Anxiety Disorders Flashcards
Tool to use to diagnose for anxiety?
AMPSS tool
Anxiety Mood Psychosis Substance use Suicide
Tool used for diagnosing depression
DSQ-2/9
Anxiety definition
Diffuse, unpleasant, vague sense of apprehension. Often accompanied by autonomic symptoms such as a headache, perspiration, palpitations, restlessness, tightness in the chest and GI distress.
Fear vs anxiety
Fear = response to a known external definite threat
Anxiety = response to an unknown internal and vague threat
Panic attack strict definition
Abrupt onset of intense fear or discomfort that peaks within minutes.
Includes at least 4 of the following symptoms
- palpitations
- sweating
- short of breath
- chest pain
- dizziness/lightheadedness
- feeling faint
- paresthesia
- fear of losing control
- trembling/shaking
- sensation of choking
- nausea/ab discomfort
- chills or flushing
- overwhelmslming sense of fear/dying/dread
need this one almost every time
Algophobia
Fear of pain
Trypanophobia
Fear of needles/injections
Agoraphobia
Fear of facing/anticipating at least 2 specific situations usually dealing with open,public spaces. Must last at least 6 months
- feel “stuck or unable to escape”
- often leads to someone staying in their home (this is not diagnostic though)
Epidemiology of anxiety
25% of patients with comorbidity are to have anxiety
Women have anxiety more than men
- however both sexes get treated on average the same amount
- women are more likely to remain quiet
42 billion dollars a year are spent on health care costs and lost of productivity associated with anxiety
50% of patients who are “recovered” often experience recurrence and failure to go into remission.
Glossophobia
Fear of public speaking
Ophidiophobia
Fear of snakes
What is the timeline required for almost all anxiety disorders?
> 6 months
Social anxiety disorder
Social phobia/pathological shyness
Exaggerated fear of embarrassment in social situations for at least 6 months
includes:
- public speaking
- public/social performances
- fear of basically any social situations
Onset is usually in teenage years but can present at any age
Treatment methods:
- CBT and SSRIs
- Venlafaxine is 2nd line
- use BBs and Benzos (small doses) as needed if the disorder is performance-based
often presents with panic attacks as well
any symptoms they have are out of proportion to the actual threat
if not treated, often leads to MDD
Nosocomephobia
Fear of hospitals
Coulrophobia
Fear of clowns
Iatrophobia
Fear of doctors
3 components of pain
Psychological
Neuroleptic
Visceral and somatic
What is the screening tool sensitive to GAD diagnosis?
GAD-7
Panic disorder epidemiology
Women are 3x more likely than men to be affected
Onset is typically young adulthood (25 is mean)
Divorce or Seperation with partner increases odds of this (only social factor known to be linked)
Is often also seen in conjunction with comorbid diagnosis and other mental health disorders
Initial panic attack is usually idiopathic
DSM-5 criteria of panic disorder
Recurrent unexpected panic attacks followed by at least 1 month of one or both of the following:
- persistent concern about having additional panic attacks or consequences of having panic attacks
- maladaptive change in behavior in response to the panic attacks
How is GAD different from panic disorder?
There is NO spontaneous panic attacks in GAD
DSM-5 criteria for GAD
Greater than 6 months of excessive worrying about various aspects of daily life on a near daily basis. Associated with at least 3 of the following (in children need at least 1) - restlessness - irritability - sleep disturbances - fatigue - muscle tension - difficulty concentrating
Medical conditions associated with anxiety-like symptoms
Cardiovascular: CAD/CHF/PE/MVP/HTN emergencies
Pulmonary: pneumonia/asthma/COPD
Endocrine: thyroid dysfunction, hyperparathyroidism, hypoglycemia, menopause, cushings disease, pheochromocytoma
Hematologic: anemia
Neurologic: seizures, encephalopathies
Substance abuse disorders
Treatment of anxiety disorders
Nonpharmacologic first:
- build relationship with patient
- address other conditions
- CBT
Pharmacological second:
- SSRIs
- venlafaxine
- benzos and BBs (performance anxiety only)
Goal of maintenance therapy
- 6 months - 1 year of treatment