| Anxiety Disorders & Anxioytics |
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| What is criteria for dx? |
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| Who likely gets this? |
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| What do they tell you? |
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| Treatment |
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| Associated conditions/ddx |
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| Remember this... |
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| GAD
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uncontrolled, excessive anxiety or worry about life to point of disruption
anxiety on most days for 6 months + at least 3 somatic symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, disturbed sleep) |
Women in early 20s with first degree relative dx w/ anxiety d/o |
Anxiety on most days for at least 6 months and somatic symptoms |
1. lifestyle changes 2. Psychotherapy 3. Meds- SSRIs, venlafaxine and Buspirone. Benzos for immediate treatment |
Depression, caffeine intoxication, withdrawal from CNS depressants, panic d/o, OCD |
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| Panic Disorder |
Recurrent and unexpected panic attacks either with or without agoraphobia |
Women (2-3X >), age 25 with agorphobia in 30-50% of cases. Found with people that had separations during childhood |
Panic attacks: intensive fear or discomfort with 4 symptoms that peak in 10 minutes--> palpitations, diaphoresis, fear of dying or "going crazy". Pts feared more attacks for over a month and have made lifestyle adjustments (avoid situations) |
CBT, meds (SSRIs and TCA)s, benzos for acute but avoid long-term use b/c addiction/tolerance |
Mitral valve prolapse, lactate infusion, abnml neurophysiology....ddx includes anxiety d/o due med condition, substance-induce anxiety d/o |
Elucidate if panic d/o with agorphobia (fear of being alone in public places; can be dx alone or with panic d/o) |
| Social Phobia |
marked fear due to social or performance situations that embarrassment could occur. Specific (public speaking, urinating in public) or general (social interaction). |
Starts in adolescents, women |
excessive/unreasonable fear and/or avoidance of object/situation that impairs function. Related hx of traumatic events. Recognize fear excessive. |
CBT! SSRIs, low-dose benzo or beta-blocker (performance anxiety) |
Part of avoidance PD, low self-esteem, other anxiety d/os |
Pts recognize fear is excessive and irrational |
| PTSD |
S/s following threatening event that causes intense fear, horror, or helplessness lasting >1 month. |
3 subtypes: ACUTE d/o lasts <3 months; CHRONIC and DELAYED ONSET s/s begin 6 months after traumatic event |
1) reexperiencing event- dreams, flashbacks, intrusive thoughts 2) Avoidance of stimuli- detachment, anhedonia 3) increased arousal- anxiety, sleep d/o, hyper-vigilance |
SSRI are first line, TCAs and MAOI. Acute beta blockers, benzo and alpha agonists. Psychotherapy and support groups |
Survivor guilt, poor concentration, amnesia, personality change, substance abuse, depression and suicide ideation |
reexperience event, numbed responsiveness, and increased arousal |
| OCD |
obsessions/compulsions recognized by patient and interrupt life |
M:F is 1:1, presents late teens/early adult- chronic and hard to treat |
(obsessions) fear of contamination, fear of harm to self/another that can't control that cause (compulsions) such as hand washing, rituals for tasks, counting and excessive checking to neutralize anxiety |
Clomipramine and SSRIs with CBT, desensitization, and pt edu |
depression, anxiety, hypochondriasis, phobic avoidance, Tourette d/o, delusional d/o |
Pts recognize thoughts irrational and want to stop. Often present to other doctors (derm) with skin complaint due to washings |
| Specific Phobia |
Anxiety provoked by feared object/situation (animals, heights, airplanes). Most begin in childhood |
Women and children... blood-injection-injury phobia |
excessive anxiety causing impairment in function |
CBT!! Systematic desensitization with relaxation training, SSRIs, benzos, beta-blockers |
hx fainting, restricted lifestyle, other anxiety d/o, PTSD, OCD |
Recognize fear is outrageous |
