OCD + Anxiety Disorder

\_ are intrusive + unwanted \__, \_ + \_ that create anxiety and uncertainity. Obsessive thoughts can take many forms.

Obessions; thoughts; urges; images

Obsessions often lead to \_ which are \__, such as hand washing, or \_, such as praying, counting, or repeating words that sufferers feel \_ to perform in response to the obsessive thoughts.

compulsions; repeatative behaviors; mental acts; driven

performing compulsions brings temporary \_ from the anxiety or discomfort or sense of incompleteness created by the obsessive thoughts, but only serves to ultimately \_ the vicious cycle of obsessive thinking and compulsive behavior.

relief; reinforce

To be diagnosed with Obsessive-Compulsive disorder, an individual must experience either significant \___ in their work life, relationships, etc. or the obsessive/compulsive behaviors / rituals take at least \__ of time each day.

distress or impairment; 1 hour

In OCD, as with other OC-Related Disorders, typically obsessive thoughts are \_ and experienced as \_. The patient experiences the obsessions as contrary to what they really want or who they see themselves to be. These types of thoughts are known as \__ because they conflict with the patient’s \_ and sense of \_.

unwanted; intrusive; ego-dystonic; values; self

\_ aka “Hair Pulling Disorder” and \_ disorder, AKA “Skin Picking Disorder” are considered \____ (_). Often times these BFRB’s are used to \_ to self-soothe. Individuals may just “find themselves pulling their hair.

Trichotillomania; Excoriation; body focused repeatitve behaviors (BFRB); unconsciously

OCD can take a variety of forms, but there are 4 common themes seen across \_.

cultures

\_ obsessions are frequently followed by \_ or \_ or \_ rituals. As many as 60% of patients with OCD have contamination fears.

Contamination ; washing; cleaning; avoidance

\_ obsessions involve a need for things to be arranged, ordered, or done “\__” and if they aren’t, there may be a sense that things feel “ \_ “. Symmetry obsessions are frequently followed by rituals that involve compulsive \_, \_ or \_ until things seem perfectly ordered. Individuals with symmetry obsessions may be excessively \_ to complete tasks and have rituals that take an excessive amount of \_.

Symmetry; “just right”; incomplete; ordering; rearranging; re-writing; slow; time

Individuals with \_ or \_ obsessive thoughts are commonly plagued by intrusive thoughts or images or urges of things that violate one’s values, such as blaspheming God , committing unacceptable sexual acts, or hurting loved ones. Sometimes individuals with this form of obsessive thinking don’t perform noticeable compulsive behaviors, sometimes called \_ but most do have at least perform compulsive \__, such as praying, repeating mantras, or in some cases doing behaviors, such as going to confession.

taboo; unacceptable; pure O; mental acts

Some individuals have obsessive thoughts focused on themes of \_ that often involve believing one will or has \_ harmed a loved one or even a stranger. Obsessive thoughts of harm often involve \__ about whether one has accidently caused harm. For example, one may have an obsessive thought that they forgot to turn off stove. Even if they just checked the stove, they develop extreme doubt about whether they did. This leads to fears of the consequences.. (burn down house + kids) leading to compulsive \_ behavior (up to 80% of OCD pt have compulsive checking rituals).

harm; accidentally; pathological doubt; checking

OCD has genetic loading but less than for disorders like \_ and \__ meaning that environmental triggers + \_ likely play a significant role in its development.

Schizoprenia; bipolar; epigenetics

While not definitive, many with OCD report excessive \_ life events or trauma that \_ the development of OCD.

stressful; preceded

The physiology of OCD is thought to involve dysfunctions in Cortical-Striatal - Thalamocortical circuits, diverse brain networks, and dysregulation of \_, \_ and \_.

glutamate; dopamine; serotonin

First line treatment is considered psychotherapy. While many have been found to be beneficial, \_________ is considered gold-standard.

Cognitive BT (CBT_ w/ exposure + response prevention (ERP)

First line medication treatment (for OCD) involves the use of \_, often at \_ doses than are used for depressions + anxiety. Additionally, SSRIs often need to be trialed for \_ time periods to demonstrate effectiveness. While generally well tolerated compared to other medications, given the high doses often used, monitoring of \_, \__, and electrolytes, especially for \_ duue to SIADH needs to occur more frequently addition to other common side effects of GI disturbance, insomnia, and sexual side effect.

SSRIs; high; longer; ECG, liver enzymes; hyponatremia

\_ (Anafranil), a TCA is effective for OCD but has an increased \_ effect profile, including a high risk of \_ abnormalities and risk of death in overdose.

Clomipramine; side; cardiac

2nd gen antipsychotics like \_ (Abilify) may also be used, especially in treatment resistant cases, and appear help better “tune” the salience network to allow better ability to let go of obsessions and shift attention. NMDA antagonists like \_ may also be used to calm glutamate over activity.

Aripiprazole; memantine

Anxiety is a common experience. Anxiety symptoms that rise to the level of a \_ share some common features including that they cause \_ disturbances like \__, and \_.

Disorder; behavioral; muscle breathing, avoidance

Anxiety disorders also cause \_ symptoms, usually of at least \__ as well as \_ distress + impairment.

persistent; 6 months; significant

Anxiety involves \_ future threats or uncertain outcomes. The cognitive or mental component of anxiety is called \_. Anxiety also involves \_ symptoms that are noticeable but often less intense those that occur in more acute fear-based disorders \_ involves emotional reactions to real or perceived imminent \_. Fear-based disorders, such as \_ often involve intense physical reactions to the feared stimulus.

anticipating; worry; physical; fear; threat; phobias

\_ anxiety disorder (GAD) involves excessive and unrealistic worry about a variety of \_ events. It is called GAD, because the worry usually occurs as a variety of worried thoughts (are my kids going to be safe walking to school, will I have enough money to retire, what if my partner doesn’t like what I make for dinner, etc). IN other words, the worry is generalized to a variety of possible future threats, mishaps, or problems.

Generalized; everyday

GAD involves an \_ to control worries that persists for at least \__ and may lead to \_, poor \_ , \_, \_, \_ disturbance and muscle \_.

inability; 6 months; irritability; concentration; restlessness; fatugue; sleep; tension

First-line treatments for Anxiety disorders including GAD, Social Anxiety Disorder, and Separation Anxiety Disorder typically include the use of \_ + \_.

SSRIs; CBT

CBT works “\_” by helping people engage rational thinking to challenge \__ to lessen the impact of ruminating thoughts. Medications like \_ work “\_” to calm the neural circuits involved in creating and sustaining anxiety,

top down; cognitive distortions; SSRI’s; bottom up

\_ anxiety disorder involves the development of \___ anxiety or fear of social or \_ situations where one might be scrutinized, embarrassed, or \_. Some individuals only experience social anxiety in \_ situations, such as giving a speech. In these cases, medications like \_ that can be taken in advance of a known event can help to calm the physical components of social anxiety. To qualify for a diagnosis of social anxiety disorder, one must have symptoms that cause significant distress or impairment for at least \_.

Social; out-of-proportion; performance; judged; performance; Propranolol; 6 months

\_ anxiety disorder involves significant worry and distress if separated or anticipating separation from primary attachment figures. This may involve excessive worry that \_ or an \_ event will come to a caregiver that will cause separation, \_ about being separated, fears of being \_, leaving \_ to go to school, \_ away from home. While frequently diagnosed in childhood, separation anxiety disorder does occur in \_. Some who experience it as adults had the disorder in childhood and in others it appears related, or at least in some cases, to \_ or \__.

Seperations; harm; unfortunate; nightmares; alone; home; sleeping; adults; trauma; prolonged grief

Phobias + panic attacks typically involve the brains fear circuitry. Often the \_ is overactive leading to chronic activation of the \_ response. With chronic activation of SNS + HPA axis, the parts of the brain that help to calm the amygdala, including the \_ cortex (Rational thinking + Self talk) + \_ (memory), become underactive and unable to inhibit the fear signals from the amygdala or put the fear signals into context (noise was can falling, not a threat)

amygdala; F/F; pre-frontal; Hippocampus

\_ attacks involve a sudden surge of \_ that causes physical ( autonomic/sympathetic) reactions which may include the 3 C’s of \__ (or SOB), \_ , and \_ (or hot flashes).

Panic; fear; choking sensation; chest pain; chills

Panic attacks can occur in a wide variety of conditions including mental health disorders like \__ disorder, \_ disorders, and \_ conditions like \__. Panic attacks may occur only occasionally or frequently. When they are clearly cause by specific \_ or only occur in the context of other disorders, such as social situations, their presence is indicated as a \_. For example, Social Anxiety Disorder with Panic attacks.

Major Depressive; anxiety; medical; Hyperthyroidism; situations; specifier

When panic attacks happen without a clear \_, are recurrent and lead to \__ or more of persistent \_ and efforts to \_ situations that could cause a panic attack, an individual qualifies for a diagnosis of \__.

trigger; 1 month; worry; avoid; panic disorder

Specific \_ are an intense and usually irrational \_ of specific triggering stimuli. Phobias can develop to a wide variety of stimuli but usually fall into some common categories including phobias to \_ (dog, snakes, spiders), \_ environment (height, storms), \___ ( sight of needles, sight of blood, etc), \_ like driving, flying, or riding on elevators, or \_ situations, such a vomiting or choking. To be diagnosed with a specific phobia, the feared stimuli must always trigger the phobia, lead to \_ of the feared stimuli, cause significant \__ and persist for at least \__.

phobias; fear; animal; natural; blood-injection-injury; situations; other; avoidance; distress/impairment; 6 months

Individuals with a specific phobia are often unlikely to seek treatment if they can avoid the feared stimulus sufficiently. \__ is considered the first-line therapy for phobias.

CBT w/ ERP

\_ is an intense fear of being in situations that can’t easily be \_ or where finding \_ would be difficult. These fears are often paired with the fear of having a \_ attack or doing smt embarrassing in a place that wouldn’t allow easy escape.

Agoraphobia; escaped; help; panic

Agoraphobia can manifest as a fear of \_ or \_ spaces, \_ transportations (buses, planes), going \_ (neighborhood), or \_ spaces or lines. Patients with agoraphobia wind up \_ the feared situation. When untreated, patients with agoraphobia, can become \__. Many with agoraphobia also have \__. \__ and SSRI’s are considered first-line treatments for agoraphobia, though in some cases, exposure therapy must start in the patient’s home.

open; enclosed; public; outside; crowded; avoiding; house bound; panic attacks; CBT w/ ERF

CBT involves challenging \_ distortions in order to develop less extreme \_ responses and changing \_ to promote adaptive coping and avoid reinforcing habits that reinforce distortion. ERP involves \_ yourself to feared situations while refraining from habitual response to \” __” fear.

cognitive; emotional; behaviorsl exposing; unlearn

Benzodiazepines are highly \_ at reducing anxiety but also pose a very high risk of \_.

Effective; dependence.

Benzo are best used as a short-term \_ medications to help pt manage anxiety symptoms until longer acting meds, like \_ start to work, or as an intermittent \_ medication to stop \__ or manage specific \_ situations that cause extreme anxiety like taking a necessary plane ride. Finally they are effective in managing detox from \__.

bridge; SSRI; abortive; panic attacks; phobia; anxiety; Alcohol

Managing benzo OD usually involves \__. In patients who have ODed on just Benzo, the most common signs + symptoms include sedation while remaining arousable with \_ (or almost normal) vital signs and possible \__, \_ (balance/coordination problems), and an \_ MS.

supportive care; sedation; normal; slurred speech; ataxia; altered

When patients become dependent on Benzo, they should \_ be discontinued abruptly but rather tapered \_. Withdrawal effects can include significant rebound \_, \_, \_ \_, increase \_, \_, \_ and an increased risk for \_.

NOT; gradually; anxiety; irritability; insomnia; sweating; bp; headache; agitation; seizures

Withdrawal seizures are possible with all types of Benzo (short, medium, long acting) and even after short-term use, but the risk is greatest with abrupt discontinuation of \__ benzos like Lorazepam (Ativan) and alprazolam (Xanax) and for pts who have been using them for \_ periods of time.

short-acting; long

Seizure are usaully tonic-clonic (AKA) \__ and can be \_.

grand mal; fatal

Chronic use of benzos or alcohol shifts the balance of \_ (inhibitory) and \_ (excitatory) in the brain making the brain \__ and leading to symptoms like seizures if benzos are stopped too quickly.

GABA; glutamate; hyperexcitable