Understanding Anxiety and OCD

Anxiety

• Anxiety is a natural response to stress, characterized by feelings of fear or apprehension about the future.

Anxiety Disorder

• An anxiety disorder occurs when feelings of anxiety are extreme, out of proportion, uncontrollable, and last for longer than six months, interfering with daily functioning.

Obsessive Compulsive Disorder (OCD)

• OCD is a mental health condition characterized by distressing, intrusive thoughts (obsessions) and repetitive physical or mental acts (compulsions) to reduce anxiety.

Causes of Anxiety Disorders

• Anxiety disorders are caused by an interplay of genetic, neuro-endocrine, and psycho-social factors.

Signs and Symptoms of Anxiety in Children

• Varying presentations depending on age and cognitive level
• Ongoing somatic complaints with no cause (e.g., tummy pain, headache)
• Enuresis and encopresis
• Change in behavior
• Avoidance
• Change in mood (e.g., irritability, labile, low)

Signs and Symptoms of Anxiety in Adults

• Generalized anxiety: persistent, excessive worry about multiple things, associated with restlessness, tiredness, poor concentration, irritability, muscle tension, and sleep issues
• Panic attacks: recurrent, unexpected periods of intense fear/anxiety, usually reaching a peak within 5 minutes and associated with difficulty breathing, chest pain, fear of dying, etc.
• Agoraphobia: fear and avoidance of places and situations that may cause panic, entrapment, helplessness, or embarrassment
• Social anxiety disorder: marked, persistent fear of social situations, resulting in avoidance

Post-Traumatic Stress Disorder (PTSD)

• Caused by experiencing, witnessing, or learning about a traumatic event
• Symptoms include:
  • Intrusive symptoms (e.g., flashbacks, nightmares, panic attacks with triggers)
  • Avoidance of people, places, conversations, activities, objects, or situations that bring up memories of the traumatic event
  • Negative changes in thoughts and mood (e.g., shame, anger, fear, self-blame, inability to remember)
  • Hyperarousal (e.g., heightened startle response, difficulty concentrating, problems sleeping)

Approach to the History

• Establish a rapport with the patient
• Attempt to make the patient feel at ease
• Empathy and non-judgemental approach
• Ask open-ended questions
• Explore patient's feelings, experiences, and coping strategies

Approach to the Mental State Examination

• Appearance and behavior: patients may appear anxious, display avoidance or compulsions
• Speech: usually logical and coherent
• Mood: may be euthymic (normal) or depressed
• Affect: congruent with mood
• Thought form: usually no formal thought disorder
• Thought content: obsessions, pre-occupation with traumatic events, etc.
• Cognition: generally well-oriented to time, place, person (unless there is an underlying cognitive disorder)
• Insight and judgment: vary according to severity