wamss notes anxiety disorders Flashcards
panic attack criteria
Abrupt surge of intense fear or discomfort that reaches peak within minutes with 4 or more of the following Sx:
- Palpitations, pounding heart, ↑ HR
- Sweating
- Trembling, shaking
- Sensation of SOB
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Dizzy, unsteady, lightheaded, faint
- Chills or heat sensations
- Paraesthesia
- Derealisation or depersonalisation
- Fear of losing control or going crazy
- Fear of dying
generalised anxiety disorder
Excessive worry & feelings of apprehension about everyday events with Sx of muscle & psychic tension causing significant clinical distress/impairment
epidemiology of generalised anxiety disorder
3%
classification of generalised anxiety disorder
Excessive & Anxiety and Worry occurring more days than not for at least 6 months about a
number of events or activities
Pt finds it difficult to control the worry
Associated with 3 or more of the following:
- Worry
- Anxiety
- Tension in Muscles
- Concentration difficulty or mind going blank
- Hyperarousal (irritability)
- Energy loss
- Restlessness
- Sleep Disturbances
pathophysiology of generalised anxiety disorder
Hyper-responsive amygdala to anxiety ques
Multiple NTs: NA, Serotonin, Dopamine, GABA
risk factors of generalised anxiety disorder
- Trauma or stress (parental death, war, family dysfunction)
- Childhood stress
- Excessive caffeine use or stimulant use
- Prolonged benzodiazepine use can worsen
screening for generalised anxiety disorder
In the last 4 weeks…
About how often did you feel nervous?
About how often did you feel so nervous that nothing could calm you down?
How often did you feel restless of fidgety?
How often did you feel so restless you could sit still?
DDx of generalised anxiety disorder
- Other anxiety disorders or mental disorders
- Substance use
- Arrhythmias
- Hyperthyroidism
- Asthma
- Pheochromocytoma
treatment of generalised anxiety disorder
Symptomatic Management
- B-blockers (atenolol)
First Line:
- SSRI
- SNRI venlafaxine & duloxetine
Second Line:
- TCA
- Buspirone
Third Line:
- Long term benzodiazepines
non-pharmacological management of generalised anxiety disorder
CBT, relaxation techniques, contingency planning, cognitive methods, psychotherapy
short term management of generalised anxiety disorder
Benzodiazepines – diazepam
Tx for up to 2 weeks followed by gradual reduction in dose to 0 within 6 weeks - Lorazepam
doses of generalised anxiety medication
prognosis of generalised anxiety disorder
Full recovery poor
Remission rates low -30% 3yrs
70% residual Sx 6yr
social anxiety disorder
Marked fear or anxiety about social situations in which the pt is being exposed to possible scrutiny by others, >
6months
Pt fears they will act in a way or show anxiety Sx that will be negatively evaluated
Social situations almost always provoke fear or anxiety
Social situations are avoided
specific phobia
Marked fear or anxiety about a specific object or situation
Almost always provokes fear or anxiety
Is actively avoided
More than 6/12
Causes significant clinical distress or impairment in functioning
panic disorder
Recurrent unexplained Panic Attacks in which the onset is not associated with a situational trigger
Classification the same a Panic Attack
separation anxiety disorder
Developmentally inappropriate fear or anxiety concerning separation from those to whom the individual is
attached
selective mutism
Constant failure to speak in situations where there is an expectation for speaking despite speaking in other
situations (school)
Not attributed to a lack of knowledge or comfort with the language
agoraphobia
Fear or anxiety about 2 or more of:
- Using public transport
- Being in open spaces
- Being in closed places
- Standing in line or being in a crowd
- Being outside the home alone
Pt fears or avoids these situations due because escape may be difficult in the event of developing panic like Sx
Fear & anxiety is out of proportion to the actual danger
anxiety disorders due to another medical condition
- Pheochromocytoma
- Diabetes
- Temporal lobe epilepsy
- Hyperthyroidism
- Carcinoid
- Alcohol Withdrawal
- Arrhythmias
