Anxiety Disorders (incomplete)

Panic Disorder (Episodic paroxysmal anxiety) - F41.0

Generalised Anxiety Disorder - F41.1

Guidelines

ICD-10

F40 = Phobic anxiety disorders

F41 = Other anxiety disorders

A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous.

Characteristic Features

Recurrent attacks of severe anxiety which are not restricted to any particular situation or set of circumstances and are therefore unpredictable

Symptoms

  • Sudden onset of palpitations
  • Chest pain
  • Choking sensations
  • Dizziness
  • Feelings of unreality
  • Secondary fear of dying, losing control or going mad

Diagnosis

Should not be given if the patient has a depressive disorder at the time the attacks start

Rule out physical conditions

e.g. Hyperthyroidism

Post-Traumatic Stress Disorder

Obsessive-compulsive disorder

Body dysmorphic disorder

Social Anxiety Disorder

Disorders in which manifestation of anxiety is the major symptom and is not restricted to any particular environmental situation. Depressive and obsessional symptoms, and even some elements of phobic anxiety, may also be present, provided that they are clearly secondary or less severe

Suspect an anxiety disorder in:

  • Past history
  • Somatic symptoms of an anxiety disorder
  • Recent experience of a traumatic event
  • People who avoid social situations

Management

  1. Psychological treatment
  1. Drug Treatment
  1. Self-help

CBT

NICE Pathway

Insufficient evidence for a self-reporting screening instrument

Weekly sessions of 1-2 hours within a max 4 months

Antidepressants

SSRIs

TCAs

If no improvement after 12 weeks consider imipramine or climpramine

Bibliotherapy

Support groups

Exercise

  1. Review & offer referral from primary care if appropriate
  1. Care in specialist mental health services

Thorough holistic reassessment of the individual, environment & social circumstances

Panic Disorder with Agoraphobia

Refers to a cluster of phobias which result in avoidance of exposed situations for fear of panic or inability to escape.

Panic Attacks - discrete episode of unexpected, sudden, intense anxiety

Patients can end up housebound - most incapacitating phobic disorder

a) psychological/autonomic symptoms of anxiety

Aetiology

Biological

Genetic

Sociological

Environment

Also the option of intensive CBT or briefer CBT with self-help material to supplement

Consider age, previous response to treatment, likelihood of OD (deliberate or accidental)

Side effects

  • Transient increase in anxiety at start of treatment
  • Delay in onset of effect

Expressive therapy that involves the reading of specific texts with the purpose of healing. Patients relate to the content of written texts and gain insight by seeing their issues at a new angle, leading to behavioural change

Provide additional support

If with 2 interventions, symptoms are still present

Should be a period free from anxiety between attacks

In reality, anticipatory anxiety is common

"Complex somatic, cognitive, affective & behavioural effects of psychological trauma"

Diagnosis

Epidemiology

Aetiology

Any traumatic event has the potential to cause PTSD

  • Sexual relationship violence

Biological

  • Family history
  • Genetics
  • Female sex (may be source of trauma)
  • Belonging to a racial minority

Psychological factors

  • Other co-morbid psychiatric problems
  • Lower intelligence/lack of education

Sociological

  • Lack of social support

PTSD sufferers show several grossly altered neuroendocrine & neuroanatomical findings

Upregulated

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Downregulated

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Symptoms

  1. Re-experiencing the event

ICD 10: F43.1

ICD-10

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Obsessions

Should be the patient's own thoughts

Persistent thoughts, images, doubts or impulses

UNPLEASANT

EGODYSTONIC