Anxiety Disorders Flashcards
Types of disorders
Panic disorder Agoraphobia Specific phobia Social anxiety disorder or social phobia Generalised anxiety disorder Anxiety disorder due to another medical condition Substance/medication nudged anxiety disorder Separation anxiety disorder Selective mutism
DSM5 for Separation anxiety disorder
A - Developmentally inappropriate and excessive fear or anxiety concerning separation from attached person with at least 3 of the following
- Recurrent excessive distress with anticipating or experiencing from home or major attachment figure
- Persistent and excessive worry about losing, harm,illness, disaster or death to attachment figure
- Persistent and excessive worry about experiencing an untoward event eg lost or kidnapped or ill that separated them from figure
- Persistent reluctance or refusal to go out or away from home eg school because of fear of separation
- persistent and excessive fear of or reluctance about being alon or without major attachment figures at home or elsewhere
- Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a mj attachment figure.
- Repeated nightmares of theme of separation
- Repeated complaints of physical symptoms when separation occures or anticipated
B - persistent for 4 wk in child, 6m in adolescent or adult
C- Significant distress or impairment
D - not autism, psychotic disorder of agoraphobia or generalised anxiety disorder or illness anxiety disorder
DSM5 for selective mutism
A - Failure to speak in specific social situation where it is expected despite speaking fine in other settings
B - Disturbance interferes with educational or occupational achievement or social communication
C - at least 1 month and not just the first month of school
D - Not due to lack of knowledge or comfort or language
E - not communication disorder eg childhood onset fluency disorder. Not autism, schizophrenia, or other psychotic disorder
DSM 5 for Specific phobia
A - Marked fear or anxiety about a specific object or situation eg flying
B - situation or object alway provokes immediate fear or anxiety
C - actively avoids or endured with intense fear or anxiety
D - Fear or anxiety is out of proportion to the actual danger posed
E - at least 6 months
F - significant distress or impairment
G - Not panic symptoms like agoraphobia, OCD, PTSD, Separation anxiety , social anxiety disorder
DSM5 Social anxiety disorder
A - marked fear or anxiety about 1 or more social situations in which the individual is exposed to possible scrutiny by other
B - Fear of acting in a way or show anxiety symptoms that in embarrass or reject them
C - Social situations always provoke fear or anxiety
D - avoids or endured with intense fear or anxiety
E - Out of proportion to acutal threat posed
F - at. Least 6 m
G - significant distress or impairment
H - not due to drugs or medical condition
I - Not panic disorders, body dysmorphic disorder or autism
J - if medical condition eg parkinson’s, obesity, disfigurement from burns or injury, is present then fear, anxiety etc is clearly unrelated or is excessive.
DSM 5 of panic disorder
A - recurrent unexpected panic attacks. Abrupt surges of intense fear or discomfort the reaches a peak within minutes, during which time 4 of the following symptoms occur
1- Palpitations, accelerated heart rate
2 - sweating
3 - Trembling or shaking
4 - sensation of SOB or smothering
5 - Feelings of choking
6 - chest pain or discomfort
7 - Nauseas or abdominal distress
8 - feeling dizzy, unsteady, light headed, or faint
9 - Chills or heat sensation
10 - paresthesias - numbness or tingling
11- Derealization or depersonalization
12 - fear of losing control or going crazy
13 - fear of dying
B - at least 1 attack is following by 1month of one or both of:
1 - Persistent concern or worry about additional panic attacks or their consequences eg losing control, having a heart attack, going crazy)
2 - Maladaptive changes in behaviour to avoid paniic attacks
C - not drugs, or medical condition eg hypothyroidism, cardiooplumonary disorder
D - not social anxiety, phobic, OCD, PTSD, separation anxiety disorder
DSM5 Agoraphobia
A - fear or anxiety in 2 of 5 situation
1- public transportation
2- Being in open spaces
3 - Being enclosed places
4 - standing in line or crowd
5 - being outside of the home alone
B - fear or avoid situation as thought of escape might be difficult or help might not be available. If they have panic symptoms, incapacitating of embarrassng symptoms eg incontinence
C- agoraphobic situations almost always provoke fear or anxiety
D - Actively avoids the situation or endures with intense fear
E - out of proportion to actual danger posed
F - at least 6 m
G - significant distress
H - is medication condition present eg IBD, Parkinson’s then fear/anxiety/avoidance is excessive
I - Not specific phobia, social anxiety disorder, OCD, Body dysmorphic disorder, PTSD, Separation anxiety disorder.
Generalised anxiety disorder DSM 5
A - Excessive anxiety and worry occur more days than not for 6 m about a number of events or activities.
B - individual finds it difficult to control worry.
C - associated with at least 3 of the following
1- restlessness or feeling keyed up or on edge
2 - being easily fatigued
3 - difficulty concentrating or mind going blank
4 - irritability
5 - Muscle tension
6 - sleep disturbance
D - signifcnat distress
E - not due to drugs or medical condition eg hyperthyroidism
F - Not panic disorder, social phobia, OCD, Separation anxiety, PTSD, anorexia nervosa, somatic symptom disorder, body dysmorphic disorder, illness anxiety disorder, schizophrenia or delusion disorder.
Substances that can cause anxiety
Alcohol Caffeine Cannabis Phencyclidine Other hallucinogen Inhalant Opioid Sedative, hypnotic, or anxiolytic Amphatamine Cocaine
Management of anxiety disorder
Dx what type it is
Address stresses eg financial or relationship difficulties, or lifestyle factors eg alcohol, caffeine, drugs, excessive work or lack of sleep.
Reassurance that physical they are well
Mild to moderate - Psychological interventions - eTherapy, CBT,
Severe - Pharmacological - SSRIs,
Benzodiazepines not recommended
Mx of generalised anxiety disorder
Exclude organic factors eg hyperthyroidism, caffeine intoxication, stimulant use, alcohol/drug discontinuation syndrome or AE of medication. Adjustment disorder. In older patient depression or dementia.
Psychological - psychoeducation on anxiety and relaxation techniques and coping skills. Stress management approaches eg scheduling,. Modifying lifestyle factors, Problem focused counselling. CBT
Severe - Pharmacotherapy as an add on to psychological factors. SSRIs (citalopram or escitalopram) or SNRIs (venlafaxine 75mg PO OD). Others Tricylics, Buspirone
Crisis - Benzodiazepine - Diazepam 2-5 mg PO. Limited to 2 wks with gradual reduction over the following 6 wks.
Mx of Panic attacks
Exclude: MI, stroke, Hyperthyroidism, respiratory conditions eg asthma,
Isolated panic attack = psychological intervention
Explanation, support and stress mx advice
Attack mx - breathing slowly and deeply or rebreathing - reduce acute symptoms
Panic disorder
1 - psychological intervention - CBT - panic control tx, exposure to deliberately induced symptoms, together with techniques for controlling symptoms and reattribution of symptoms to benign causes eg palpitation are not due to cardiac arrest.
2 - Pharmacological - SSRIs (eg fluoxetine), venlafaxine, tricyclic. May need 6-12 m. Start low and increase to avoid initial increase in anxiety symptoms. Or short term benzodiazepine to bridge initial periods. May need higher doses of antidepressant then for depression.
3 - Psychiatrist referral if ongoing
CBT for anxiety
Thought change record skill Pt keeps a diary of though with the follow heading Situation Negative thoughts Degree of Belief Alternative thoughts Degree of belief in Original Thought
