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Anxiety Disorders (incomplete) (Panic Disorder (Episodic paroxysmal…
Anxiety Disorders (incomplete)
Panic Disorder (
Episodic paroxysmal anxiety
)
- F41.0
Characteristic Features
Recurrent attacks of severe anxiety which are not restricted to any particular situation or set of circumstances and are therefore unpredictable
Panic Attacks -
discrete episode of unexpected, sudden, intense anxiety
Should be a period free from anxiety between attacks
In reality, anticipatory anxiety is common
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
Insufficient evidence for a self-reporting screening instrument
Management
Psychological treatment
CBT
Weekly sessions of 1-2 hours within a max 4 months
Also the option of intensive CBT or briefer CBT with self-help material to supplement
NICE Pathway
Drug Treatment
Antidepressants
SSRIs
If no improvement after 12 weeks consider imipramine or climpramine
TCAs
Side effects
Transient increase in anxiety at start of treatment
Delay in onset of effect
Consider age, previous response to treatment, likelihood of OD (deliberate or accidental)
Self-help
Bibliotherapy
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
Support groups
Exercise
Review & offer referral from primary care if appropriate
Care in specialist mental health services
Thorough holistic reassessment of the individual, environment & social circumstances
Provide additional support
If with 2 interventions, symptoms are still present
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.
Patients can end up housebound - most incapacitating phobic disorder
a) psychological/autonomic symptoms of anxiety
Aetiology
Biological
Genetic
Sociological
Environment
Generalised Anxiety Disorder
- F41.1
Guidelines
ICD-10
F40 = Phobic anxiety disorders
A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous.
F41 = Other anxiety disorders
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
Post-Traumatic Stress Disorder
"Complex somatic, cognitive, affective & behavioural effects of psychological trauma"
Diagnosis
Symptoms
Re-experiencing the event
ICD 10: F43.1
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
PTSD sufferers show several grossly altered neuroendocrine & neuroanatomical findings
Upregulated
Downregulated
Psychological factors
Other co-morbid psychiatric problems
Lower intelligence/lack of education
Sociological
Lack of social support
Obsessive-compulsive disorder
ICD-10
Obsessions
Should be the patient's own thoughts
Persistent thoughts, images, doubts or impulses
UNPLEASANT
EGODYSTONIC
Body dysmorphic disorder
Social Anxiety Disorder
