Anxiety Disorders: Lecture Notes PDF

Anxiety disorder : Inappropriate experience of fear/worry and its physical manifestations (anxiety) incongruent with the magnitude of the perceived stressor. ▪ Symptoms interfere with daily functioning. ▪ Includes panic disorder, phobias, generalized anxiety disorder, and selective mutism. Gener...

Anxiety disorder : Inappropriate experience of fear/worry and its physical manifestations (anxiety) incongruent with the magnitude of the perceived stressor. ▪ Symptoms interfere with daily functioning. ▪ Includes panic disorder, phobias, generalized anxiety disorder, and selective mutism. Generalized anxiety disorder ▪ Anxiety lasting ≥ 6 months unrelated to a specific person, situation, or event resulting in functional impairment. ▪ Associated with 3 or more of the following symptoms: - Restlessness. - Fatigue. - Poor concentration. - Irritability. - Muscle tension. - Impaired sleep. ▪ In GAD, the anxiety is chronic, excessive, difficult to control, and causes significant distress or impairment. ▪ Treatment: - Treatment of GAD includes cognitive behavioral psychotherapy, medication, or a combination of both. - First-line medications for GAD include selective serotonin reuptake inhibitors (SSRIs) such as escitaiopram or serotonin-norepinephrine reuptake inhibitors (SNRIs). - Buspirone, TCAs, benzodiazepines are second line. Post-traumatic stress disorder Exposure to prior trauma (witnessing death, experiencing serious injury or rape) → persistent Hyperarousal, Avoidance of associated stimuli, intrusive Reexperiencing of the event (nightmares, flashbacks), changes in cognition or mood (fear, horror, Distress) ▪ Having PTSD is HARD. ▪ Disturbance lasts ≥ 1 month with significant distress or impaired social-occupational functioning. ▪ Returning combat veterans and survivors of sexual assault are at high risk for developing posttraumatic stress disorder. ▪ Treatment: - Trauma-focused cognitive-behavioral therapy and selective serotonin reuptake inhibitors/serotoninnorepinephrine reuptake inhibitors are first-line treatments for post-traumatic stress disorder. Somatic symptom and related disorders Category of disorders characterized by physical symptoms causing significant distress and impairment. ▪ Both illness production and motivation are unconscious driven. Symptoms not intentionally produced or feigned. ▪ More common in women. ▪ It is best treated with cognitive-behavioral therapy. Somatic symptom disorder: - ≥ 1 somatic symptoms (pain, fatigue) causing distress and functional impairment for ≥ 6 months duration. - It involves excessive preoccupation and overestimation of the seriousness of ≥ 1 somatic complaints and is associated with high levels of medical care utilization. - Associated with excessive, persistent thoughts and anxiety about symptoms. - Initial management of somatic symptom disorder consists of regularly scheduled visits with the same physician to develop the physician-patient relationship and minimize unnecessary medical testing, interventions, and subspecialty referrals. - Because symptoms often worsen during periods of stress, patients should be asked about their current emotional stressors and counseled regarding stress reduction. Obsessive-compulsive disorder Obsessive-compulsive disorder (OCD) is a condition characterized by time-consuming, recurrent, unwanted thoughts (obsessions) and repetitive behaviors that the patient feels compelled to perform (compulsions). ▪ Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieved in part by the performance of repetitive actions (compulsions). ▪ Ego-dystonic: behavior inconsistent with one’s own beliefs and attitudes (vs obsessive-compulsive personality disorder). ▪ Associated with Tourette syndrome. ▪ Treatment: - CBT, SSRIs, and clomipramine are first line. - Exposure and response prevention-based psychotherapy and selective serotonin reuptake inhibitors are first-line treatments for obsessive-compulsive disorder. - Exposure and response prevention involve repeated exposure to thoughts, images, and situations that provoke obsessional fears followed by prevention of the accompanying compulsion.