Examination: Anxiety Disorder Pathophysiology and Psychosocial Functional
Impairment Assessment, Generalized Anxiety Disorder Diagnostic Criteria and
Chronic Worry Evaluation, Panic Disorder Recurrent Attack Recognition and
Behavioral Avoidance Patterns, Agoraphobia Environmental Fear Response
Identification, Post-Traumatic Stress Disorder Intrusion Avoidance and
Hyperarousal Symptom Clusters, Obsessive-Compulsive Disorder Obsessions
and Compulsions Behavioral Analysis, Anxiety Risk Factors and Sympathetic
Nervous System Differential Diagnosis, Evidence-Based Anxiety
Pharmacotherapy Including SSRI SNRI and Benzodiazepine Management,
Buspirone and Anticonvulsant Adjunctive Treatment Strategies Exam Questions
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Anxiety
Unpleasant state of physical and psychological arousal that interferes with effective psychosocial
functioning
Experience of dread, foreboding, or panic
Apprehension, fear, irritability, intolerance, frustration, and overreaction
Behaviors such as avoidance, distractability, restlessness
Apathy, compulsions, rigidity, overreactions, preoccupation
Repetitive actions: nail biting, hair pulling
Affects approximately 40 million Americans
Females > Males
20-45 year old age group
Anxiety risk factors
Organic syndromes
Use of of withdrawal from meds and/or substances
Family history
,Social stress Psychiatric disorders
Anxiety: subjective
Complaints of apprehension,
restlessness
Insomnia
Somatic complaints: fatigue, dry mouth, sweating, diarrhea, hyperventilation, vomiting, parasthesias
Anxiety differentials/diagnostics
Differentials:
Any medical condition that involves stimulation of the sympathetic nervous system: MI, meds, anemia,
PE, endocrine, hyperthyroidism
Diagnostics:
TSH, CBC, UA, UDS, EKG
Generalized anxiety disorder
Excessive worry for > 6 months about multiple concerns that are difficult to control
Diagnosis requires evidence of disrupted or impaired occupational or social functioning
More disruptive than normal anxiety
60% have other comorbid psychiatric condition (depression)
Anxiety is excessive and interferes with other aspects of the patient's life
Primary difference is that symptoms must interfere with the patient's life: shakiness, restlessness,
headaches, excessive sweating, GI complaints, cardiac complaints, irritability
Panic disorder
, Typically presents in younger adults and can be disabling
Can impair social, family and working lives of those affected
Recurrent, short, intense episodes of panic-level psychological and physical symptoms of anxiety
Initial episode must be spontaneous and unexpected
Fear compels the patient to seek emergency healthcare due to feeling symptoms are life threatening
and signal a serious health problem
Based on a pattern of recurrent and unexpected panic attacks
One attack must be followed by 1 month or more of persistent worry and/or maladaptive changes in
behavior
Likely to make significant changes in their behavior and routines in the hope of avoiding future panic
episodes
agoraphobia
30%-50% also have panic disorder
Marked fear about 2 or more of the following:
Using public transportation
Being in open spaces
Being in enclosed spaces
Standing in line or in a crowd
Being outside of the home alone
PTSD
Syndrome that develops after a person witnesses, participates in ,or hears of an extreme traumatic
stressor
Reaction is fear and helplessness, reliving the event over and over, trying to avoid being reminded of it
Symptoms must be severe enough to last more than 1 month after the event and must significantly
effect critical areas of the person's life such as relationships and work