Mkgrady8 Neuro 5 Anxiety Disorders

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what are the 10 anxiety disorders

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separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, substance/medication induced anxiety disorder, anxiety disorder due to another med condition, and other specifed anxiety disorder and unspecified anxiety disorders

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separation anxiety disorder

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REMEMBER THIS IN THE CONTEXT OF ADULTS; excessive anxiety regarding separation from places or people to whom the pt has a strong emotional attachment; 12 month prevalence in childhood is 4% and in adults is 1-2%; onset of the disorder in childhood usually does not progress into adulthood and the attachment is usually to a parent; the majority of adults have the onset of their symptoms in adulthood with the attachment to a spouse or friend; the symptoms must be present for at least 4 weeks in children but 6 months or more in adults; 3 types of distress or worry may occur and include distress when anticipating or experiencing separation from home or other major figures; excessive worry about an event that causes separation; reluctance to go out from home because of fear of separation; fear of being alone or without attachment figures; reluctance to sleep away from home; repeated nightmares with the theme of separation; complaints of physical symptoms when separated; the symptoms cause clinically significant distress or impairment in areas of function; not better accounted for by another mental disorder

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separation anxiety disorder treatment

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meds in combo with individual psychotherapy and potentially family therapy; SSRIs, benzodiazepines; cognitive behavioral therapy, social skills training, graded exposure and relaxation training

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selective mutism

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persistent failure to speak in specific social situations; uncommon but usually in younger children; do not initiate speech or respond reciprocally in social situations; not diagnosed unless it goes on longer than 1 month; this is not related to poor familiarity with the language; only diagnosed when a child has an established capacity to speak in some social situations; specific criteria include= failure to speak in specific social situations in which it is expected, duration of one month not limited to the first month of school, not attributable to lack of knowledge or comfort with the language, not better explained by a communication disorder or during the course of autism spectrum disorder, schizophrenia, or other psychosisse

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selective mutism treatment

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difficult; use SSRIs; behavioral techniques; parental counseling

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specific phobias and social anxiety disorder

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phobias are irrational fears of specific objects, places, or situations, or activities; social anxiety disorder or "social phobia" is the fear of humiliation or embarrassment in social situations; specific phobias include isolated phobias such as the intense and irrational fear of snakes

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criteria for a specific phobia

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marked fear or anxiety about a specific object or situation i.e. flying, heights, animals, seeing blood mixed; the phobic object or situation almost always provokes immediate fear or anxiety; the phobic object is actively avoided or endured with intense fear or anxiety; the fear or anxiety is out of proportion to the actual danger; fear or avoidance is persistent typically lasting 6 months or more; fear, anxiety, and avoidance causes functional impairment; symptoms are not better accounted for by other diagnoses

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criteria for a social phobia

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marked fear or anxiety about one or more social situations in which exposure to possible scrutiny of others; fear that one will act in a way or show anxiety that will be negatively evaluated; social situations almost always provoke fear or anxiety; the social situations are avoided or endured with intense fear or anxiety; the fear or anxiety is out of proportion to the actual danger; fear or avoidance is persistent typically lasting 6 months or more; fear, anxiety, and avoidance causes functional impairment; symptoms are not better accounted for by other diagnoses

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social phobia: differential diagnosis

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must rule out other anxiety disorders; must differentiate irrational fears from delusions and the psychotic pt; people with avoidant personality disorder feel insecure about social relationships and fear being hurt by others; schizoid personality disorders have little interest in social relationships

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social phobia: medications

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fluoxetine, paroxetine, sertaline, and long acting venlafaxine; other SSRIs, MAOIs, and benxodiazepines are probably effective for social anxiety; tricyclic antidepressants are probably less effective; meds are generally ineffective for the treatment of specific phobias; benzodiazepines may provide temporary relief but have risk of abuse and dependence

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social phobia: psychological treatments

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behavioral therapy can be very effective (exposure therapy); cognitive behavioral therapy can be used to correct dysfunctional thoughts about fear

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panic disorder

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recurrent unexpected panic attacks; accompanied by at least one month of persistent concern about having another attack, worry about the implications of having an attack or maladaptive change in behavior related to the attacks; at least 4 of 13 characteristic symptoms must occur; the attacks are not related to substance or medical condition or better accounted for by another mental disorder

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criteria for a panic attack

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panic attacks are not a mental disorder; can occur in the context of any anxiety disorder or other mental disorder and some medical conditions; an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and which 4 or more of the following sx occur= palpitations, sweating, trembling or shaking, shortness of breath or smothering, feelings of chocking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy unsteady lightheaded or faint, chills or heat sensations, paresthesias such as numbness or tingling, derealization or depersonalization, fear of losing control or going crazy, fear of dying

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criteria for panic disorder

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recurrent unexpected panic attacks; at least one attack has been followed by one month or more of either persistent concern or worry of another attack or a maladaptive change in behavior to avoid having an attack; the symptoms are not attributable to substances or medical conditions; sx are not better explained by another mental disorder

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panic disorder: differential diagnosis

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hyperthyroidism, pheochromocytoma, hypoglycemia, supraventricular tachycardia, major depressive disorder, schizophrenia, depersonalization disorder, somatization disorder, borderline personality disorder, etc.

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panic disorder: clinical management

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usually a combo of meds and individual psychotherapy; SSRIs are the DOC and are effective in 70-80% of pts; typically start low and go slow; the FDA has approved fluoxetine, paroxetine, sertraline, and long acting venlafaxine for the treatment of panic disorder; SSRIs/SNRIs have superseded tricyclic antidepressants and monoamine oxidase inhibitors due to side effects; benzos can be helpful in the short term but have the risk of dependence and tolerance; positive factors for response to treatment include milder anxiety, later age of onset, fewer panic attacks, and a relatively normal personality; should encourage to limit stimulants including caffeine; cognitive behavioral therapy is a benefit

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agoraphobia

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a condition in which an individual fears being unable to get out of a place of situation quickly in the event of a panic attack; as a consequence of the pts fear they avoid places or situations in which they believe that this may occur; it is often but not always a complication of panic disorder; it is nearly as common as panic disorder with women more likely than men to suffer from it; the true fear is being separated from a source of security; as is common in anxiety states, avoidance of places or situations that the pt believes exacerbate their symptoms is typical; often being accompanied and reassured by a significant other is quite helpful

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criteria for agoraphobia

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fear or anxiety about 2 or more of the following= using public transport, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, being outside of the home alone; avoidance of these situations for fear that escape might be difficult or that help may not be available; the situation almost always provokes fear or anxiety; situations are actively avoided, require a companion, or endured with intense fear or anxiety; the fear or anxiety is out of proportion to the actual danger; the fear, anxiety, or avoidance is persistent for at least 6 months; the symptoms cause clinically significant distress and impairment of functioning; not related to another medical condition; not better explained by the symptoms of another mental disorder

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generalized anxiety disorder

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pts worry excessively about life circumstances as the central feature; the pt will often have symptoms of restlessness or being keyed up, easily fatigued, difficulty concentrating, irritability, muscle tension, or poor sleep; symptoms are present more days than not and cause distress and impairment

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criteria for generalized anxiety disorder

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excessive anxiety and worry more days than not for at least 6 months; the individual finds it hard to control the worry; the anxiety and worry are associated with 3 or more of the following symptoms most days over 6 months= restlessness or feeling keyed up, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance; the symptoms cause significant distress or impairment in functioning; symptoms not attributable to the effects of a substance or another med condition; not better explained by another mental disorder

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generalized anxiety disorder: differential diagnosis

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rule out substance inducing including= caffeine intoxication, stimulant abuse, alcohol, benzo, and sedative hypnotic withdrawal

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generalized anxiety disorder: clinical management

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meds= SSRIs paroxetine and escitalopram, SNRIs venlafaxine and duloxetine; off label use of benzos (rapidly effective but have the risk of tolerance and dependence); sedating TCAs but side effects; pt education about the chronic nature of the disorder and the tendency of symptoms to wax and wane with stressors; behavior therapy including relaxation training, re breathing exercises and meds may be effective if sx are mild

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obsessive compulsive spectrum disorders

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included body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation (skin picking) disorder

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criteria for OCD

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the presence of obsessions, compulsions, or both; they are time consuming (more than 1 hr a day) and cause distress or impairment in functioning; obsessions= recurrent and persistent thoughts, urges, or images that are experienced at some time during the disturbance as intrusive and unwanted and in most individuals cause marked anxiety or distress; compulsions= repetitive behaviors that individuals feel driven to perform in response to an obsession or according to rules applied rigidly

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OCD: clinical management

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typically involves meds and behavioral therapy (exposure with response prevention); SSRIs are particularly effective and the FDA has approved fluoxetine, fluvoxamine, paroxetine, and sertaline; typically higher doses and more lengthy trials are required for response

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PTSD

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occurs to those exposed to actual or threatened death, serious physical injury or sexual violence; the event is typically outside of the range of normal human experience; age, history of psychiatric illness, level of social support, and proximity to the stress are all major factors; the major elements of PTSD include= reexperiencing the trauma through dreams or recurrent and intrusive thoughts, persistent avoidance of stimuli associated with the event, negative alteration in mood i.e. emotional numbing and detachment from others, alterations in arousal and reactivity such as anger and exaggerated startle

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PTSD: treatment

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SSRIs paroxetine and sertraline; short term benzos; cognitive behavioral therapy, group therapy, family therapy