Anxiety, obsessions and compulsion

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