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MED-SURG
ANXIETY DISORDER
| Term | Definition | Definition 2 |
|---|---|---|
| NORMAL ANXIETY | ● Diffuse, unpleasant, vague sense of apprehension, which is often accompanied by autonomic symptoms and restlessness. | |
| PERIPHERAL MANIFESTATIONS OF ANXIETY | - Diarrhea - Dizziness, lightheadedness - Hyperhidrosis - Hyperreflexia - Urinary frequency - Palpitations - Pupillary mydriasis - Restlessness (e.g., pacing) | - Syncope - Urinary hesitancy - Tachycardia - Tingling in extremities - Tremors - Upset stomach - Urinary urgency |
| FEAR | ● Emotional response to unknown, definite or non- conflictual threat. | |
| ANXIETY | ● Alerting signal which enables a person to take measures to deal with a threat ● Response to a threat that is unknown, internal, vague, or conflictual | |
| ANXIETY ● Two components: | (1) the awareness of the physiological sensations and the (2) awareness of being nervous or frightened | |
| PATHOLOGICAL ANXIETY | ● 1 out of 4 met the diagnostic criteria for at least one anxiety disorder ● 12-month prevalence rate: 17.7 percent ● W>M ● Prevalence decreases with higher socioeconomic status | |
| PSYCHOANALYTIC THEORIES ● Freud: | anxiety stemmed from a physiological buildup of libido | |
| PSYCHOANALYTIC THEORIES ● "Inhibitions, Symptoms, and Anxiety," → | ● Redefined anxiety as a signal of the presence of danger in the unconscious ● Psychic conflict between unconscious sexual or aggressive wishes and corresponding threats from the superego or external reality | ● Ego mobilized defense mechanisms to prevent unacceptable thoughts and feelings from emerging into conscious awareness |
| PSYCHOANALYTIC THEORIES | "It was anxiety which produced repression." | |
| PSYCHOANALYTIC THEORIES ● From a psychodynamic perspective, the goal of therapy is to | increase anxiety tolerance-capacity to experience anxiety-and use it as a signal to investigate the underlying conflict that has created it. | |
| PSYCHOANALYTIC THEORIES ● Developmental issues: | ○ Disintegration anxiety ○ Persecutory anxiety | |
| Disintegration anxiety | - Fear that the self will fragment because others are not responding with needed affirmation and validation | |
| Persecutory anxiety | - Perception that the self is being invaded and annihilated by an outside malevolent force | |
| Pathological anxiety | - A child who fears losing the love or approval of a parent or loved object. | |
| Castration anxiety | - A powerful parental figure may damage the little boy's genitals or otherwise cause bodily harm | |
| Superego anxiety | - Guilt feelings about not living up to internalized standards of moral behavior derived from the parents. | |
| BEHAVIORAL THEORIES | ● Anxiety is a conditioned response to a specific environmental stimulus. | |
| Classic conditioning | ○ A girl raised by an abusive father, for example, may become anxious as soon as she sees the abusive father. ○ Through generalization, she may come to distrust all men. | |
| Social learning model | ○ A child may develop an anxiety response by imitating the anxiety in the environment, such as in anxious parents. | |
| EXISTENTIAL THEORIES | ● People experience feelings of living in a purposeless universe. ● Anxiety is their response to the perceived void in existence and meaning. | |
| NEUROBIOLOGICAL BASIS ● Autonomic Nervous System | ○ If you are feeling anxious, you may also feel the autonomic symptoms like tachycardia, having palpitations, having headaches, gastrointestinal symptoms like diarrhea, and even breathlessness, respiratory symptoms. | ○ These patients with anxiety disorder exhibit increased sympathetic tone. ○ They adapt slowly to repeated stimuli, and they would respond excessively to moderate stimulus. |
| NEUROBIOLOGICAL BASIS ● Neurotransmitters | ○ Norepinephrine (NE) ⬆ ○ Serotonin ⬇ ○ y-aminobutyric acid (GABA) ⬇ | |
| NEUROBIOLOGICAL BASIS ● Cortisol and CRH ⬆ | ○ Cortisol and corticotrophic releasing hormone, which is increased. | |
| NEUROBIOLOGICAL BASIS ● Neuropeptide Y | ○ Counterregulatory effects on corticotropin-releasing hormone, thus lowering anxiety | |
| NEUROBIOLOGICAL BASIS ● Galanin | ○ Modulates anxiety-related behaviors | |
| BRAIN IMAGING STUDIES | ● Increase in the size of cerebral ventricles ● Abnormal findings in the right hemisphere ● Abnormality in the frontal cortex, occipital, temporal areas | |
| BRAIN IMAGING STUDIES ● Panic disorder: | parahippocampal gyrus, right temporal lobe | |
| BRAIN IMAGING STUDIES ● OCD: | caudate nucleus | |
| BRAIN IMAGING STUDIES ● PTSD: | amygdala | |
| GENETIC STUDIES | ● Almost half of all patients with panic disorder have at least one affected relative. ● Higher frequency of the illness in first-degree relatives of affected patients | |
| NEUROANATOMICAL CONSIDERATIONS ● Locus ceruleus and raphe nuclei → | limbic system and cerebral cortex | |
| NEUROANATOMICAL CONSIDERATIONS ● Limbic System | ○ NE and serotonin ○ High concentration of GABAA receptors ○ Generation of anxiety and fear responses ○ Increased activity in the septohippocampal pathway, which may lead to anxiety | ○ Cingulate gyrus, which has been implicated particularly in OCD |
| NEUROANATOMICAL CONSIDERATIONS ● Cerebral Cortex | ○ The frontal cerebral cortex is connected with the parahippocampal region, the cingulate gyrus, and the hypothalamus and thus may be involved in the production of anxiety disorders. | ○ The temporal cortex has also been implicated as a pathophysiological site in anxiety |
| PANIC DISORDER Code: 300.01 (F41.0) | ● Acute intense attack of anxiety accompanied by feelings of impending doom ● Panic attack may last from minutes to hours. | ● Women are 2-3x more likely to be affected. ● Commonly develops in young adulthood —mean age 25 years |
| PANIC DISORDER ● Lifetime prevalence: | 1-4% | |
| PANIC DISORDER ● 6-month prevalence: | 0.5 to 1.0% (3- 5.6% for panic attacks) | |
| PANIC DISORDER ● Comorbid conditions: | MDD, Social Anxiety Disorder, Agoraphobia, Specific Phobia, GAD, PTSD, OCD, Illness Anxiety Disorder, Personality Disorder, Substance Related Disorders | |
| PANIC DISORDER BIOLOGICAL FACTORS | ● NE, serotonin, GABA ● Noradrenergic neurons of the locus ceruleus ● Serotonergic neurons of the median raphe nucleus ● Limbic system ● Prefrontal cortex | |
| Limbic system | possibly responsible for the generation of anticipatory anxiety | |
| Prefrontal cortex | possibly responsible for the generation of phobic avoidance | |
| PANIC DISORDER BRAIN IMAGING | ● Temporal lobes: hippocampus and the amygdala ● Cortical atrophy in the right temporal lobe ● Dysregulation of cerebral blood flow | |
| PANIC DISORDER GENETIC FACTORS | ● First-degree relatives of patients: 4-8x higher risk for panic disorder ● Monozygotic twins are more likely to be concordant for panic disorder than are dizygotic twins | |
| PANIC DISORDER SYMPTOMS | 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feelings of choking 6. Chest pain or discomfort | 7. Nausea or abdominal distress 8. Feeling dizzy, unsteady, light-headed, or faint 9. Chills or heat sensations 19. Derealization or depersonalization 20. Fear of losing control or "going crazy" 21. Fear of dying |
| PANIC DISORDER COURSE AND PROGNOSIS ● 30 to 40% of patients | seem to be symptom-free at long-term follow-up. | |
| PANIC DISORDER COURSE AND PROGNOSIS ● 50% | would have symptoms that are sufficiently mild not to affect their functioning | |
| PANIC DISORDER COURSE AND PROGNOSIS ● 10 to 20% | would continue to have significant symptoms | |
| PANIC DISORDER COURSE AND PROGNOSIS TREATMENT ● Pharmacotherapy | ○ Alprazolam, Paroxetine ○ SSRIs ○ Clomipramine ○ MAOIS ○ TCAS | |
| PANIC DISORDER COURSE AND PROGNOSIS TREATMENT | ● Continue treatment for 8 to 12 months ● 30-90% of patients with panic disorder who have had successful treatment have a relapse when their medication is discontinued. | |
| PANIC DISORDER COURSE AND PROGNOSIS TREATMENT ● Non-pharmacological therapies | ○ Cognitive and behavior therapies ○ Cognitive therapy | |
| Cognitive therapy | ■ Instruction about a patient’s false beliefs and information about panic attacks ■ Because they have this tendency to misinterpret that if I'm having this, it will lead to death already | ■ We have to inform them or include explanation that when panic attacks occur, they are time-limited and not life-threatening |
| AGORAPHOBIA Code: 300.22 (F40.00) | ● Fear of or anxiety regarding places from which escape might be difficult ● Prefer to be accompanied by a friend or a family member in busy streets, crowded stores, closed-in spaces, and closed-in vehicles. | ● In many cases, the onset of agoraphobia follows a traumatic event. |
| AGORAPHOBIA ● Lifetime prevalence: | 2-6% | |
| AGORAPHOBIA ● DSM 5: | Persons older than age 65 years have 0.4% prevalence rate | |
| AGORAPHOBIA DIFFERENTIAL DIAGNOSIS | ● Major depressive disorder, schizophrenia, paranoid personality disorder, avoidance personality disorder, and dependent personality disorder | |
| AGORAPHOBIA COURSE AND PROGNOSIS | ● Most cases are thought to be caused by panic disorder. ● Agoraphobia without a history of panic disorder is often incapacitating and chronic, and depressive disorders and alcohol dependence often complicate its course. | |
| AGORAPHOBIA TREATMENT ● Pharmacotherapy | ○ Benzodiazepines ○ SSRIs | |
| AGORAPHOBIA TREATMENT ● Psychotherapy | ○ Supportive psychotherapy | |
| Supportive psychotherapy | ■ Building therapeutic alliance to the patient so that we can promote adaptive coping. ■ Adaptive defenses and coping styles are encouraged and strengthened, those maladaptive ones are discouraged. | |
| AGORAPHOBIA TREATMENT ○ Insight-oriented psychotherapy | ■ We help the patient develop insight into the psychological conflict that he or she has | |
| AGORAPHOBIA TREATMENT ○ Behavior therapy | ■ Change can occur without the development of psychological insight into underlying causes. | ■ The techniques included in behavior therapy are: ● positive & negative reinforcement ● systematic desensitization ● graded exposure ● relaxation techniques, ● hypnosis |
| AGORAPHOBIA TREATMENT ○ Cognitive therapy | ■ Based on the premise that maladaptive behavior is secondary to the cognitive distortions that these patients have. | ■ Treatment is short-term and interactive. Sometimes they would give assigned homework that they can perform between sessions, which focuses on correcting assumptions and cognitions |
| AGORAPHOBIA TREATMENT ○ Virtual therapy | ■ They allow patients to see themselves as avatars. They are placed in open or crowded places. So they identify with avatars in repeated computer sessions so that they can master their anxiety through the conditioning. | |
| Phobia | ○ Excessive fear of a specific object, circumstance, or situation | |
| SPECIFIC PHOBIA | ● Requires the development of intense anxiety, even to the point of panic, when exposed to the feared object | |
| SPECIFIC PHOBIA EPIDEMIOLOGY | ● Specific phobia is the most common mental disorder among women and the second most common among men. ● W>M | |
| SPECIFIC PHOBIA EPIDEMIOLOGY ● Lifetime prevalence: | 10% | |
| SPECIFIC PHOBIA EPIDEMIOLOGY ● 6-month prevalence of specific phobia: | 5-10 per 100 persons | |
| SPECIFIC PHOBIA EPIDEMIOLOGY ● Peak age of onset for natural environment type and the blood-injection-injury type: | 5- 9 years | |
| SPECIFIC PHOBIA EPIDEMIOLOGY ● Peak age of onset for situational type (except fear of heights): | mid-20s | |
| SPECIFIC PHOBIA EPIDEMIOLOGY ● Comorbid conditions: | ○ Anxiety ○ Mood ○ Substance-related disorders | |
| SPECIFIC PHOBIA ETIOLOGY ● Behavioral Factors | ○ John Watson ○ Pavlovian stimulus response | |
| Pavlovian stimulus response | ■ Anxiety is aroused by a naturally frightening stimulus that occurs in contiguity with a second inherently neutral stimulus. | ■ When the two stimuli are paired on several successive occasions, the originally neutral stimulus becomes capable of arousing anxiety by itself. |
| SPECIFIC PHOBIA ETIOLOGY ● Classic stimulus-response theory | ○ The conditioned stimulus gradually loses its potency to arouse a response if it is not reinforced by periodic repetition of the unconditioned stimulus. ○ In phobias, attenuation of the response to the stimulus does not occur. | |
| SPECIFIC PHOBIA ETIOLOGY ● Operant conditioning theory | ○ The organism learns that certain actions enable it to avoid the anxiety-provoking stimulus. ○ These avoidance patterns remain stable for long periods as a result of the reinforcement they receive from their capacity to diminish anxiety. | |
| SPECIFIC PHOBIA PSYCHOANALYTIC FACTORS ● Freud - Displacement: | In patients with phobias, the sexual conflict is displaced from object or situation, which then has the power to arouse a constellation of affects → signal anxiety. | |
| SPECIFIC PHOBIA PSYCHOANALYTIC FACTORS ● Freud - Symbolization: | The phobic object or situation may have a direct associative connection with the primary source of the conflict and thus symbolizes it. | |
| SPECIFIC PHOBIA PSYCHOANALYTIC FACTORS ● Freud - Avoidance: | The person can escape suffering serious anxiety. | |
| behavioral inhibition to the unfamiliar | Longitudinal studies suggest that certain children are constitutionally predisposed to phobias because they are born with a specific temperament known as _________, | but a chronic environmental stress must act on a child's temperamental disposition to create a full-blown phobia. |
| SPECIFIC PHOBIA PSYCHOANALYTIC FACTORS ● Counterphobic Attitude | ○ Otto Fenichel ○ Phobic anxiety can be hidden behind attitudes and behavior patterns ○ A person reverses the situation and actively attempts to confront whatever is feared. | ○ Persons with counterphobic attitudes seek out situations of danger and rush enthusiastically toward them. ○ Such patterns may be secondary to phobic anxiety or may be normal means of dealing with a realistically dangerous situation. |
| SPECIFIC PHOBIA GENETICS | ● Studies have reported that two-thirds to three-fourths of affected probands have at least one first-degree relative with specific phobia of the same type. ● The blood-injection-injury type has a particularly high familial tendency. | |
| SPECIFIC PHOBIA CLINICAL FEATURES | ● Arousal of severe anxiety when patients are exposed to specific situations or objects or even anticipate exposure to the situations or objects ● Avoidance of the phobic stimulus | ● MSE: irrational and ego-dystonic fear of a specific situation, activity, or object ● Depression may be present in as many as one-third of all patients with phobia. |
| Code based on the phobic stimulus: ● F40.218 | Animals | |
| Code based on the phobic stimulus: ● F40.228 | Natural environment | |
| Code based on the phobic stimulus: ● F40.23x | Blood injection injury | Note. Select specific ICD-10-CM code as follows: |
| Code based on the phobic stimulus: ● F40.230 | blood | |
| Code based on the phobic stimulus: ● F40.231 | injections and transfusions | |
| Code based on the phobic stimulus: ● F40.232 | other medical care | |
| Code based on the phobic stimulus: ● F40.233 | injury | |
| Code based on the phobic stimulus: ● F40.248 | Situational | |
| Code based on the phobic stimulus: ● F40.298 | Other | |
| ACROPHOBIA | Fear of heights | |
| AGORAPHOBIA | Fear of open places | |
| AILUROPHOBIA | Fear of cats | |
| HYDROPHOBIA | Fear of water | |
| CLAUSTROPHOBIA | Fear of closed spaces | |
| CYNOPHOBIA | Fear of dogs | |
| MYSOPHOBIA | Fear of dirts and germs | |
| PYROPHOBIA | Fear of fire | |
| XENOPHOBIA | Fear of strangers | |
| ZOOPHOBIA | Fear of animals | |
| SPECIFIC PHOBIA DIFFERENTIAL DIAGNOSIS | ● Substance use (particularly hallucinogens and sympathomimetics), ● CNS tumors, and cerebrovascular diseases ● Schizophrenia | ● Panic disorder, agoraphobia, and avoidant personality disorder ● Hypochondriasis, OCD, and paranoid personality disorder |
| SPECIFIC PHOBIA COURSE AND PROGNOSIS ● Bimodal age of onset - Childhood peak: | for animal phobia, natural environment phobia, blood-injection-injury phobia | |
| SPECIFIC PHOBIA COURSE AND PROGNOSIS ● Bimodal age of onset - Early adulthood peak: | for situational phobia. | |
| SPECIFIC PHOBIA TREATMENT ● Behavior Therapy | ○ The patient's commitment to treatment ○ Clearly identified problems and objectives ○ Available alternative strategies for coping with the feelings ○ Systematic desensitization | |
| Systematic desensitization | ■ Patient is exposed serially to a predetermined list of anxiety-provoking stimuli, which are graded in hierarchy from the list to the most frightening one. | ■ And then they need to master the techniques. They are taught to use these techniques to induce relaxation in the face of each anxiety-provoking stimulus. And as they become desensitized to each stimulus, the patients move up to the next. |
| SPECIFIC PHOBIA TREATMENT ● Imagery or desensitization in vivo | ○ Our imaginal flooding. So they are exposed to phobic stimulus for as long as they can tolerate the fear. Until they reach a point at which they can no longer feel it. | ○ It would require patients to experience that similar anxiety through exposure to the actual phobic stimulus. |
| SPECIFIC PHOBIA TREATMENT ● Insight-Oriented Psychotherapy | ○ Enables patients to understand the origin of the phobia, the phenomenon of secondary gain, and the role of resistance and enables them to seek healthy ways of dealing with anxiety- provoking stimuli. | |
| SPECIFIC PHOBIA TREATMENT ● Virtual Therapy | ○ Patients are exposed to or interact with the phobic object or situation | |
| SPECIFIC PHOBIA TREATMENT ● Other Therapeutic Modalities | ○ Hypnosis, supportive therapy, and family therapy | |
| SPECIFIC PHOBIA TREATMENT ● Exposure therapy | ○ Therapists desensitize patients by using a series of gradual, self- paced exposures to the phobic stimuli, and they teach patients various techniques to deal with anxiety, including relaxation, breathing control, and cognitive approaches. | ○ The cognitive-behavioral approaches include reinforcing the realization that the phobic situation is, in fact, safe. |
| SOCIAL ANXIETY DISORDER Code: 300.23 (F40.10) | ● Social phobia | |
| Social phobia | ○ Fear of social situations, including situations that involve scrutiny or contact with strangers | |
| SOCIAL ANXIETY DISORDER EPIDEMIOLOGY ● Lifetime prevalence: | 3-13 percent% | |
| SOCIAL ANXIETY DISORDER EPIDEMIOLOGY ● 6-month prevalence: | 2-3 per 100 persons | |
| SOCIAL ANXIETY DISORDER EPIDEMIOLOGY ● Comorbid conditions: | other anxiety disorders, mood disorders, substance-related disorders, and bulimia nervosa | |
| SOCIAL ANXIETY DISORDER EPIDEMIOLOGY | ● W>M ● Peak age of onset is in the teens, ● Onset is also common as young as 5 years of age and as old as 35 years. | |
| SOCIAL ANXIETY DISORDER ETIOLOGY | ● Consistent pattern of behavioral inhibition ● Parents of persons with social anxiety disorder were less caring, more rejecting, and more overprotective of their children than were other parents. | |
| SOCIAL ANXIETY DISORDER NEUROCHEMICAL FACTORS | ● NE ● Dopamine ● Certain medications that would involve the noradrenergic pathway and also the dopaminergic pathway, then it would lead to a beneficial effect or a reduction in the anxiety of those with social anxiety disorder. | |
| SOCIAL ANXIETY DISORDER GENETIC FACTORS | ● First-degree relatives of persons with social anxiety disorder are about 3x more likely to be affected with social anxiety disorder. ● Monozygotic twins are more often concordant than are dizygotic twins. | |
| SOCIAL ANXIETY DISORDER DIFFERENTIAL DIAGNOSIS | ● Agoraphobia, panic disorder, avoidant personality disorder, major depressive disorder, and schizoid personality disorder | |
| SOCIAL ANXIETY DISORDER COURSE AND PROGNOSIS | ● Onset in late childhood or early adolescence ● Typically chronic although patients whose symptoms do remit tend to stay well. | |
| SOCIAL ANXIETY DISORDER TREATMENT ● Pharmacotherapy | ○ SSRIs ○ Benzodiazepines ○ Venlafaxine ○ Buspirone ○ MAOIs ○ Schizoaffective disorder | |
| SOCIAL ANXIETY DISORDER TREATMENT ● Performance situations: | -adrenergic receptor antagonists shortly before exposure to a phobic stimulus - atenolol or propranolol; short-or intermediate-acting benzodiazepine - as lorazepam or alprazolam | |
| SOCIAL ANXIETY DISORDER TREATMENT ● Non-pharmacological treatment | ○ Cognitive, behavioral, and exposure techniques ○ Behavioral and cognitive methods, including~ cognitive retraining, desensitization, rehearsiouring sessions, assignments. | |
| GENERALIZED ANXIETY DISORDER 1 Code: 300.02 (F41.1) | ● Excessive anxiety and worry about several events or activities for most days during at least a 6-month period | ● The worry is difficult to control and is associated with somatic symptoms, such as muscle tension, irritability, difficulty sleeping, and restlessness. |
| GENERALIZED ANXIETY DISORDER 2 | ● Not focused on features of another disorder, not caused by substance use or a general medical condition, and does not occur only during a mood or psychiatric disorder. | ● Subjectively distressing, and produces impairment in important areas of a person's life. |
| GENERALIZED ANXIETY DISORDER EPIDEMIOLOGY ● 1-year prevalence: | 3-8 percent% | |
| GENERALIZED ANXIETY DISORDER EPIDEMIOLOGY | ● W:M = 2:1 ● Onset in late adolescence or early adulthood | |
| GENERALIZED ANXIETY DISORDER EPIDEMIOLOGY ● Comorbid conditions: | social phobia, specific phobia, panic disorder, a depressive disorder, substance-related disorder | |
| GENERALIZED ANXIETY DISORDER ETIOLOGY | ● Cause is not known ● Lower metabolic rate in basal ganglia and white matter in patients with GAD than in normal control subjects. ● About 25 percent of first-degree relatives of patients with generalized anxiety disorder are also affected. | ● Some twin studies report a concordance rate of 50% in monozygotic twins and 15% in dizygotic twins. ● Sleep EEG studies have reported increased sleep discontinuity, decreased delta sleep, decreased stage 1 sleep, and reduced rapid eye movement sleep. |
| GENERALIZED ANXIETY DISORDER ETIOLOGY ● Biological Factors | ○ Aminobutyric acid and serotonin neurotransmitter systems ○ Occipital lobe ○ Basal ganglia, limbic system, and frontal cortex ○ Norepinephrine, glutamate, and cholecystokinin systems. | |
| Occipital lobe | - highest concentrations of benzodiazepine receptors in the brain | |
| GENERALIZED ANXIETY DISORDER PSYCHOSOCIAL FACTORS ● Cognitive- behavioral school | ○ According to the cognitive-behavioral school, patients with generalized anxiety disorder respond to incorrectly and inaccurately to perceived dangers. | |
| GENERALIZED ANXIETY DISORDER PSYCHOSOCIAL FACTORS ● Psychoanalytic school | ○ Anxiety is a symptom of unresolved, unconscious conflicts. | |
| GENERALIZED ANXIETY DISORDER DIFFERENTIAL DIAGNOSIS | ● Neurological, endocrinological, medication-related disorders metabolic, ● Panic disorder, phobias, OCD, and PTSD and ● Patients with generalized anxiety disorder frequently develop major depressive disorder. | |
| GENERALIZED ANXIETY DISORDER COURSE AND PROGNOSIS | ● Only 1/3 of patients who have generalized anxiety disorder seek psychiatric treatment. ● Because of the high incidence of comorbid mental disorders in patients with GAD, the clinical course and prognosis of the disorder are difficult to predict. | ● The occurrence of several negative life events greatly increases the likelihood that the disorder will develop. ● It is a chronic condition that may be lifelong. |
| GENERALIZED ANXIETY DISORDER TREATMENT | ● Combination of psychotherapeutic, pharmacotherapeutic, and supportive approaches ● Benzodiazepines ● Buspirone ● Venlafaxine | |
| GENERALIZED ANXIETY DISORDER TREATMENT ● Psychotherapy | ○ Cognitive-behavioral, insight oriented | |
| GENERALIZED ANXIETY DISORDER TREATMENT ● Psychodynamic therapy | ○ To increase the patient's anxiety tolerance (a capacity to experience anxiety without having to discharge it), rather than to eliminate anxiety ○ Involves a search for the patient's underlying fears | |
| SSRIs | mainstream of treatment for GAD | |
| ANXIETY DISORDER DUE TO ANOTHER MEDICAL CONDITION | Code: 293.84 (F06.4) | |
| SCREENING TOOL - HAMILTON ANXIETY RATING SCALE (HAM-A) ● <17 | mild severity | |
| SCREENING TOOL - HAMILTON ANXIETY RATING SCALE (HAM-A) ● 18-24 | mild to moderate severity | |
| SCREENING TOOL - HAMILTON ANXIETY RATING SCALE (HAM-A) ● 25-30 | moderate to severe | |
| SCREENING TOOL - GAD-7 ANXIETY ● 0-4 | minimal anxiety | |
| SCREENING TOOL - GAD-7 ANXIETY ● 5-9 | mild anxiety | |
| SCREENING TOOL - GAD-7 ANXIETY ● 10-14 | moderate anxiety | |
| SCREENING TOOL - GAD-7 ANXIETY ● 15-21 | severe anxiety |
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