Anxiety And Related Disorders

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Anxiety disorder

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-anxiety disorder is characterized by inappropriate experience of fear/worry and its physical manifestations (anxiety), when the source of the fear/worry is either not real, or insufficient to account for severity of the symptoms

-symptoms interfere with daily functioning

-lifetime prevalence of 30% in women and 20% in men

-includes panic disorder, phobias, and generalized anxiety disorder

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Panic disorder

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-panic disorder is defined by presence of recurrent panic attacks (periods of intense fear and discomfort peaking in 10 minutes with at least four of the following:

--Palpitations, Paresthesias
--Abdominal distress
--Nausea
--Intese fear of dying or sling control
--LIght-headedness
--Chest pain, Chills, Choking, dis-Connectedness
--Sweating, Shaking, Shortness of breath

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Diagnosis of panic disorder

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-diagnosis requires attack followed by one month or more of 1 (or more) of the following:

--persistent concern of additional attacks
--worrying about consequences of the attack
--or behavioral change related to attacks

-symptoms of panic disorder are the systemic manifestations of fear

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Specific phobia

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-specific phobia is fear that is excessive or unreasonable, and interferes with normal function

-cued by presence or anticipation of specific object or situation

-person with phobia recognizes that fear is excessive

-phobia can be treated with systematic desensitization

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Social anxiety disorder

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-phobia

-exaggerated fear of embarrassment in social situations (e.g., public speaking, using public restrooms).

-treat social anxiety disorder with SSRIs

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Agoraphobia

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-agoraphobia is exaggerated fear of open or enclosed places; using public transportation; being in line or in crowds; or leaving home alone

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Generalized anxiety disorder (GAD)

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-pattern of uncontrollable anxiety for AT LEAST SIX MONTHS that is unrelated to a specific person, situation, or event

-GAD is associated with sleep disturbance, fatigue, GI disturbance, and difficulty concentrating

-treatment for GAD is SSRIs, SNRIs, buspirone, cognitive behavioral therapy

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Adjustment disorder

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-sub-class of generalized anxiety disorder

-characterized by emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (divorce, illness) and lasting LESS THAN 6 MONTHS.

-over six months duration seen in presence of chronic stressor

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Obsessive-compulsive disorder

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-recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress

-distress relieved in part by performance of repetitive actions (compulsions)

-ego dystonic: behavior inconsistent with one's own beliefs and attitudes (vs. obsessive-compulsive personality disorder)

-OCD associated with Tourette disorder

-treatment of OCD: SSRIs, clomipramine

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Body dysmorphic disorder

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-body dysmorphic disorder is preoccupation with a minor or imagined defect in appearance

-leads to significant emotional distress or impaired functioning

-patients with body dysmorphic disorder often repeatedly seek cosmetic surgery

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Post-traumatic stress disorder

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-PTSD is persistent re-experiencing of a previous traumatic event (war, rape, robbery, serious accident, fire)

-may involve nightmares or flashbacks, intense fear, helplessness, or horror

-PTSD leads to avoidance of stimuli associated with the trauma, and persistently increased arousal

-disturbance lasts MORE THAN ONE MONTH, with onset of symptoms beginning anytime after event

--causes significant distress, negative cognitive alterations, and/or impaired functioning

-treatment for PTSD: psychotherapy, SSRIs

vs. acute stress disorder, which lasts between 3 days and 1 month

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Malingering

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-patinet consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary (external) gain – e.g., avoiding work, obtaining compensation

-poor compliance with treatment or follow-up diagnostic tests

-complaints cease after gain (vs. factitious disorder)

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Factitious disorders

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-patient CONSCIOUSLY creates physical and/or psychologic symptoms in order to assume "sick role," and to get medial attention (primary/internal gain)

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Munchausen syndrome

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-type of factitious disorder

-in Munchausen, there is CHRONIC factitious disorder with predominantly physical signs and symptoms

-characterized by a history of multiple hospital admissions and willingness to receive invasive procedures

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Munchausen syndrome by proxy

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-when illness in a child or elderly patient is caused by caregiver

--form of child/elder abuse

-motivation is to assume a sick role by proxy

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Somatic symptom and related disorders

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-somatic symptom and related disorders are a category characterized by physical symptoms with no identifiable physical cause

-both illness production and motivation are UNCONSCIOUS drives

-symptoms not intentionally produced or feigned

-more common in women

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Somatic symptom disorder

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-variety of complaints in one or more organ systems lasting for moths to years

-associated with excessive persistent thoughts and anxiety about symptoms

-somatic symptom disorder may co-occur with medical illness

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Conversion disorder

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-conversion disorder is sudden loss of sensory or motor function (paralysis, blindness, mutism), often following an acute stressor

-patient is aware of, but sometimes indifferent to, symptoms

-more common in females, adolescents and young adults

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Illness anxiety disorder (hypochondriasis)

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-hypochondriasis is preoccupation with and fear of having a serious illness despite medical evaluation and reassurance to the contrary.