Study guide: Anxiety disorders/OCD

First line pharmacological intervention: Antidepressants

SSRIs (first choice) such as sertraline, fluoxetine, escitalopram; SNRIs (if SSRIs are infeffective) like venlaxafine and duloxetine; TCAs (less used) such as clomipramine for OCD.

Nonpharmacologic

CBT: gold standard; Exposure therapy

Lab workup

Thyroid panel (TSH, T3, T4) because hyperthyroidism can mimic anxiety; Electrolytes and glucose because electrolyte imbalances can cause anxiety like symptoms; CBC and Iron because anemia can contribute to fatigue and anxiety; UDS to rule out substance induced

Safety considerations

Suicidality (always assess); Impairment in daily functioning

MSE findings

Appearance: restless, hypervigilence, fidgeting; Mood/Affect: anxious, fearful, tense; Thought process: ruminative (GAD), obsessional (OCD), catastraphic thinking (panic); Insight and judgement: preserved in anxiety but may be impaired in severe OCD or hoarding