostic criteria for social phobia set a severity level intended to include individuals who are generally shy.

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Genetic factors are suggested to have a minor role in the development of social phobia.

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Avoidant personality disorder typically has an identifiable onset that is longer than that of social phobia.

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People with body dysmorphic disorder often experience avoidance of social situations due to a clear misunderstanding of their appearance.

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The anticipation of public speaking in individuals with social phobia activates cortical regulatory areas such as the prefrontal cortex.

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The average age of onset for agoraphobia is typically in childhood.

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Panic attacks associated with agoraphobia can be triggered by specific situations or occur spontaneously.

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A common starting point for an episode of agoraphobia is while waiting for transportation.

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Agoraphobia without panic attacks is more frequent in clinical samples than in community studies.

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Agoraphobia is exclusively classified as a type of anxiety disorder without overlaps with other diagnoses.

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Individuals with agoraphobia often develop a growing habit of avoidance once panic attacks begin.

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The lifetime prevalence of agoraphobia without panic is estimated to be around 3.4%.

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Avoidance behaviors in agoraphobia are often initiated by immediate severe stress.

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The cognitive hypothesis explains anxiety attacks as stemming from irrational fears of physical symptoms experienced in certain situations.

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Women have a lower risk of developing both agoraphobia and panic disorder compared to men.

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Evidence suggests that agoraphobia can occur independently of panic disorder.

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Family problems have no influence on the maintenance of agoraphobia symptoms.

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Benzodiazepines are recommended for long-term treatment of agoraphobia due to their effectiveness.

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Cognitive behavior therapy for agoraphobia is considered less effective than medication in the long term.

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Antidepressant drugs are beneficial even for agoraphobic patients who do not have depression.

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A genetic predisposition to anxiety disorders can be observed in relatives of individuals with panic disorder.

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Psychoanalytic theory on anxiety is widely supported by independent evidence.

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Exposure treatment is the first behavioral intervention proven effective for agoraphobia.

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Agoraphobia tends to resolve itself within a year for most patients.

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Conditioning and avoidance learning are directly evidenced as causes of anxiety.

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Agoraphobic patients are anxious mainly when they are with trusted companions.

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Panic attacks in agoraphobia are always triggered by external environmental stimuli.

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Maintaining medication for several months after a clinical response has been obtained can significantly lower relapse rates.

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A common situation that may provoke anxiety in agoraphobic patients is being in a crowded bus.

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Panic attacks are often perceived as true emergencies rather than false alarms.

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The treatment of choice for established cases of agoraphobia is solely exposure to phobic situations without cognitive therapy.

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Anticipatory anxiety in severe cases can appear several hours before entering the feared situation.

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Individuals suffering from agoraphobia only experience anxiety in public settings, completely avoiding private spaces.

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Self-help books are considered an ineffective resource for individuals with agoraphobia.

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Partners and friends usually demonstrate strong support for both medication and behavior therapy when treating agoraphobia.

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Children and pets can help reduce anxiety symptoms for agoraphobic patients.

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Antidepressants can sometimes be used as a first treatment for severe panic attacks.

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Anxiety symptoms experienced by agoraphobic patients differ significantly from those experienced in other anxiety disorders.

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Avoidance behaviors related to agoraphobia typically result in increased exposure to anxiety-triggering situations.

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Behaviour therapy is recommended for patients who have experienced a relapse after drug treatment.

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Discontinuing medication for anxiety disorders should be done suddenly to minimize relapse risks.

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Depressive symptoms are uncommon in patients suffering from agoraphobia.

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Avoidance behavior in agoraphobia can be attributed solely to personal determination.

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The primary factors that provoke anxiety in agoraphobic patients are distance, crowding, and isolation.

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Individuals with agoraphobia usually improve significantly and retain no symptoms after treatment.

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Panic attacks can occur in multiple anxiety disorders, including generalized anxiety disorder.

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The heritability of panic disorder is estimated to be around 60%.

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Diagnostic criteria for panic disorder in DSM-5 require panic attacks to be consistently linked to a phobic situation.

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Chemical agents such as sodium lactate can increase the likelihood of panic attacks in susceptible individuals.

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Patients with panic disorder exhibit lower levels of GABA compared to healthy individuals.

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The prevalence of panic disorder is higher in men compared to women.

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Individuals who experience hyperventilation during panic attacks are breathing slowly and deeply.

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Functional imaging studies have consistently shown abnormal responses in the fear-related neural circuitry in panic disorder patients.

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The presence of a family history of panic disorder significantly increases the risk for first-degree relatives.

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Cognitive biases associated with panic disorder lead to increased attention to non-threatening stimuli.

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The cognitive hypothesis suggests that the fears about serious illness are more frequent among patients with panic attacks than among those without panic attacks.

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Controlled studies have shown that cognitive therapy is less effective than antidepressant medication in treating panic disorder.

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Hyperventilation has been conclusively shown to be the cause of panic disorder.

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About 30% of patients with panic disorder remit without experiencing any subsequent relapse.

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The treatment of panic disorder in the UK commonly employs high doses of benzodiazepines.

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Benzodiazepines are commonly used to treat panic disorder due to their efficacy in preventing panic attacks without significant side effects.

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Antidepressants such as SSRIs and SNRIs have been shown to be beneficial for treating panic disorder.

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The initial effect of antidepressants on patients with panic disorder often includes pleasant feelings of relaxation.

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Cognitive therapy involves inducing physical symptoms that the patient fears in order to reduce anxiety.

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Patients diagnosed with panic disorder typically experience a significant improvement in symptoms shortly after starting treatment.

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The term 'panic disorder' was introduced in the DSM-III in 1980.

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Panic attacks are defined only by psychological symptoms without any physical manifestations.

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DSM-5 requires at least four symptoms for diagnosing panic disorder during a panic attack.

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Agoraphobia must be present to diagnose panic disorder in DSM-IV criteria.

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Paul Wood's work during the Second World War shifted the view of panic attacks to being more psychological than physical.

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Before 1980, panic attacks were primarily classified under anxiety disorders without a distinct category.

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ICD-10 differentiates panic disorder from agoraphobia by performing two separate diagnoses.

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The symptoms of a panic attack vary between patients, with not all patients experiencing all of them.

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Panic disorder was first recognized as a mental health condition in the late 19th century.

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The classification of panic disorder has remained entirely unchanged since its introduction in DSM-III.

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Obsessive-compulsive disorder is classified in ICD-10 only as a disorder characterized by obsessional thoughts.

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Differential diagnosis of OCD from other disorders often requires a careful mental state examination.

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Obsessive-compulsive symptoms are uncommon in individuals diagnosed with schizophrenia.

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The symptoms of OCD are usually evident and easily diagnosed without additional history-taking.

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Obsessive-compulsive symptoms can emerge in children alongside developmental disorders like autism.

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Cognitive therapy is generally less costly than medication for treating anxiety disorders.

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Alprazolam is recommended for use in the UK for patients with anxiety disorders.

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SSRIs are preferred over tricyclics due to having fewer side effects.

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If no improvement is noticed after 12 weeks, cognitive therapy is the first option for changing treatment.

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Panic disorder often occurs alongside a certain degree of agoraphobic avoidance.

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Mixed anxiety and depressive disorder is least likely to occur when symptoms are mild.

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Self-help books based on cognitive behavior principles can be beneficial for patients.

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The overlap of anxiety and depressive symptoms is less pronounced when the symptoms are mild.

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Mixed anxiety and depressive disorder is included in DSM-5 classification.

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Childhood adversity is linked to both anxiety and depression in adults.

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The term 'cothymia' is used to describe severe anxiety and depression.

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Antidepressant medication is the most common treatment for mixed anxiety and depression.

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The prognosis for mixed anxiety and depressive disorders is better than that of specific anxiety disorders.

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In some cultures, anxiety is experienced primarily through psychological symptoms.

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Koro is a form of social anxiety disorder characterized by fear of losing bodily functions.

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Cognitive behaviour therapy has shown comparatively greater effectiveness in treating mixed anxiety and depression than pure anxiety disorders.

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Societal stressors can trigger episodes of koro among men.

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Taijin-kyofu-sho is prevalent among men in Japan and involves intense fear of social situations.

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Obsessive-compulsive disorder is characterized solely by compulsive behaviors without the presence of obsessional thoughts.

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The effort to resist obsessional thoughts is the more variable aspect compared to the inner sense of compulsion associated with OCD.

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Obsessional ruminations involve internal debates that are limited to the thoughts surrounding major life decisions.

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The presence of compulsion in OCD does not necessarily lead to a significant reduction in anxiety for the individual.

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Obsessional personality disorder is synonymous with obsessive-compulsive disorder.

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In DSM-5, it is necessary for patients with OCD to view their obsessions and compulsions as unreasonable for diagnosis.

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ICD-10 requires that obsessional symptoms are present daily for at least 2 weeks to diagnose OCD.

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Depersonalization is a common symptom in OCD that has a well-established relationship with other OCD features.

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Obsessional doubts primarily concern actions that are confirmed to have been completed correctly.

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Compulsive acts in OCD can be intrinsically pleasurable, according to ICD-10.

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The gene SLC1A1 has been consistently replicated in studies related to OCD.

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Obsessive-compulsive symptoms are frequently reported among patients who have experienced Sydenham's chorea.

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Compulsive behavior is linked more specifically to projections from the medial striatum to the orbitofrontal cortex.

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The effects of serotonin reuptake inhibitors on obsessive-compulsive symptoms are immediate and clearly understood.

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Freud proposed that obsessive-compulsive symptoms stem from unresolved childhood conflicts and impulses.

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Neuropsychological tasks indicate that individuals with OCD perform better in tasks requiring altered responses once a habit has formed.

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Inconsistent findings on serotonin function in OCD have been noted in studies using neuroendocrine tests and PET scans.

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The corticostriatal-thalamic loops are believed to play a key role in supporting neuropsychological functions such as motor control.

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Compulsivity is defined as the tendency to act impulsively without regard for negative outcomes.

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Evidence linking OCD symptoms to streptococcal infections is clear and consistent across studies.

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The lifetime prevalence of OCD in the USA is reported to be 2.1%.

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According to research, the ratio of lifetime prevalence between females and males is consistently 1 in clinic populations.

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Familial studies suggest that the risk of developing OCD is increased sixfold in first-degree relatives compared to control rates.

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Monozygotic twins show lower concordance rates for OCD than dizygotic twins.

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Checking and hoarding are the least reported behaviors among those with obsessive-compulsive symptomatology.

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Healthy individuals never experience intrusive thoughts similar to those of obsessional patients.

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Molecular genetic studies have identified associations between OCD and various genes, including those for glutamate transporters.

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Rates of comorbidity for OCD are limited only to other anxiety disorders.

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The prevalence of OCD symptomatology not meeting full DSM-IV criteria is around 50% of those surveyed.

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Family history of OCD is not considered a significant factor in its development.

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Compulsivity and impulsivity are entirely unrelated behaviors with no shared anatomical basis.

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Cognitive theory regarding OCD suggests that the occurrence of intrusive thoughts is the primary issue for patients.

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The prognosis for OCD is generally worse when the onset occurs in childhood.

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Clomipramine is currently used as a first-line treatment for OCD.

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SSRIs have similar efficacy to clomipramine in reducing obsessional symptoms in OCD.

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About two-thirds of patients with moderately severe rituals can expect substantial improvement through exposure and response prevention.

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The interplay between impulsivity and compulsivity typically enhances individual impulse control.

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Relapse rates after stopping clomipramine treatment are low if exposure therapy is maintained.

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A higher dose of SSRIs has been found to be more efficacious in treating OCD symptoms.

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Cognitive behavior therapy is solely ineffective for OCD without the inclusion of medication.

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Cognitive therapy aims to increase the frequency of obsessional thoughts by encouraging suppression.

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Neurosurgery for severe OCD often results in an immediate reduction of distress and tension.

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Thought-stopping has substantial and specific evidence supporting its effectiveness in treating obsessional thoughts.

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In cognitive therapy, the patient's conviction that thinking something makes it happen is strengthened.

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Incorporating cognitive approaches into behavior therapy may enhance the treatment effects.

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Dynamic psychotherapy is highly effective for patients with obsessional patterns.

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The long-term effects of deep brain stimulation (DBS) for OCD are well established and widely agreed upon.

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The therapy technique of exposure to audio-recorded repetition of obsessional thoughts is a part of cognitive therapy.

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Cognitive approaches have been shown to be less successful than behavioral treatments for obsessional thoughts.

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Improvement rates from neurosurgery for OCD show that around half of the patients experienced no changes.

True Signup and view all the answers

Effective treatment of depressive disorder does not improve obsessional symptoms in patients with OCD.

False Signup and view all the answers

Involving a patient's partner in treatment sessions about OCD can be beneficial.

True Signup and view all the answers

Exposure with response prevention is always well-tolerated by all OCD patients.

False Signup and view all the answers

SSRI medication is typically not effective as a first-line treatment for OCD.

False Signup and view all the answers

Repeated reassurance is helpful for relatives of obsessional patients in dealing with rituals.

False Signup and view all the answers

Patients with OCD will invariably not experience remission of their symptoms.

False Signup and view all the answers

When behavior therapy has a waiting list, it is advisable to start medication first.

True Signup and view all the answers

Individuals with severe OCD symptoms should immediately start exposure with response prevention.

False Signup and view all the answers

Involvement of family members in the rituals of OCD patients is encouraged for better outcomes.

False Signup and view all the answers

Trichotillomania is defined by hair pulling that is not preceded by increasing tension.

False Signup and view all the answers

Pathological gambling is classified under the same category as trichotillomania in ICD-10.

True Signup and view all the answers

Fluoxetine has consistently shown to be an effective treatment for trichotillomania.

False Signup and view all the answers

The prevalence of trichotillomania among first-degree relatives is lower when compared to obsessive-compulsive disorders.

False Signup and view all the answers

Cognitive behavior therapy has proven less effective than placebo treatments in managing trichotillomania.

False Signup and view all the answers

Trichotillomania can have its onset only during adulthood.

False Signup and view all the answers

Hoarding disorder is recognized as a distinct disorder in DSM-5.

True Signup and view all the answers

The primary treatment for hoarding disorder has been shown to be consistently effective without the need for therapy.

False Signup and view all the answers

In most cases, individuals with hoarding disorder resist the urge to hoard.

False Signup and view all the answers

Trichotillomania primarily involves the action of hair pulling that leads to visible hair loss.

True Signup and view all the answers

SSRIs have shown no benefit in the treatment of pathological hoarding.

False Signup and view all the answers

Hoarding behavior typically interferes with the use of living areas intended for daily activities.

True Signup and view all the answers

The prevalence of pathological hoarding is estimated to be higher in women compared to men.

False Signup and view all the answers

The impulsive act of pulling hair in trichotillomania is often preceded by feelings of tension.

True Signup and view all the answers

The DSM-5 no longer associates hoarding with obsessive-compulsive personality disorder.

False Signup and view all the answers

Cognitive behavior therapy for hoarding disorder has been developed but the extent of its benefit remains unresolved.

True Signup and view all the answers

Which of the following are psychological symptoms of anxiety? (Select all that apply)

Fearful anticipation Signup and view all the answers

Irritability is a symptom of autonomic arousal.

False Signup and view all the answers

What is a gastrointestinal symptom of anxiety?

Dry mouth Signup and view all the answers

Which of the following symptoms belong to cardiovascular arousal? (Select all that apply)

Palpitations Signup and view all the answers

A symptom of anxiety related to sleep is __________.

insomnia Signup and view all the answers

Match the following symptoms with their category of anxiety:

Dry mouth = Gastrointestinal Difficulty inhaling = Respiratory Palpitations = Cardiovascular Insomnia = Sleep disturbance Signup and view all the answers

Tremors are categorized under muscle tension.

True Signup and view all the answers

What is the median prevalence of specific phobia in the European Union?

4.9% Signup and view all the answers

Which anxiety disorder has the highest 12-month prevalence range in the European Union?

Specific phobia Signup and view all the answers

What is the median prevalence of obsessive-compulsive disorder in the European Union?

0.7% Signup and view all the answers

The median prevalence of social phobia is ____%.

2.0 Signup and view all the answers

Panic disorder has a higher median prevalence than agoraphobia.

False Signup and view all the answers

Match the following anxiety disorders with their median prevalence:

Specific phobia = 4.9% Social phobia = 2.0% Panic disorder = 1.2% Agoraphobia = 1.2% Obsessive-compulsive disorder = 0.7% Generalized anxiety disorder = 2.0% Signup and view all the answers

Which of the following are symptoms of Generalized Anxiety Disorder? (Select all that apply)

Worry and apprehension Signup and view all the answers

Depression is a feature of Generalized Anxiety Disorder.

True Signup and view all the answers

What are some psychological features that may accompany Generalized Anxiety Disorder?

Obsessions and depersonalization Signup and view all the answers

One symptom of Generalized Anxiety Disorder is _____ disturbance.

sleep Signup and view all the answers

What is the first step in the stepped-care approach for generalized anxiety disorder?

Identification and assessment Signup and view all the answers

Which of the following are considered low-intensity psychological interventions for GAD? (Select all that apply)

Pure self-help Signup and view all the answers

High-intensity psychological interventions include cognitive behaviour therapy and applied relaxation.

True Signup and view all the answers

What should be initiated if the patient presents with more severe symptomatology?

Treatment at Step 3 Signup and view all the answers

What is included in specialist treatment for GAD?

Crisis services Signup and view all the answers

Which of the following describes the ICD-10 criteria for social phobia?

Symptoms restricted to or predominate in feared situations Signup and view all the answers

Which statement reflects the DSM-5 criteria for social phobia?

Not secondary to another disorder Signup and view all the answers

Both ICD-10 and DSM-5 criteria require symptoms to be secondary to another disorder.

False Signup and view all the answers

In the ICD-10, significant emotional distress is recognized as _______ or unreasonable.

excessive Signup and view all the answers

Match the criteria with their respective diagnostic system (ICD-10 or DSM-5):

Marked fear or avoidance of being the focus of attention = ICD-10 Social situations almost always provoke anxiety = DSM-5 The fear is out of proportion to actual threat = DSM-5 Duration at least 6 months = DSM-5 Signup and view all the answers

Which of the following situations is included in the ICD-10 criteria for agoraphobia? (Select all that apply)

Public places Signup and view all the answers

The DSM-5 criteria for agoraphobia includes fear of five specific situations.

True Signup and view all the answers

What is a common outcome of avoidance behavior in agoraphobia according to both ICD-10 and DSM-5?

Significant distress Signup and view all the answers

At least one symptom of autonomic ______ plus one other anxiety symptom is required in the feared situations according to ICD-10.

arousal Signup and view all the answers

Match the DSM-5 criteria descriptions with the corresponding features:

Avoidance or distress due to escape thoughts = Recognized as excessive or unreasonable Anxiety disproportionate to actual danger = Persistent fear lasting six months or more Clinically significant distress or functional impairment = Not accounted for by another disorder Signup and view all the answers

Which of the following are symptoms of a panic attack? (Select all that apply)

Palpitations Signup and view all the answers

Dizziness is a symptom of a panic attack.

True Signup and view all the answers

What sensation is often experienced during a panic attack that relates to feeling detached from reality?

Derealization Signup and view all the answers

Name a feeling of intense fear often experienced during a panic attack.

Fear of dying Signup and view all the answers

A common respiratory sensation felt during a panic attack is ______.

choking sensations Signup and view all the answers

Which of the following are symptoms caused by hyperventilation? (Select all that apply)

Headache Signup and view all the answers

Numbness is a symptom caused by hyperventilation.

True Signup and view all the answers

What sensation is often felt in the hands, feet, and face due to hyperventilation?

Tingling Signup and view all the answers

Name a symptom of hyperventilation that involves discomfort in the chest area.

Precordial discomfort Signup and view all the answers

Hyperventilation can cause a feeling of __________.

breathlessness Signup and view all the answers

Which of the following are considered obsessional symptoms in obsessive-compulsive disorder? (Select all that apply)

Thoughts Signup and view all the answers

Compulsive rituals are a feature of obsessive-compulsive disorder.

True Signup and view all the answers

What is NOT a principal feature of obsessive-compulsive disorder?

Euphoria Signup and view all the answers

Name two emotional states associated with obsessive-compulsive disorder.

Anxiety and depression Signup and view all the answers

Individuals with obsessive-compulsive disorder may experience _______ slowness.

abnormal Signup and view all the answers

What is the term used to describe feelings of unreality in OCD?

Depersonalization Signup and view all the answers

What is thought-action fusion?

Magical thinking where one believes that thinking of harming others means they might act on it. Signup and view all the answers

What does an inflated sense of responsibility indicate in obsessive-compulsive disorder?

The belief that one has power to prevent harm to others. Signup and view all the answers

How do compulsions function in obsessive-compulsive disorder?

They reinforce a belief that failing to perform them could result in increased discomfort or harm. Signup and view all the answers

What is meant by the overestimation of the likelihood that harm will occur?

Believing that negative outcomes are more likely than they actually are. Signup and view all the answers

What does intolerance of uncertainty and ambiguity refer to in the context of OCD?

A person's inability to cope with the unpredictability or lack of clarity in situations. Signup and view all the answers

Why might someone with OCD have a need for control?

To mitigate perceived risks and prevent harm. Signup and view all the answers

Study Notes

Anxiety Disorders Overview

Anxiety disorders exhibit mental and physical anxiety symptoms without underlying organic brain disease or other psychiatric disorders.
Common symptoms include worry and apprehension, psychological arousal, autonomic overactivity, muscle tension, hyperventilation, and sleep disturbances.
Symptoms can vary in intensity and pattern among different types of anxiety disorders (e.g., generalized anxiety disorder, phobic anxiety disorder, panic disorder).

Classification of Anxiety Disorders

Generalized Anxiety Disorder (GAD): Symptoms are persistent and not tied to specific situations.
Phobic Anxiety Disorders: Anxiety occurs intermittently in specific contexts (e.g., fear of heights).
Panic Disorder: Anxiety is intermittent and not linked to particular circumstances.
Classification differs between ICD-10 (includes mixed anxiety–depressive disorder) and DSM-5 (does not classify mixed disorders).

Historical Development of Anxiety Disorders

Until the late 19th century, anxiety was not classified separately from mood disorders.
Freud proposed "anxiety neurosis" in 1895, differentiating cases with psychological and physical anxiety symptoms.
Phobias studied since antiquity, with systematic medical classification beginning in the 18th century.
Westphal's 1872 description of agoraphobia highlighted the role of anxiety.

Epidemiology and Comorbidity

Meta-analysis shows GAD prevalence at 4.4% in England; prevalence around 2% in some European countries.
Women are diagnosed with GAD at twice the rate of men.
Common comorbid conditions include major depression, with up to 23% of GAD cases also having social phobia.

Diagnostic Conventions

The distinction between GAD and normal anxiety is based on symptom severity and duration; DSM-5 requires symptoms to persist for at least 6 months.
Significant overlap exists between GAD and depressive disorders; evaluating the severity and timing of symptoms is crucial for diagnosis.
Special attention needed for differentiating GAD from schizophrenia, dementia, substance misuse, and physical illnesses.

Symptoms and Signs of GAD

GAD characterized by prolonged, uncontrolled worries across various domains, not focused on a single issue.
Patients may experience irritability, poor concentration, restlessness, and a range of physical symptoms (e.g., palpitations, sweating).
Sleep disturbances are prevalent, with difficulties in falling or staying asleep and non-restorative sleep patterns.

Differential Diagnosis

Key to avoid misdiagnosing GAD as depressive disorders, schizophrenia, or dementia by assessing the history and severity of symptoms.
Physical conditions such as thyrotoxicosis, phaeochromocytoma, and hypoglycemia must be considered as they can mimic anxiety symptoms.

Current Classification Systems

DSM-5 focuses on clinical significance in diagnosing anxiety disorders.
ICD-10 categorizes anxiety into phobic and other anxiety disorders, highlighting differences in diagnostic criteria for various conditions.

Additional Insights

Anxiety's role in depressive disorders complicates diagnosis; clinical presentations can intertwine.
Clinicians should remain vigilant for misdiagnosis during initial assessments, considering both psychological and physical factors.

Aetiology of Generalized Anxiety Disorder (GAD)

GAD is influenced by genetic and environmental factors, often triggered by stressors acting on predisposed personalities.
Stressful life events, particularly those involving loss, can increase the risk of GAD, with events deemed as 'danger' also prevalent among those who develop the disorder.
Twin studies indicate a higher concordance for anxiety disorders in monozygotic twins, suggesting a genetic component.
Genetic predisposition to GAD may overlap with other anxiety disorders and major depression.
Early adverse experiences, such as childhood indifference or abuse, correlate with higher rates of GAD, agoraphobia, and depression in adulthood.
Overprotective parenting styles may increase the risk of developing GAD.

Psychological Perspectives

Psychoanalytic theory posits that GAD results from intrapsychic conflicts where the ego is overwhelmed by external or internal stimuli.
Good parenting can mitigate anxiety, providing children with a secure base to navigate challenges.
Cognitive theories suggest that people predisposed to GAD may exhibit heightened attention to threats, leading to a 'looming cognitive style.'
Individuals may use worry as an approach to cope with perceived threats, leading to a cycle of excessive worrying known as ‘worry about worry.’

Personality Traits and Disorders

High levels of neuroticism are associated with increased anxiety symptoms, indicating genetic overlap between neuroticism and GAD.
GAD occurs alongside various personality disorders, particularly anxious-avoidant ones.

Neurobiological Mechanisms

GAD involves multiple brain regions, with the amygdala playing a key role in processing fear and anxiety.
Neurotransmitters like norepinephrine, serotonin, and GABA influence anxiety responses; increased norepinephrine elevates anxiety while GABA generally reduces it.
Abnormalities in brain activity, particularly in the amygdala and prefrontal cortex, have been observed during emotional regulation tasks.

Prognosis

Symptoms of GAD must persist for at least six months for diagnosis; duration often results in poorer prognosis.
GAD is typically chronic with low remission rates; mean age of onset is around 21, with an average duration of approximately 20 years.
A study indicated a 40% recovery rate over 12 years among those diagnosed with GAD in primary care settings, although many continued to experience other psychiatric disorders.

Treatment Approaches

Self-help and Psychoeducation: Various methods, including guided self-help and group psychoeducation, offer modest benefits.
Relaxation Training: Regular practice can reduce anxiety; applied relaxation shows effectiveness under therapy guidance.
Cognitive Behaviour Therapy (CBT): Combines relaxation techniques and cognitive strategies to address worrying; outcomes are comparable to other interventions.
Medication: Anxiolytics may provide rapid symptom relief but carry a risk of dependency; SSRIs and SNRIs are preferred long-term treatments due to their efficacy and lower dependency risk.

Pharmacological Treatment

Short-term use of benzodiazepines like diazepam is suitable for controlling GAD symptoms but should not exceed three weeks to prevent dependence.
Pregabalin is approved in the UK for GAD treatment and offers an alternative for those intolerant to SSRIs or SNRIs.
Maintenance of treatment beyond 6 months can significantly reduce the risk of relapse in those responding to medication.

Management of Generalized Anxiety Disorder (GAD)

Early intervention includes education and self-help techniques before formal GAD diagnosis.
Severe anxiety may require a short benzodiazepine course for rapid relief.
Key information for patients: GAD is characterized by excessive, uncontrolled worries affecting social and occupational functions.
Symptoms include physical tension, exhaustion, and overall poor health.
Effective treatments: psychological therapies and medications can be tailored to the individual's needs.
Involve family members in understanding the patient's symptoms for supportive care.
Assess for comorbid conditions such as depression, substance abuse, or physical ailments.
Evaluate psychosocial factors contributing to anxiety, including relationship issues and health concerns.
Self-help resources, including books on cognitive behavioral techniques, can be useful.
Structured psychological treatments include cognitive behavioral therapy (CBT) or applied relaxation techniques.
For unresponsive cases or significant disability, CBT from trained therapists should be considered.
Medication options typically start with SSRIs; benzodiazepines should be used cautiously and short-term.
Effective treatment plans require collaboration among patients, general practitioners, and community teams.

Phobic Anxiety Disorders

Core symptoms of phobias: anxiety triggered by specific objects or situations, leading to avoidance behavior.
Phobic disorders classified as specific phobia, social phobia, and agoraphobia in ICD-10 and DSM-5.
Agoraphobia can present with or without panic disorder, creating distinct diagnostic criteria between the two.
Specific phobias involve inappropriate anxiety in presence of a feared object or situation and avoidance behaviors.
Anticipatory anxiety is common, complicating social interactions and personal activities.

Specific Phobia Characteristics

Specific phobias classified by stimulus type: animals, natural environments, medical situations, social interactions, and other feared agents.
Dental phobia affects approximately 5% of adults, often leading to untreated dental issues.
Flying phobia may cause significant travel distress; airlines sometimes offer desensitization programs.
Blood/injury phobia uniquely triggers a vasovagal response, complicating symptoms with dizziness and fainting.
Choking phobia leads to intense fear and discomfort when swallowing, often treated through desensitization techniques.
Illness phobia presents irrational fears of severe health conditions, differing from obsessions seen in OCD.

Epidemiology and Aetiology of Specific Phobias

Lifetime prevalence: approximately 7% in men and 17% in women for specific phobias.
Onset usually occurs in childhood, with specific phobias often persisting into adulthood.
Factors influencing persistence: childhood fears, genetic predisposition, conditioning and observational learning.
Neural mechanisms involve hyperactivity in the amygdala and changes in fear response with successful treatment.

Diagnosis and Prognosis

Diagnosis is straightforward; complications may arise from underlying depressive disorders or obsessional conditions.
Prognosis for childhood phobias is generally poor, while those beginning in adulthood have a higher likelihood of improvement.

Treatment Approaches

Exposure therapy remains the primary treatment, demonstrating significant reductions in phobia intensity.
Response to therapy depends on the willingness to undergo repeated exposure; some patients may resist.
Benzodiazepines may be temporarily used to alleviate acute anxiety related to phobic situations.
Virtual reality therapy has shown promise in treating phobias.
D-cycloserine, a glutamate receptor modulator, may enhance the effectiveness of exposure therapy.

Inappropriate anxiety experienced in social situations where individuals feel observed and potentially criticized.
Individuals often avoid these situations or minimize engagement, resulting in extreme anxiety during encounters.
Differentiation from shyness occurs through levels of personal distress and social or occupational impairment.

Situational Triggers

Common scenarios include restaurants, seminars, and board meetings, leading to heightened anxiety.
Variability exists with generalized social phobia affecting various situations versus performance-only phobia linked solely to public speaking or similar contexts.

Symptoms and Comorbidities

Frequent symptoms include blushing and trembling, driven by a preoccupation with being critically observed.
Alcohol misuse is prevalent, often as a coping mechanism, correlating with increased occurrence of depressive and anxiety disorders.

Onset and Development

Condition typically starts during early teenage years, marked by sudden anxiety episodes in public.
Severity escalates over time, frequently leading to increased avoidance behavior.

Diagnostic Criteria

Both ICD-10 and DSM-5 have similar diagnostic criteria, focusing on anxiety symptoms and persistence of at least six months.
Key differential diagnoses include agoraphobia, generalized anxiety disorder, schizophrenia, body dysmorphic disorder, and avoidant personality disorder.

Epidemiology

Lifetime prevalence rate around 12%, showing slight gender disparity, with higher community reports among women.
Associated frequently with depression and alcohol misuse.

Aetiology

Genetic: Higher incidence among first-degree relatives with an estimated heritability of 55%.
Conditioning: Initial anxiety episodes may trigger the development of phobic symptoms.
Cognitive Factors: Fear of negative evaluation and self-critical thoughts are prevalent, leading to safety behaviors that hinder social interactions.

Neural Mechanisms

Functional neuroimaging reveals increased amygdala response to negative facial expressions and decreased activation in regulatory cortical areas during anxiety-provoking situations.

Course and Prognosis

Early onset in childhood/adolescence may persist for years, with only 50% seeking treatment after lengthy symptoms.

Treatment Options

Psychological Treatment:
- Cognitive behavior therapy (CBT) is the primary option, often modified to address specific cognitive abnormalities in social phobia.
- Dynamic psychotherapy may be beneficial in selected cases linked to interpersonal issues, though limited controlled evidence exists.
Drug Treatment:
- SSRIs are recommended as first-line pharmacological treatment, with other effective options including venlafaxine, phenelzine, and moclobemide.
- Benzodiazepines may be used for short-term relief, while beta-adrenergic blockers can help manage performance-related symptoms.

Management Guidelines

Patients should focus on recognizing maladaptive thinking patterns and behaviors contributing to anxiety.
Cognitive behavioral strategies and self-help resources can facilitate coping while awaiting professional treatment.
Treatment selection should prioritize psychological approaches, with medication reserved for those who decline or inadequately respond to psychological therapy.

Clinical Features of Agoraphobia

Patients exhibit anxiety when away from home, in crowds, or in situations difficult to exit.
Avoidance of anxiety-provoking situations is common, leading to confinement to home in severe cases.
Anxiety symptoms resemble those of other anxiety disorders, often involving panic attacks and fears of fainting or losing control.

Situations Triggering Anxiety

Common triggers include distance from home, crowded locations, and confined spaces.
Specific examples of anxiety-inducing places are public transport, shops, and settings where abrupt exits are challenging.
Accompaniment by trusted individuals can temporarily alleviate anxiety symptoms.

Anticipatory Anxiety

Anticipatory anxiety may occur hours before entering a feared situation, adding to distress.
In severe cases, it can suggest generalized anxiety rather than a specific phobia.

Associated Symptoms

Depressive symptoms frequently accompany agoraphobia, stemming from the limitations of normal life or as an integral part of the disorder.
Severe depersonalization may also occur.

Onset and Course of Agoraphobia

Typically begins in early to mid-twenties or mid-thirties, later than other phobic disorders.
First episodes often occur in public settings, such as while waiting for transport or shopping unexpectedly.
Panic attacks lead to increasing avoidance of triggering situations, sometimes occurring without panic attacks.

Impact on Family Dynamics

Patients often become dependent on relatives or partners for activities, which can cultivate relationship difficulties.
Over-involvement of family members can hinder treatment efforts.

Diagnostic Conventions

Many patients have panic attacks; diagnosis may involve both panic disorder and agoraphobia.
The ICD-10 differentiates criteria from DSM-5, affecting diagnosis classification.

Differential Diagnosis

Important to distinguish from social phobia, generalized anxiety disorder, panic disorder, depressive disorder, and paranoid disorders based on symptom history and patterns.

Epidemiology

Lifetime prevalence for agoraphobia without panic is estimated at 0.6%, increasing to 3.4% with diagnostic variations.
The lifetime risk in the U.S. is approximately 2.6%, with a higher incidence in women compared to men.

Aetiology

Initial anxiety attack often occurs in public settings, frequently linked to panic attacks.
Genetic predispositions may increase risks; discrepancy exists on whether agoraphobia and panic disorders are genetically separate or connected conditions.
Theories for spread include conditioning, anxiety response patterns, personality traits, and family dynamics.

Prognosis

Chronic course is common; cases lasting over a year likely persist for five years.
Depression episodes frequently occur alongside chronic agoraphobia, prompting patients to seek help.

Treatment Approaches

Psychological treatments involve exposure therapy and cognitive-behavioral therapy, often combined for improved effectiveness.
Medication typically mirrors that for panic disorder and includes anxiolytics (short-term) and antidepressants.
SSRIs are recommended for their safety compared to tricyclic antidepressants.

Management and Patient Education

Understanding that panic attacks are akin to false alarms can help both patients and their families grasp the nature of agoraphobia.
Emphasis on persistent efforts to confront avoided situations is necessary, often supplemented with self-help resources.
Patients are encouraged to return to feared situations gradually and systematically.

Conclusion

Many individuals improve through treatment, though complete symptom resolution is rare.
Relapse is a common challenge, underscoring the importance of early intervention when symptoms re-emerge.

Overview of Panic Disorder

Panic disorder recognized in nomenclature since 1980; historical cases described under various names for over a century.
Central feature is the occurrence of panic attacks, characterized by sudden anxiety and physical symptoms, often with fears of severe medical conditions (e.g., heart attack).
Historically termed as "irritable heart," "Da Costa’s syndrome," and others, initially linked to cardiac dysfunction.

Historical Context

World War II revived interest; cardiologist Paul Wood demonstrated panic attacks as a form of anxiety disorder.
Prior to 1980, patients were classified with generalized or phobic anxiety disorders.
DSM-III established panic disorder as a separate category; later editions refined distinctions, including agoraphobia's impact on diagnosis.

Clinical Features

Panic attacks involve rapid buildup of severe anxiety and fear of catastrophic outcomes.
DSM-5 requires at least four symptoms for diagnosis; symptoms can vary among individuals.
Hyperventilation prevalent in some cases, causing increased anxiety symptoms and a paradoxical sensation of breathlessness.

Diagnostic Criteria

Panic attacks must be recurrent, unexpected, and followed by persistent fear of another attack or significant behavioral changes for diagnosis.
ICD-10 aligns closely with DSM-5 but has less precision regarding course criteria.

Epidemiology

National Comorbidity Survey Replication reported 12-month prevalence of DSM-IV panic disorder at 2.7% and lifetime risk at 4.7%.
Panic disorder prevalence higher in women, typically around double that of men.
Often co-occurs with other anxiety disorders, major depression, and alcohol misuse.

Aetiology

Genetics

Familial nature with fivefold increased risk in first-degree relatives; heritability estimated at 40%.
Offspring of panic disorder patients have increased risk for developing panic disorders.

Biochemical Factors

Various chemical agents can provoke panic attacks in affected individuals, including sodium lactate and noradrenaline antagonists.
Changes in GABA levels and serotonin receptor binding suggest biochemical correlations to panic disorder.

Neural Mechanisms

Neural circuits involved in fear and escape behaviors: amygdala, periaqueductal grey, hippocampus, hypothalamus, and locus coeruleus.
Imaging studies show variable findings in brain structure and function related to panic disorder, particularly in the insula.

Cognitive Theories

Anxiety spiral hypothesis suggests fears about illness exacerbate physical symptoms, leading to heightened anxiety.
Development of cognitive therapy treatment aimed at addressing these fears.

Course and Prognosis

Follow-up studies indicate that symptoms can persist over decades, though outcomes vary.
Approximately 30% remit without relapse; treatment can improve prognosis.
Higher mortality rates from cardiovascular conditions observed, potentially linked to sympathetic nervous system dysregulation.

Treatment Options

Treatment includes supportive measures and medications or cognitive therapy.

Medications

Benzodiazepines demonstrated effectiveness but can lead to withdrawal symptoms; gradual dosage reduction recommended.
Antidepressants (e.g., SSRIs, tricyclics) shown to be beneficial; initial dosing should start low and gradually increase.

Cognitive Therapy

Aims to reduce physical symptom fears; therapist helps patients recognize connections between symptoms and panic onset.
Studies show cognitive therapy effectiveness comparable to antidepressant medications.
Combining medication and therapy may enhance acute response but long-term effectiveness remains uncertain.

Management of Patients with Anxiety Disorders

Patients should articulate their disorder clearly to relatives and friends, particularly regarding agoraphobia.
Recognizing harmful thinking patterns and behaviors is crucial in understanding the disorder.
Self-help resources based on cognitive behavior principles can be beneficial for patients.

Treatment Options

Cognitive therapy and medication provide similar symptomatic relief; choice depends on patient preference, availability, cost, and long-term benefits.
SSRIs are favored over tricyclics due to fewer side effects; alprazolam is not recommended in the UK.
If no progress is noted after 12 weeks, treatment may switch to a different class of antidepressants or initiate cognitive therapy.
If cognitive therapy fails, medication can be introduced, especially if panic disorder includes agoraphobic avoidance which warrants exposure treatment.

Mixed Anxiety and Depressive Disorder

Occurs commonly; about 9% of adults in England meet criteria for mixed anxiety and depression (higher rates in women and low-income households).
When symptoms are mild and do not fit diagnostic criteria, referred to as minor affective disorder or cothymia.
Mixed anxiety and depressive disorder is recognized in ICD-10 but not in DSM-5.

Aetiology of Comorbid Disorders

Common predisposing factors: childhood adversity links to both anxiety and depression (evidence shows genetic similarities).
Stressful life events can trigger anxiety and depression simultaneously.
Follow-up studies indicate that persistent anxiety frequently leads to the onset of depression.

Treatment Landscape

Formal treatment is infrequent, with antidepressants most commonly prescribed—controlled trials for mixed anxiety and depression are limited.
Counseling and brief cognitive behavior therapy show moderate benefit; cognitive therapy's effectiveness is less pronounced compared to pure anxiety disorders.

Cultural Variations in Anxiety Disorders

Anxiety disorders are global but exhibit cultural differences in prevalence and symptoms, often emphasizing somatic complaints over psychological ones.
Koro is a culturally specific anxiety disorder seen in some Asian cultures, marked by an irrational fear regarding genital retraction, linked to social stressors.
Taijin kyofusho in Japan reflects intense social anxiety, characterized by the fear of how one is perceived by others.

Understanding Obsessive-Compulsive Disorder (OCD)

Characterized by compulsion to perform certain actions, intrusive thoughts, and varying levels of distress.
Obsessional thoughts often include disturbing or violent content, while compulsive behaviors may aim to alleviate anxiety.
Can involve complex rituals and is often connected to feelings of guilt or embarrassment.

Clinical Features of OCD

Symptoms include both obsessional ideas and compulsions, with significant anxiety, depression, and sometimes depersonalization.
Obsessions often manifest as persistent, intrusive thoughts that are recognized as irrational but difficult to resist.
Compulsions may take the form of rituals or tasks that provide temporary relief from distress but are ultimately ineffective.

Diagnostic Criteria for OCD

Requires either obsessions or compulsions that are time-consuming (over one hour daily) or cause distress and impairment.
Symptoms must not be attributed to substance effect or another medical condition; insight into these symptoms varies.
ICD-10 criteria similarly necessitate the presence of symptoms on most days for two consecutive weeks.

Differential Diagnosis

OCD is distinct from other anxiety disorders, depressive disorders, schizophrenia, and organic disorders.
Differentiate from Generalized Anxiety Disorder (GAD) and panic disorder—intense symptom history is essential.
Symptoms may overlap with those of other mental health conditions, necessitating careful assessment to avoid misdiagnosis.

Epidemiology

One-year prevalence of OCD in the USA is 2.1% with 1.2% not comorbid with other anxiety disorders.
Lifetime risk of developing OCD is also estimated at 2.1%, with high comorbidity rates with mood, impulse control, and substance misuse disorders.
25% of surveyed individuals reported obsessive-compulsive symptoms not meeting DSM-IV criteria, with checking and hoarding as the most common behaviors.
Female-to-male ratio for lifetime prevalence varies from 1.2 (Puerto Rico) to 3.8 (New Zealand); in clinical settings, the ratio is closer to 1.

Aetiology

Healthy individuals experience intrusive thoughts; distinction lies in the frequency and persistence of these thoughts in OCD patients.
Monozygotic twins show higher concordance rates for OCD than dizygotic twins, suggesting a genetic component.
Risk of OCD in first-degree relatives is about four times greater than in the general population.
Genetic associations found with genes coding for glutamate and serotonin transporters, though some findings lack replication.

Evidence of Brain Disorder

Associations with neurological conditions and brain imaging studies indicate dysfunction in brain function in OCD.
Patients with OCD show variable changes in brain structure, particularly increased grey matter in the striatum and decreases in orbitofrontal and anterior cingulate cortex.
Functional imaging reveals increased activity in brain regions during psychological challenges that trigger OCD symptoms, implicating disorders in corticostriatal-thalamic loops in symptom development.

Abnormal Serotonergic Function

OCD symptoms respond to drugs enhancing serotonin (5-HT) function, although this does not definitively prove serotonin abnormalities in the disorder.
Studies assessing serotonin function yield inconsistent results, complicating the understanding of serotonergic involvement in OCD.

Psychoanalytical Theories

Freud theorized that obsessional symptoms stem from unconscious aggressive or sexual impulses, repressed by defense mechanisms.
Regression to the anal stage of development was suggested as a cause for obsessional symptoms related to excretory functions and contamination fears.

Neuropsychological Function

Compulsivity manifests as a tendency to perform repetitive actions, contrasting with impulsivity, which involves inability to inhibit inappropriate behaviors.
Patients with OCD struggle with neuropsychological tasks requiring shifting and reversal learning, indicating a possible over-reliance on habitual learning.

Cognitive Theory

Focuses on obsessional patients' inability to manage intrusive thoughts, leading to inflated feelings of responsibility and resulting compulsive behaviors.
Seeks to reduce attempts to suppress disturbances, which can exacerbate their frequency and intensity.

Prognosis

Approximately two-thirds of OCD cases improve within one year; chronic cases may have fluctuating or stable courses.
Better prognosis associated with triggering events and good social adjustment; poorer outcomes linked to childhood onset and presence of personality disorders.
Major depression as a comorbidity correlates negatively with recovery.

Treatment

Medication:
- Clomipramine, a tricyclic antidepressant, was historically significant but is no longer first-line due to common side effects.
- SSRIs are effective for reducing symptoms; individual response may vary, and higher doses might yield better results.
- Antipsychotic agents added to SSRIs may improve outcomes, particularly with low doses of risperidone and aripiprazole.
- Anxiolytics might provide short-term relief but are not recommended for extended use.
Cognitive Behavioral Therapy:
- Exposure and response prevention techniques show substantial efficacy in managing obsessional rituals.
- Cognitive approaches focus on reducing avoidance and suppression of obsessional thoughts, potentially enhancing the effects of behavior therapy.
Dynamic Psychotherapy:
- Generally ineffective for obsessional symptoms and may worsen conditions due to excessive rumination.
Neurosurgery & Deep Brain Stimulation:
- Surgical interventions can lead to immediate relief but long-term effects remain uncertain due to lack of controlled trials.
- Deep brain stimulation is experimented with for intractable OCD but is still under research for efficacy.

OCD Management and Treatment

OCD may have a fluctuating course with potential long periods of remission.
Depressive disorder often co-occurs with OCD; effective treatment of depression can improve OCD symptoms.
Patients should be reassured that OCD symptoms are not a sign of impending insanity.
Involving partners or close relatives in educational sessions about OCD can be beneficial.
Family members should be trained to resist involving themselves in patients' rituals to avoid enabling the behavior.

Treatment Approaches

Medication, usually SSRIs, can control OCD symptoms but may lead to relapse upon discontinuation.
Combining medication with exposure and response prevention therapy tends to yield better long-term results.
Cognitive behavioral therapy (CBT) should be utilized if not previously administered.
Higher doses of antidepressants may be more effective for OCD patients; full dosage ranges should be explored if tolerated.
Long-term maintenance treatment may be necessary for patients who respond to medication.

Disorders such as body dysmorphic disorder, hoarding disorder, and trichotillomania have prominent compulsive features similar to OCD.

Hoarding Disorder

Recognized as a distinct disorder in DSM-5, hoarding involves emotional difficulties in discarding possessions.
Clutter from hoarding obstructs intended use of living spaces, leading to hygienic and safety issues.
Commonly hoarded items include newspapers, clothing, and sometimes animals, leading to domestic neglect.
Diagnosis requires evidence of significant distress and accumulation of items rendering living areas unusable.
Lifetime prevalence estimated between 2% and 4%, with a familial and genetic component.

Management of Hoarding Disorder

Management is challenging due to patients' perception of hoarding as non-problematic.
Cognitive behavioral therapy has shown improvements, but more specific forms are still being evaluated.
SSRIs and venlafaxine show potential benefits based on limited studies; further randomized controlled trials are needed.

Trichotillomania

Characterized by recurrent hair pulling leading to noticeable hair loss, often associated with a sense of relief.
Can affect various body areas, with particular prevalence in the scalp, eyebrows, and eyelashes.
The disorder can develop in childhood, adolescence, or adulthood, more commonly found in women.
Diagnosis involves a repeated failure to resist pulling hair, causing distress and impairment in life functioning.

Epidemiology of Trichotillomania

Prevalence rates are unclear but approximately 1-2% of college students report hair-pulling issues.
Family studies show an increased incidence of OCD and grooming disorders among relatives, suggesting a shared genetic diathesis.

Management of Trichotillomania

Best validated management involves psychological therapies, particularly behavioral treatments like habit reversal.
CBT has shown to be more effective than clomipramine and placebo in some studies.
Mixed responses to medications; clomipramine and N-acetylcysteine show promise, while fluoxetine lacks consistent efficacy.

Psychological Arousal Symptoms

Fearful anticipation can create a persistent sense of dread about potential threats.
Increased irritability may lead to difficulties in social interactions and increased conflicts.
Heightened sensitivity to noise can result in discomfort and distraction in daily environments.
Restlessness manifests as an inability to relax, often leading to constant movement or fidgeting.
Poor concentration impacts academic and work performance, hindering productivity.
Worrying thoughts often revolve around future events and can perpetuate a cycle of anxiety.

Autonomic Arousal Symptoms

Gastrointestinal Symptoms

Dry mouth makes it unusually difficult to swallow and can lead to discomfort during meals.
Difficulty in swallowing may indicate increased muscle tension in the throat.
Epigastric discomfort can present as a feeling of unease in the stomach area, often accompanied by nausea.
Excessive wind leads to bloating and discomfort, frequently resulting in embarrassing situations.
Frequent or loose motions can indicate a nervous stomach, causing unpredictability in daily routines.

Respiratory Symptoms

Constriction in the chest can create a sensation of tightness, contributing to a feeling of panic.
Difficulty inhaling can exacerbate feelings of anxiety and can be mistaken for a panic attack.

Cardiovascular Symptoms

Palpitations create a heightened awareness of heart rhythms, often causing increased anxiety.
Discomfort in the chest may mimic serious cardiac issues, leading to further panic.
Awareness of missed beats can create a preoccupation with heart health and anxiety escalation.

Genitourinary Symptoms

Frequent or urgent micturition can disrupt daily activities, leading to embarrassment and anxiety.
Failure of erection can result in performance anxiety, particularly in sexual contexts.
Menstrual discomfort can be exacerbated by anxiety, intensifying the experience of symptoms.

Muscle Tension Symptoms

Tremor can manifest as increased restlessness, often noticeable in the hands or legs.
Headaches may occur as a result of prolonged muscle tension and stress.
Aching muscles often result from chronic tension, which can interfere with daily activities.

Hyperventilation Symptoms

Dizziness may occur due to changes in carbon dioxide levels from rapid breathing.
Tingling in the extremities can create discomfort and alarm, often worsening anxiety.
Feeling of breathlessness can instigate panic and lead to hyperventilation cycle.

Sleep Disturbance Symptoms

Insomnia disrupts sleep patterns, leading to fatigue and increased anxiety levels.
Night terror can cause significant distress and fear, often involving vivid, frightening dreams.

Prevalence of Anxiety Disorders in the EU

Specific phobia shows a 12-month prevalence rate ranging from 3.1% to 11.1%, with a median of 4.9%.
Social phobia has a lower prevalence, varying from 0.6% to 7.9%, with a median rate of 2.0%.
Panic disorder prevalence is low, ranging from 0.6% to 3.1%, and has a median of 1.2%.

Generalized anxiety disorder presents a prevalence range of 0.2% to 4.3%, with a median of 2.0%.
Agoraphobia shows a prevalence range similar to panic disorder, from 0.1% to 3.1%, also with a median of 1.2%.
Obsessive-compulsive disorder (OCD) has a very low prevalence, ranging from 0.1% to 2.3%, with a median prevalence of 0.7%.

Symptoms of Generalized Anxiety Disorder

Persistent worry and apprehension about various aspects of life, often disproportionate to actual events.
Muscle tension experienced frequently, leading to physical discomfort and fatigue.
Autonomic overactivity includes symptoms like increased heart rate and sweating, indicative of heightened anxiety levels.
Psychological arousal may manifest as irritability, restlessness, and difficulty concentrating.
Sleep disturbances often include trouble falling asleep, frequent awakenings, or restless sleep patterns contributing to daytime fatigue.

Other Features Associated with GAD

Depression may co-occur, presenting as persistent sadness, loss of interest, or feelings of hopelessness.
Obsessions can surface, typically characterized by intrusive and distressing thoughts that are hard to control.
Depersonalization may occur, where individuals feel detached from themselves or their surroundings, adding to the distress of the disorder.

Stepped-Care Approach for Generalized Anxiety Disorder (GAD)

Incorporates a structured framework to assess and treat GAD, enhancing the effectiveness of interventions.
Starts with identification and assessment, educating patients about GAD and available treatment options while actively monitoring their condition.

Low-Intensity Psychological Interventions

Involves strategies such as pure self-help and guided self-help techniques.
Includes group psychoeducation to provide support and knowledge about managing anxiety.

High-Intensity Interventions

Patients may progress to more intensive psychological interventions, including:
- Cognitive Behaviour Therapy (CBT), focusing on changing negative thought patterns.
- Applied Relaxation techniques, promoting relaxation and stress relief.
Alternatively, pharmacological treatments can be chosen based on individual needs and symptom severity.

Specialist Treatment Options

Encompasses complex drug regimens and intensive psychological strategies.
Involves multidisciplinary teams, ensuring comprehensive care through collaboration among various healthcare providers.
Access to crisis services and day hospitals is included for high-risk patients, providing immediate support and treatment.

Treatment Initiation Considerations

Immediate treatment at Step 3 is recommended for patients showing severe symptoms or significant impact on daily functioning, ensuring timely intervention and support.

ICD-10 Criteria

Characterized by a marked fear or avoidance of being the center of attention or acting in a way considered embarrassing or humiliating during social situations.
Requires the presence of two anxiety symptoms when exposed to feared situations.
Additional symptoms may include blushing, shaking, fear of vomiting, and urgency related to micturition or defecation.
Must cause significant emotional distress, recognized by the individual as excessive.
Symptoms are limited to specific social situations or their anticipation.
Diagnosis must not be secondary to another mental disorder.

DSM-5 Criteria

Defined by a marked fear or avoidance of situations involving unfamiliar people or potential scrutiny, with an emphasis on the fear of embarrassing or humiliating behavior.
Social anxiety often provokes immediate anxiety or leads to avoidance of social situations.
Fear experienced is disproportionate to any actual social threat present.
Interference with daily functioning or significant distress is required for diagnosis.
Symptoms must persist for a minimum duration of six months.
Diagnosis also must not be secondary to another mental disorder.

Diagnostic Criteria for Agoraphobia in ICD-10 and DSM-5

ICD-10 identifies marked, consistent fear or avoidance in at least two common situations such as crowds, public transit, solo travel, and being away from home.
DSM-5 specifies fear or anxiety about two or more of five defined scenarios: public transport, open spaces, enclosed places, being in a crowd, and being away from home alone.
Both ICD-10 and DSM-5 require that avoidance or anxiety leads to significant distress; however, ICD-10 emphasizes that fear is recognized as excessive or unreasonable.
In DSM-5, situations are often avoided or tolerated with distress, motivated by fears of feeling trapped or helpless should incapacitating or embarrassing symptoms arise.
ICD-10 requires at least one symptom of autonomic arousal (e.g., increased heart rate) along with another anxiety symptom within the feared situations.
DSM-5 clarifies that the anxiety felt is disproportionate to the actual danger posed by the feared situations.
ICD-10 symptoms are highly context-specific, present mainly in feared situations or when contemplating them.
DSM-5 emphasizes that fears, anxiety, or avoidance must persist for six months or longer to meet diagnostic criteria.
Both classifications state that symptoms must not be attributed to another disorder or cultural beliefs.
DSM-5 highlights that the fear, anxiety, or avoidance results in clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Symptoms of a Panic Attack

Panic attacks begin abruptly, often without warning or a clear trigger.
Palpitations: rapid heartbeat that may feel like pounding or fluttering in the chest.
Choking sensations: feelings of tightness in the throat or difficulty breathing, leading to distress.
Chest pain: intense discomfort that can mimic heart-related issues, often causing anxiety.
Dizziness and faintness: feelings of lightheadedness that may result in the individual feeling faint or unbalanced.
Depersonalization: sensation of feeling detached from oneself, experiencing an altered sense of reality.
Derealization: perception that the external world feels unreal or distorted, affecting one's environment.
Intense fear: overwhelming anxiety related to the fear of dying, losing control, or experiencing a mental breakdown.

Symptoms of Hyperventilation

Dizziness can occur due to decreased carbon dioxide levels in the blood, affecting brain function.
Tinnitus involves ringing or buzzing in the ears, often linked to changes in blood flow due to hyperventilation.
Headaches may arise from muscle tension or reduced oxygen delivery to the brain during rapid breathing.
A feeling of weakness can manifest as the body reacts to imbalances in oxygen and carbon dioxide.
Faintness is a common sensation resulting from inadequate blood flow to the brain, often exacerbated by hyperventilation.
Numbness may occur in extremities due to nerve hypersensitivity caused by altered carbon dioxide levels.
Tingling sensations in the hands, feet, and face are often signs of peripheral nerve involvement as a result of rapid breathing.
Carpopedal spasms, involuntary contractions of the hands and feet, can result from changes in electrolyte balance due to hyperventilation.
Precordial discomfort, or chest pain, may arise as a consequence of anxiety and muscle strain associated with hyperventilation.
A sensation of breathlessness can paradoxically occur even though an individual is breathing rapidly, often linked to anxiety and panic responses.

Principal Features of Obsessive-Compulsive Disorder (OCD)

Obsessional Symptoms: Involuntary and distressing thoughts or impulses that recur persistently, leading to significant discomfort.
Ruminations: Excessive focus on certain thoughts or memories that often relate to fears or doubts, causing emotional distress.
Impulses: Sudden, uncontrollable urges that can lead to compulsive behaviors in an attempt to alleviate anxiety.
'Phobias': Intense fears that may be directly related to the obsessions, often leading to avoidance behaviors.

Compulsive Rituals

Repetitive behaviors or mental acts performed in response to obsessions, intended to reduce anxiety or prevent a feared event.

Other Symptoms

Abnormal Slowness: Individuals may exhibit noticeably delayed responses in their actions, often linked to the need to perform compulsive rituals.
Anxiety: High levels of anxiety are commonly experienced, driven by both obsessions and the compulsive need for relief.
Depression: Co-occurring depressive symptoms are frequently observed, exacerbated by the stress and dysfunction caused by OCD.
Depersonalization: Feelings of detachment from oneself or reality, which can occur as a reaction to intense anxiety or overwhelming obsessions.

Cognitive Processes in Obsessive-Compulsive Disorder (OCD)

Thought-action fusion: Involves magical thinking, where individuals believe that merely thinking about harming someone increases the likelihood of acting on that thought or reflects past actions.
Inflated sense of responsibility: Patients feel an excessive obligation to prevent harm, believing they possess significant power to influence critical outcomes.
Compulsions and safety-seeking behaviors: These can be either behavioral or mental; they provide temporary anxiety relief, reinforcing the belief that not performing them would lead to greater discomfort or harm.
Overestimation of harm: Individuals with OCD often perceive a higher probability of negative events occurring, which intensifies their anxiety.
Intolerance of uncertainty and ambiguity: This cognitive process manifests as a difficulty in accepting the lack of definitive answers or outcomes, contributing to obsessive thoughts.
Need for control: Many with OCD have a strong desire to control their environment and experiences, driving compulsive behaviors as a means to achieve this control.

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Description

This quiz explores the symptoms and characteristics of anxiety disorders as described in Chapter 1. It focuses on the mental and physical symptoms of anxiety and their occurrence in various disorders. Understand the underlying themes and diagnostic patterns in anxiety-related conditions.