Anxiety disorders Flashcards
DSM criteria for panic disorder
A. recurrent unexpected panic attacks - a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur
- palpitations, pounding heart, or accelerated heart rate
- sweating
- trembling or shaking
- sensations of shortness of breath or smothering
- feelings of choking
- chest pain or discomfort
- nausea or abdominal distress
- feeling dizzy, unsteady, light-headed, or faint
- chills or heat sensations
- paresthesias (numbness or tingling sensations)
- derealization (feelings of unreality) or depersonalization (being detached from oneself)
- fear of losing control or “going crazy”
- fear of dying
B. 1 mo (or more) of “anxiety about panic attacks” - at least one of the attacks has been followed by one or both of the following:
- persistent concern or worry about additional panic attacks or their consequences
- a significant maladaptive change in behaviour related to the attacks
C. the disturbance is not attributable to the physiological e ects of a substance or another medical condition
D. the disturbance is not better explained by another mental disorder
STUDENTS FEAR the 3 Cs
- Sweating
- Trembling
- Unsteadiness, dizziness
- Depersonalization, Derealization
- Excessive heart rate, palpitations
- Nausea
- Tingling
- Shortness of breath
- Fear of dying, losing control, going crazy
- 3 Cs: Chest pain, Chills, Choking
What is the difference between panic attacks and panic disorder?
Panic disorder consists of panic attacks + other criteria
Panic attack is not a codable disorder and can occur in the context of many different disorders
DSM criteria for agoraphobia
A. marked fear or anxiety about two (or more) of the following 5 situations:
- using public transportation
- being in open spaces
- being in enclosed place
- standing in line or being in a crowd
- being outside of the home alone
B. the individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms
C. the agoraphobic situations almost always provoke fear or anxiety
D. the agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety
E. the fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context
F. the fear, anxiety, or avoidance is persistent, typically lasting ≥6mo
G. the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
H. if another medical condition is present, the fear, anxiety, or avoidance is clearly excessive
I. the fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder and are not related exclusively to obsessions, perceived defects or flaws in physical appearance, reminders of traumatic events, or fear of separation
DSM criteria for GAD
A. excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 mo, about a number of events or activities (such as work or school performance)
B. the individual finds it difficult to control the worry
C. the anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 mo)
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance (di culty falling or staying asleep, or restless, unsatisfying sleep)
D. the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
E. the disturbance is not attributable to the physiological effects of a substance or another medical condition
F. the disturbance is not better explained by another mental disorder
C-FIRST
- Concentration issues
- Fatigue
- Irritability
- Restlessness
- Sleep disturbance
- Tension (muscle)
Treatment of GAD
• lifestyle:
- caffeine and EtOH avoidance, sleep hygiene
- psychological: CBT including relaxation techniques, mindfulness
• biological
- SSRIs and SNRIs are 1st line (paroxetine, escitalopram, sertraline, venlafaxine XL)
- 2nd line: buspirone (tid dosing), bupropion (caution due to stimulating e ects),
- add-on benzodiazepines (short-term, low dose, regular schedule, long half-life, avoid prn usage)
- β-blockers not recommended
Diagnostic criteria for phobic disorders
- exposure to stimulus almost invariably provokes an immediate anxiety response; may present as a panic attack
- person recognises fear as excessive or unreasonable
- situations are avoided or endured with anxiety/distress
- significant interference with daily routine, occupational/social functioning and/or marked distress
What is social phobia (social anxiety disorder)?
- definition: marked and persisten (>6mo) fear of social performance situations in which one is exposed to unfamiliar people or to possible scrutiny by others; feating they will act in a way that will be humilating or embarrassing (eg. public speaking, dating, eating in public)
Treatment of phobic disorders?
Treatment
psychological
- cognitive behaviour therapy (focusing on both in vivo and virtual exposure therapy, gradually facing feared situations)
- behavioural therapy is more effecacious than medication
biological
- SSRIs/SNRIs (e.g. uoxetine, paroxetine, sertraline, venlafaxine), MAOIs
- β-blockers or benzodiazepines in acute situations (e.g. public speaking)
DSM criteria for OCD
A. presence of obsessions, compulsions, or both
- obsessions are defined by (1) and (2)
- recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and cause marked anxiety or distress in most individuals
- the individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e. by performing a compulsion; see below)
- compulsions are defined by (1) and (2)
- repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
- behaviours/mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive
B. the obsessions or compulsions are time consuming (e.g. take >1 h/d) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C. the obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition
D. the disturbance is not better explained by the symptoms of another mental disorder
Treatment of OCD
Treatment
- CBT: exposure with response prevention (ERP)
- pharmacotherapy - SSRIs, SNRIs, clomipramine (2nd line), adjunctive antipsychotics (risperidone)
Differentials for GAD
Depression: Anxiety symptoms are common in depression and co-morbid
depression is often seen with GAD. The type of symptom that appears first and is
more severe is conventionally considered to be primary.
• Panic disorder: There is a discrete episode of intense fear with sudden onset and a
subjective need to escape.
• Other anxiety disorders: They have the same core symptoms as in GAD but the
symptoms occur in specific situations as in phobic anxiety disorder, OCD or PTSD.
• Substance misuse: Symptoms of alcohol or drug withdrawal may mimic those of
anxiety.
• Physical illness: A host of medical conditions can mimic GAD – endocrine disorders
such as hyperthyroidism or phaeochromocytoma; neurological disorders such as
migraine; deficiency states such as anaemia or vitamin B12 deficiency; cardiac
conditions such as arrythmias and mitral valve prolapse, and metabolic conditions
such as hypoglycaemia and porphyria.
DSM criteria for social anxiety disorder (social phobia)
A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., hav- ing a conversation, meeting unfamiliar people), being observed (e.g., eating or drink- ing), and performing in front of others (e.g., giving a speech).
B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).
C. The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.
D. The social situations are avoided or endured with intense fear or anxiety.
E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
I. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
