Anxiety Flashcards
Sequence of events
Open question- tell me more Timeline- how long? How did it start? Have things gotten worse? Describe it for me Ideas Effect on life
Systems review
Autonomic- dry mouth, sweating, tremor, nausea, heart beating fast, pain
Panic attack- overcome by sudden feeling of panic that appears to hit you out of the blue? What happens exactly? How long does it last?
Specific phobia vs generalised anxiety- particular time place or situation where it’s worse or can it come on at any time? Do you feel on edge all the time? Would you consider yourself a worrier?
Social events- new people, do you need a drink beforehand etc.
OCD- repetitive intrusive thoughts you cannot resist, if so, what happens if you get these thoughts? Any rituals or routines you are compelled to follow? If so, what happens when you don’t follow them?
Depression with secondary anxiety- ever low in mood/ could you be depressed?
Hyperthyroidism- changes in weight, periods, eyes etc.
Psychosis- auditory hallucinations/ visual hallucinations/ altered sensations/ delusions of thought and control
Mania- energy levels/ have people said you are hyper/ spending habits/ libido
Depression- mood/anhedonia/ sleep/ future
Others- memory loss/ anxiety/ insight/ relationship with food
Risk
Consider a mini summary
Then tentatively discuss self harm, harm towards others
Previous self harm or suicide attempts?
Risk from others ?
Patients perspective
Concerns
Expectations
Insight
Anxiety red flags
Chest pain (rule out ACS)
Dual diagnosis eg. Depression
Thoughts of self harm or suicide
Severe symptoms affecting function
PMH
Psychiatric conditions, physical, cardiac conditions
Pre morbid personality
Have you always been a worrier
DH
Allergies
Regulars/ OTC
FH
Anything in the family
anybody had a similar problem
SH
Job- what does it involve. Impact on job
Home situation- occupants and difficulties
How is mood affecting home life
Support from family or friends
Smoke alcohol recreational drugs
Have you been looking after yourself and the home eg. showering and cleaning
Important points
Could be a presentation of palpitations (assess whether it’s anxiety or cardiac in origin)
“I can see you’re upset, it must have been difficult to come here today”
General symptoms of an anxiety disorder
Autonomic- palpitations, sweating, tremor, dry mouth
Chest/abdo- breathing difficulty, choking, chest pain, nausea, abdominal distress (churning)
Dizzy or fearful
General- hot flush, cold chill, numbness, restlessness, ye se or irritable
NB- will likely either be GAD, panic attack disorder, specific phobia, OCD or depression and anxiety
GAD
Tense and worried by everyday situations
Symptoms present for at least 6 months
Can’t be due to an organic cause
Paroxetine 20mg PO once (or venlafaxine, citalopram, duloexetine)
Panic attack disorder
Unpredictable recurrent attacks of severe anxiety
Sudden onset and lasts a few minutes
Not associated with marked exertion or exposure to a dangerous situation
Sertraline
Phobic anxiety disorders
Anxiety triggered by particular situations leading to significant emotional distress
Subsequent avoidance of the situations
Includes panic attacks that can occur in established phobic situations (not necessarily a stand alone disorder)
Agoraphobia- leaving home, public places, crowds, travelling alone
Social phobia- scrutiny of others, social situations
Specific phobias- restricted to specific situations eg. Flying
Sertraline (under social anxiety disorder)
Acute stress reaction
Develops quickly after an unexpected life crisis
Symptoms settle within hours to days
