Anxiety Disorders

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Author:
jknell
ID:
196521
Filename:
Anxiety Disorders
Updated:
2013-01-30 00:53:09
Tags:
MBB II
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MBB II
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  1. Fear vs Anxiety
    Fear: apprehension about what is known, usually rational

    Anxiety: apprehension about unknown, irrational or excessive

    Anxiety can be normal or clinical
  2. Physical Diseases that can present with anxiety
    • -hyperthyroid
    • -hypoglycemia
    • -Cushings
    • -Anemia
    • -electrolyte imbalance
    • -Mitral Valve Prolapse
    • -cardiac arrhythmias
  3. Drugs that can present with anxiety
    • Withdrawal from CNS depressants
    • -alcohol
    • -sedative hypnotics
    • -antianxiety drugs

    • CNS stimulant intoxication:
    • -Amphetamines
    • -Cocaine
    • -Methylphenidate
    • -Weight reducers
  4. Anxiety Disorders
    1. Adjustment disorder with anxious features (normal after a stress)

    2. Acute stress disorder

    3. Generalized anxiety disorder

    4. Agoraphobia

    5. Panic Disorder (+/- agoraphobia)

    6. Phobic Disorders (specific phobias, social phobias)

    7. PTSD

    8. OCD
  5. Natural History for anxiety disorders
    • -lifetime prevalence 3%
    • -1-2% annually with sx
    • -women > men
    • -onset by 30 years

    -may fluctuate in severity but rarely disappear

    -not a prodrome

    -secondary depression is common
  6. Anxiety Disorder: Diagnosis
    excessive anxiety and worry for more days than not for at least 6 months w/ 3+ of the following:

    • -restlessness
    • -increased fatigue
    • -decreased concentration
    • -irritability
    • -muscle tension
    • -sleep distrubance
  7. Agoraphobia
    -anxiety about being in places or situations from which escape might be difficult or embarassing (outside home, crowd, line etc)

    -avoids these situations
  8. Panic Disorder
    • Recurrent unexpectant panic attacks followed by 1+ month of:
    • -concern of another attack
    • -worry about consequences
    • -behaviour changes
  9. Panic Attack
    • Discrete period of intense fear or discomfort
    • -develop abruptly and peak within 10 minutes
    • -comes on with a stressor
    • with 4+ of the following:

    • -palpitations
    • -sweating
    • -trembling
    • -SOB
    • -chest pain
    • -nausea
    • -dizzy
    • -numbness or tingling
    • -chills or hot flushes
  10. Social Phobia
    -marked and persistent fear of scrutiny

    -exposure to feared social situation provokes anxiety

    -recognize that fear is unreasonable

    • 1. Generalized (3% of pop)
    • 2. Public Speaking (10% of pop)
  11. Post Traumatic Stress Disorder (PTSD)
    -exposed to traumatic event (threatened death or serious injury)

    -Reexperience: thoughts, dreams, recurring, cues

    -Avoid Stimuli

    -Persistent sx of increased arousal

    -duration > 1 month
  12. Obsessive Compulsive Disorder
    • Obsessions:
    • -persistent thoughts, impulses
    • -have insight
    • -attempt to ignore but can't
    • -cause anxiety

    • Compulsions:
    • -repetitive behaviours pt feels they need to perform in response to an obsession
    • -rituals to reduce anxiety
  13. Treatment of Anxiety Disorders
    • 1. rule out secondary causes
    • 2. diganose major anxiety disorder
    • 3. CBT
    • 4. Relaxation, meditation, exercise
    • 5. Behaviour therapies
    •      -Desensitization (phobia)
    •      -Forced immersion (phobia)
    •      -Thought-stopping (OCD)
  14. Pharmacotherpy
    • 1. Antidepressants
    •       -SSRIs (may increase anxiety in the first wks)
    •      -response in 2-3 weeks
    •      -decrease panic and anxiety
    •      -sx reappear when drug is stopped

    2. beta blockers

    3. Benzos (not usually good)

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