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PSYC Anxiety d/o

First Aide CK USMLE 2 Anxiety Disorders

Anxiety Disorders & AnxioyticsWhat is criteria for dx?Who likely gets this?What do they tell you?TreatmentAssociated conditions/ddxRemember this...
GAD 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
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
Created by: MatAnt