Anxiety, obsessions and compulsion
State of tension and apprehension – could be considered an adaptive function
Six general classes recognised in DSM-IV:
• generalised anxiety disorder (GAD)
• panic disorder
• phobic disorder
• obsessive-compulsive disorder
• post traumatic stress disorder
• acute stress disorder
Generalised anxiety disorder:
Characterised by generalised, persistent and excessive anxiety or worry.
Clinical features:
Unrealistic and/or excessive anxiety about events or activities that lasts >6 months (situational anxiety is a normal response to the stressful situation, but is temporary)
Tachycardia, sweating, tremor, tension, apprehension, poor concentration, poor sleep
Mild forms ‘butterflies’ in the stomach
Severe forms unable to function properly
Treatment of GAD:
Mild forms are usually self-limiting.
Pharmacological – anxiolytic benzodiazepines (eg diazepam; clonazepam); hypnotic benzodiazepines (eg temazepam)
Panic Disorder:
Recurrent attacks that are intensely uncomfortable (‘panic attacks’). Affects up to 1.5% of the population at some time in their lives. F>M. Usually have palpitations, increased heart beat, chest discomfort, feel short of breath, feeling of choking, dizziness, nausea, fear, parathesias in hands, flushes – usually last 30 minutes.
Treatment:
• behavioural therapy
• pharmacological – antidepressants; benzodiazepines
Obsessive-Compulsive Disorder (OCD):
Characterised by a persistent obsession and compulsions that can cause significant distress;
eg fear of contamination; affects 1-3%; M=F;
Aetiology:
Genetic influences; serotonin physiology is suspected
Clinical features:
• time consuming obsessions that interfere with everyday function
• handwashing is the commonest obsession
Treatment:
• cognitive-behaviour therapy (CBT)
• pharmacological – clomipramine (blocks serotonin reuptake); fluoxetine; fluvoxamine; sertraline; paroxetine
• course – frequent relapses
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