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Anxiety Disorders Summary Notes

The document provides an overview of anxiety disorders, including panic disorder, generalized anxiety disorder, and social anxiety disorder, detailing their symptoms, diagnostic criteria, and treatment approaches. It emphasizes the importance of pharmacotherapy, particularly SSRIs and SNRIs, along with psychoeducation and follow-up care. Additionally, it outlines the neurobiology of anxiety disorders and the distinction between fear and anxiety.

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aborlan medicare
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17 views5 pages

Anxiety Disorders Summary Notes

The document provides an overview of anxiety disorders, including panic disorder, generalized anxiety disorder, and social anxiety disorder, detailing their symptoms, diagnostic criteria, and treatment approaches. It emphasizes the importance of pharmacotherapy, particularly SSRIs and SNRIs, along with psychoeducation and follow-up care. Additionally, it outlines the neurobiology of anxiety disorders and the distinction between fear and anxiety.

Uploaded by

aborlan medicare
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ANXIETY DISORDERS

Stenely O. Manuel, MD, MPA, MHA


Aborlan Medicare Hospital

1. PANIC DISORDER
2. AGORAPHOBIA
3. GENERALIZED ANXIETY DISORDER
4. SOCIAL ANXIETY DISORDER
5. SPECIFIC PHOBIAS

DSM 5 TR/ICD 10 Basic Features


SYMPTOM CRITERIA
DURATION OF ILLNESS
IMPAIRMENT IN FUNCTIONING
EXCLUSION CRITERIA

FEAR VS. ANXIETY


FEAR- A response to threats here and now
ANXIETY- is future-focused fear
PANIC ATTACK- an abrupt surge of intense fear or intense discomfort that reaches a
peak within minutes, during which time, four or more of the following symptoms
occur:

F41.0 PANIC DISORDER


• Acute Attack of anxiety accompanied by feelings of impending doom
• All diagnoses under anxiety disorders may have episode/s of panic attacks

SYMPTOM CRITERIA (4 or more)


• Recurrent unexpected panic attacks
• Palpitations
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feelings of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, light-headed, or faint
• Chills or heat sensations
• Paresthesias (numbness or tingling sensations)
• Derealization (feelings of unreality) or depersonalization (being detached from
oneself)
• Fear of losing control or “going crazy”
• Fear of dying

EXCLUSION CRITERIA
• Not due to a medical condition
• Not due to effects of substance or medications
• Not better explained by another mental disorder

1
IMPAIRMENT IN FUNCTIONING
• Clinically significant distress or impairment in social, occupational or other
important areas of functioning
DURATION OF ILLNESS
• At least one of the attacks has been followed by 1 month (or more) of one or
both of the following
1. Persistent concern or worry about additional panic attacks or their
consequence
2. A significant maladaptive change in behavior related to the attacks

F41.1 GENERALIZED ANXIETY DISORDER (GAD)

EXCLUSION CRITERIA
• Not due to a medical condition
• Not due to effects of substance or medications
• Not better explained by another mental disorder

SYMPTOM CRITERIA
• Excessive anxiety and worry ( apprehensive expectation) about a number of
events or activities
• The individual finds it difficult to control the worry and to keep worrisome
thoughts from interfering with attention to tasks at hand
• Interfere significantly with psychosocial functioning
• Associated with three (3) or more of the following six (6) Symptoms
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance

NEUROBIOLOGY OF ANXIETY DISORDERS

FEAR PANIC
PHOBIA Amygdala-centered circuit

ANXIETY

ANXIOUS MISERY
WORRY APPREHENSIVE Cortico-striato thalamo-cortical
EXPECTATION circuit (CSTC)
OBSESSIONS

2
F40.1 SOCIAL ANXIETY DISORDER

▪ Essential feature: marked or intense fear or anxiety of social situations in which


the individual may be scrutinized by others
▪ In children, the fear or anxiety must occur in peer settings and not just during
interactions with adults
▪ When exposed to social situations, the individual fears that he or she will be
negatively evaluated. The individual is concerned that he or she will be judged
as anxious, weak, crazy, stupid, boring, intimidating, dirty or unlikable

STARTING PHARMACOTHERAPY FOR ANXIETY DISORDERS


▪ Rule out other comorbid medical conditions
▪ Start low and go slow
o Start SSRIs and SNRIs at lower doses in order to avoid side effects such
as temporary increase in anxiety
o May combine Benzos with SSRIs and SNRIs for the first 4-6 weeks
then taper the Benzo after by 25% per week
▪ Psychoeducate on efficacy of the medications and side effects

PSYCHOEDUCATION
- Explain and reassure that when panic attacks occur, they are time limited and
not life- threatening
- Teach slow abdominal breathing during panic attacks to avoid hyperventilation
syndrome
DURATION OF TREATMENT
- In general, there is good evidence for the benefit of maintenance treatment for
anxiety disorders for at least up to 6 months
- Antidepressant treatment for GAD should be continued for at least 12 months
FOLLOW-UP
- Onset of beneficial effects- 4-6 weeks after starting treatment
- Treatment should be reviewed after 4-6 weeks of pharmacotherapy
- Monitor initially weekly for adherence, adverse effects, worsening of symptoms/
response to treatment

PSYCHOPHARMACOLOGY OF ANXIETY DISORDERS


CLASSES AND GENERALIZED PANIC DISORDER SOCIAL ANXIETY
AGENTS ANXIETY DISORDER
DISORDER

SSRIs First Line First Line First Line

SNRIs First Line First Line First Line

TCAs Second Line Second Line NR

MIRTAZAPINE Second Line Second Line Second Line

BENZODIAZEPINES Second Line Second Line Second Line

3
QUETIAPINE Second Line No evidence NR

SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIs)

SSRI DOSAGE CHARACTERISTICS


RANGE
(per day)
▪ Greater risk of insomnia/agitation
FLUOXETINE 10-60 mg ▪ No withdrawal symptoms if not tapered
▪ Takes weeks to reach steady blood
levels due to long half-life

▪ Greater risk of insomnia/agitation


SERTRALINE 50-200 mg ▪ More frequent diarrhea and other GI
complaints

▪ Mildly sedating and weakly


PAROXETINE 20-50 mg anticholinergic
▪ Lower risk of insomnia/agitation
▪ Withdrawal symptoms if not tapered

▪ Lower risk of insomnia/agitation


ESCITALOPRAM 10-20 mg ▪ Few drug interactions

SEROTONIN-NOREPINEPHRINE REUPAKE INHIBITORS (SNRIs)

SNRI DOSAGE CHARACTERISTICS


RANGE
(per day)
▪ Greater risk of insomnia/agitation
DULOXETINE 60-120mg ▪ Useful for treatment of comorbid painful
conditions
▪ Withdrawal symptoms if not tapered

4
VENLAFAXINE 75-225 mg ▪ Greater risk of insomnia/agitation
▪ Increased blood pressure (diastolic) and
heart rate with increasing doses
▪ Useful for treatment of comorbid painful
conditions
▪ Few drug interactions
▪ Withdrawal symptoms if not tapered

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