What is the DDx for panic disorder (what must be ruled out)?
Thyroid disease, hypoglycemia, and cardiac disease must be ruled out.
What is the treatment of panic disorder? What about a single panic attack?
SSRIs are first-line for panic disorder. Pts may also benefit from benzodiazepines along with SSRIs; begin with both then taper off the benzo.
Benzodiazepines are first-line for a single panic attack.
What is a phobia? What are the two types?
- Phobia: the fear of an object or situation and the need to avoid it.
- Specific phobia: fear of a specific thing or object, such as animals, heights, or cars.
- Social phobia: fear of a situation, such as public restrooms, eating in public, or public speaking; these involve situations where something potentially embarrassing may happen.
What is the treatment of phobias?
- Behavioral modification techniques such as systematic desensitization expose individuals to their feared objects, moving from the least anxiety-provoking to the anxiety-provoking.
- Pts are also taught relaxation techniques such as breathing or guided imagery.
What are the features of social anxiety?
Fear of embarrassment in social situations; these pts have problems going out in fear that others will laugh at them.
How is performance anxiety treated?
Beta-blockers such as atenolol or propranolol are given 30-60 minutes before the performance.
What are the features of OCD?
Pts typically experience either obsessions alone or, most commonly, a combination of obsessions and compulsions typically affect the individual’s level of functioning.
What are obsessions? What are compulsions?
Obsessions: Thoughts that are intrusive, senseless, and distressing to the pt, thus creating anxiety; these include fear of contamination.
Compulsions: Rituals, such as counting and checking, that are done to neutralize thoughts; these are time-consuming and tend to lower anxiety.
What is the typical demographic of pts with OCD? What other disorder may coexist with OCD?
OCD is more frequently seen in young pts. There is an equal incidence in men and women. OCD can coexist its Tourette disorder.
What is the treatment of OCD?
- SSRIs are the DOC
- The main behavioral therapy used is exposure and response prevention
What is the diagnostic criteria for / features of panic disorder?
Intense anxiety along with feelings of dread and doom, accompanied by at least 4 Sx of autonomic hyperactivity, such as diaphoresis, trembling, chest pain, fear of dying, chills, palpitations, SOB, nausea, dizziness, dissociative symptoms, and paresthesias. These sensations typically last less than 30 minutes and may be accompanied by agoraphobia, defined as the fear of places where escape may be difficult.
Panic disorder is typically seen in women, can occur any time, and usually has no specific stressor.
What are the similarities between PTSD and acute stress disorder?
In both, individuals have been exposed to a stressor to which they react with fear and helplessness. Pts continually relive the event and avoid anything that reminds them of the event. These stressors are usually overwhelming and adversely affect the pts’ level of functioning.
Additional symptoms include increased startle response, hypervigilance, sleep disturbances, anger outbursts, and concentration difficulties.
How are PTSD and acute stress disorder different?
PTSD - symptoms last longer than 1 month
Acute stress disorder - symptoms last more than 2 days and a maximum of 1 month; they occur within 1 month of the traumatic event
How are PTSD and acute stress disorder diagnosed? What is important to rule out?
The main feature in diagnosing or differentiating between the two is the time period when the traumatic events occurred in relationship to the symptoms.
Depression and substance abuse must be ruled out since both worsen the symptoms.
What is the treatment for PTSD and acute stress disorder?
- Paroxetine or sertraline are used first-line.
- Prazosin is used for nightmares.
- Relaxation techniques and hypnosis have been proven helpful.
- Psychotherapy after traumatic events will allow for the development of coping techniques and acceptance of the event.
What is the presentation of generalized anxiety disorder (GAD)?
Excessive anxiety and worry about most things, lasting more than 6 months. Typically, the anxiety is out of proportion with the situation. This is accompanied by fatigue, difficulty concentrating, sleep problems, muscle tension, and restlessness.
Pts are usually women and complain of feeling anxious as long as they can remember.
What is the treatment of GAD?
- SSRIs are first-line
- Venlafaxine and buspirone are also effective
- Psychotherapy and behavioral therapy are beneficial as adjuncts
