Anxiety and OCD Lecture Notes PDF

Anxiety and OCD Lecture Notes **Anxiety: Definition and Levels** **Anxiety:** A universal human experience, characterized by feelings of apprehension, uneasiness, uncertainty, or dread, resulting from a real or perceived threat. It differs from fear, which is a reaction to a specific danger....

Anxiety and OCD Lecture Notes **Anxiety: Definition and Levels** **Anxiety:** A universal human experience, characterized by feelings of apprehension, uneasiness, uncertainty, or dread, resulting from a real or perceived threat. It differs from fear, which is a reaction to a specific danger. **Levels of Anxiety:** **Mild Anxiety:** Normal and necessary for survival, helps to focus attention and problem-solving. **Moderate Anxiety:** Focus narrows; selective attention increases but thinking is less clear. **Severe Anxiety:** Perception is greatly reduced; individual may feel overwhelmed and have difficulty concentrating. **Panic:** The most extreme level; unable to process the environment, may experience dissociation, confusion, or even terror. **Anxiety Disorders** **1. Generalized Anxiety Disorder (GAD)** **Symptoms:** Chronic, excessive worry about various life domains for at least 6 months, along with physical symptoms like restlessness, muscle tension, fatigue, and irritability. **Interventions:** Psychotherapy (CBT) Pharmacotherapy: SSRIs, SNRIs, and occasionally benzodiazepines for short-term relief. Lifestyle modifications: Exercise, sleep hygiene, and relaxation techniques. **2. Panic Disorder** **Symptoms:** Recurrent, unexpected panic attacks marked by intense fear or discomfort. Physical symptoms include chest pain, dizziness, palpitations, shortness of breath, and feelings of impending doom. **Interventions:** CBT, particularly with exposure therapy. Pharmacotherapy: SSRIs and benzodiazepines. Patient education on the physical effects of anxiety to reduce fear during an attack. **3. Phobias** **Specific Phobia:** Fear of specific objects or situations (e.g., heights, flying). **Social Anxiety Disorder (Social Phobia):** Fear of social situations where there is potential scrutiny by others, leading to avoidance of social events. **Agoraphobia:** Fear of open spaces or situations where escape might be difficult, such as public transportation or crowded places. **Interventions:** Systematic desensitization (gradual exposure to the feared object/situation). CBT to reframe irrational fears. Medications: SSRIs or beta-blockers (especially for performance-related anxiety). **Obsessive-Compulsive Disorders** **Obsessive-Compulsive Disorder (OCD)** **Obsessions:** Persistent, intrusive thoughts, urges, or images that cause anxiety (e.g., fear of contamination, intrusive sexual or aggressive thoughts). **Compulsions:** Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession (e.g., excessive handwashing, checking). **. Diagnostic Criteria (DSM-5)** To be diagnosed with OCD, the following criteria must be met: Presence of obsessions, compulsions, or both. The obsessions or compulsions are time-consuming (take more than 1 hour per day) or cause significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not attributable to the physiological effects of a substance (e.g., drug abuse or medication) or another medical condition. **Common Subtypes of OCD** **Contamination and Cleaning:** Fear of germs or dirt, leading to excessive washing or cleaning. **Harm Obsessions and Checking:** Fear of harming oneself or others, leading to constant checking (e.g., checking if the stove is turned off). **Symmetry, Order, and Counting:** Need for items to be arranged in a specific order, or the need to count items or actions. **Taboo or Forbidden Thoughts:** Intrusive thoughts involving aggressive, sexual, or religious themes, often causing guilt and distress. **Interventions:** CBT with **Exposure and Response Prevention (ERP):** Expose patients to their feared situations without allowing them to perform their compulsions. SSRIs are the first-line medications. In severe cases, augmentation with antipsychotics or neuromodulation techniques like deep brain stimulation (DBS) may be considered. **Selective Serotonin Reuptake Inhibitors (SSRIs):** First-line pharmacologic treatment for OCD. Common SSRIs used include fluoxetine, sertraline, and fluvoxamine. Higher doses are often required compared to treatment for depression. **Clomipramine:** A tricyclic antidepressant with strong serotonin reuptake inhibition, traditionally considered effective in OCD, although SSRIs are preferred due to better side-effect profiles. **Augmentation Strategies:** In cases of treatment-resistant OCD, antipsychotic medications (e.g., risperidone) may be added to SSRIs to enhance treatment effects. **Body Dysmorphic Disorder (BDD)** **Symptoms:** Preoccupation with an imagined or exaggerated defect in appearance, often leading to excessive grooming, mirror checking, or seeking cosmetic surgery. **Interventions:** CBT focusing on cognitive distortions and body image issues. SSRIs to reduce obsessive thinking. **Hoarding Disorder** **Symptoms:** Difficulty discarding possessions, regardless of value, leading to clutter that disrupts living spaces and daily functioning. **Interventions:** CBT with a focus on organizational skills and reducing acquisition. Motivational interviewing to enhance treatment engagement. **Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking Disorder)** **Symptoms:** Repeated pulling of hair or picking of skin, leading to noticeable hair loss or skin lesions. **Interventions:** CBT focusing on habit-reversal techniques. Medications such as SSRIs may help in reducing compulsive urges. **Neurobiology of Anxiety and OCD** **Amygdala:** Central in the processing of fear and anxiety. Hyperactivity in this region is associated with anxiety disorders. **Prefrontal Cortex:** Plays a role in regulating the amygdala's response to anxiety. In some disorders (e.g., OCD), the ability to inhibit these fear responses is impaired. **Neurotransmitters:** **Serotonin:** Dysregulation of serotonin is commonly linked to OCD and anxiety disorders. **Norepinephrine:** Implicated in the body's "fight or flight" response, contributing to panic and anxiety. **Gamma-Aminobutyric Acid (GABA):** The primary inhibitory neurotransmitter, reduced GABA activity is associated with heightened anxiety. **Course and Prognosis** OCD is typically a chronic condition, with symptoms waxing and waning over time. Early treatment with CBT and/or medications improves long-term outcomes. About 50--60% of patients show a significant response to SSRIs or CBT, but full remission is less common. Ongoing treatment and management may be necessary to maintain symptom control. **Differential Diagnosis** **Obsessive-Compulsive Personality Disorder (OCPD):** Unlike OCD, OCPD involves a general preoccupation with orderliness, perfectionism, and control but lacks the specific intrusive obsessions and compulsions. **Other Anxiety Disorders:** Conditions like generalized anxiety disorder (GAD) or specific phobias may involve excessive worry, but they do not involve the same repetitive behaviors seen in OCD. **Tic Disorders:** Some individuals with OCD may also have tics or a diagnosis of Tourette's syndrome, and it is important to differentiate the two.