CMN 552 Module 2 Study Guide (2026/2027) (PDF) | Primary Care Nursing | University of South Alabama

CMN 552
Module 2
Primary Study Guide
University of South Alabama

, CMN 552
Module 2 Primary Study Guide

Sadock, Chapter 14 Anxiety Disorders P. 1720 PDF 1810
Sec6on 14.1 Anxiety Disorders:
Introduc6on and Overview P. 1720 PDF 1810

DSM-5 ModificaCons in Anxiety Disorders P. 1721 PDF 1811

The major subtypes of anxiety disorders in the DSM-5 include panic disorder (with
or without agoraphobia), agoraphobia (without a history of panic disorder),
specific phobia, social phobia, and generalized anxiety disorder (GAD). Revisions
to the classifica6on of anxiety disorders in the DSM-5 involve removing obsessive-
compulsive disorder and posVrauma6c disorder have been subsumed under
newly created “obsessive-compulsive and related disorders” and “trauma- and
stressor-related disorders” categories, respec6vely. Therefore, both obsessive–
compulsive disorder and posVrauma6c stress disorder are not considered in this
chapter. Other modifica6ons to the proposed DSM-5 anxiety disorders category
include the addi6on of separa6on anxiety disorder (contained under Disorders
Usually First Diagnosed in Infancy, Childhood, or Adolescence in the DSM-IV), the
iden6fica6on of agoraphobia as a dis6nct and codable disorder (diagnosed only
with reference to panic disorder in the DSM-IV), minor revisions to criterion
language to enhance clarity, objec6vity, and consistency across the anxiety
disorders, and the relabeling of social phobia as social anxiety disorder (SAD). As
such, the term “social phobia” will now be replaced with “social
anxiety disorder.”

Sec6on 14.2 Clinical Features of the
Anxiety Disorders

Agoraphobia: Epidemiology P. 1725 PDF 1815

Similar to Panic Disorder, more women than men have agoraphobia and the age of
onset peaks in the late teens to early twen6es. Agoraphobia in the absence of
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,Panic Disorder is considered to be rarer than agoraphobia with comorbid Panic
Disorder. However, there is some variability in the prevalence data. The measured
prevalence of agoraphobia in specific clinical se^ngs may evolve as the DSM-5’s
recogni6on of agoraphobia without Panic Disorder will spur clinicians to screen
and consider the disorder more frequently, even in pa6ents who do not present
with panic aVacks. Other anxiety disorders are seen alongside agoraphobia in
comorbidity rates that oaen exceed 50 percent. Comorbid depressive disorders
are seen in 33 to 52 percent of cases, with some sugges6on that the presence of
comorbid panic aVacks increases the risk of comorbid depressive episodes.

Social Anxiety Disorder: DifferenCal Diagnosis, ECology, Course, Treatment P.
1725 PDF 1815

As men6oned above, Avoidant Personality Disorder (described in more detail
elsewhere in this book) has been the subject of debate over whether it is dis6nct
from Social Anxiety Disorder, with the DSM-5 separa6ng the two. Social Anxiety
Disorder has a high comorbidity with other anxiety and affec6ve disorders, as
well. The use of illicit anxioly6cs and seda6ves leads to the rela6vely high rate of
comorbid substance use disorders. The comorbidity between Social Anxiety
Disorder and Selec6ve Mu6sm is discussed elsewhere in this chapter. Social
Anxiety Disorder is a common comorbidity in children with an Au6sm Spectrum
diagnosis and also appears at rates above popula6on baseline in pa6ents with
Schizophrenia.

Risk factors for Social Anxiety Disorder include female gender, family history, and
childhood signs of behavioral inhibi6on. There is insufficient data on specific
gene6c factors media6ng the increased familial risk, but paren6ng styles may also
contribute to this familiality. The Mini-Social Phobia Inventory (Mini-SPIN) is an
appropriate screening tool for adults.

One could see how agoraphobia could be confused with Social Anxiety Disorder or
PTSD, though the context-dependent fears in the same situa6on would be
different. For example, a pa6ent with Social Anxiety Disorder might dislike a
crowded party because they feel that everybody is looking at them and judging
them. A pa6ent with agoraphobia might avoid the same crowded party out of
concern that, were they to develop anxiety, it would be difficult to sprint for the
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, exit. A pa6ent with PTSD might find that their desire for hypervigilance is
overwhelmed by the mul6ple s6muli in a crowded room.

There is a markedly increased rate of suicide aVempt amongst pa6ents with Social
Anxiety Disorder. This, along with the significant func6onal impairment associated
with this disorder, should mo6vate clinicians to pursue aggressive treatment for
these pa6ents. CBT has demonstrated efficacy for Social Anxiety Disorder. The
first-line pharmacologic treatments are serotonergic agents, but other, PRN
medica6ons, especially for the performance subtype (beta blockers), have been
used effec6vely. Social Anxiety Disorder is a chronic condi6on, with a high rate of
symptom re-emergence aaer symptom remission is achieved via selec6ve
serotonin reuptake inhibitors (SSRIs), for example. However, durable remission,
even aaer cessa6on of CBT and/or an6depressants, has been seen in a small
propor6on of pa6ents.

Generalized Anxiety Disorder: Epidemiology P. 1727 PDF 1817

GAD has a life6me prevalence rate of 5 percent, oaen begins in the late teens, and
is more common in women as men. The high life6me psychiatric comorbidity has
led some to view GAD as a prodromal or residual phase of a major depression,
though there is insufficient empirical support for this view. Other common
comorbidi6es include other anxiety spectrum disorders and substance use
disorders.

SeparaCon Anxiety Disorder: History/ComparaCve Nosology P. 1729 PDF 1819

The epidemiologic evidence documen6ng a high rate of onset occurring aaer 18
years old has led to a removal of the age-of-onset restric6on in the DSM-5. The
inclusion of the adult-onset formula6on has moved Separa6on Anxiety Disorder
from DSM-IV’s “Disorders Usually First Diagnosed in Infancy, Childhood or
Adolescence” to DSM-5’s “Anxiety Disorders.” As noted with Selec6ve Mu6sm, the
prominent symptom of worry 6es Separa6on Anxiety Disorder to the other,
classical diagnoses in the Anxiety Disorders sec6on.




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