DISORDERSDURATION/ONSETSYMPTOMS/MANIFESTATIONSTREATMENT

PANIC DISORDER

SPECIFIC PHOBIAS

AGORAPHOBIA

SOCIAL ANX. DISORDERPHOBIAS

OBSESSIVE COMPULSIVE DISORDER(OCD)

DISORDERS DURATI ON/ONSET SYMPTOMS/MAN I F ESTATI ONS TR EATM ENT Anxiety D. Panic Disorder >1 month ABRUPT onset: recurrent periods of intense fear discomfort peaking in 10 minutes with: P alpitations, P aresthesias. A bdominal distress. N ausea. I ntense fear of dying, Llghth headedness. C hills, C hoking, disconnectedness, C hest pain. 5 ...veatin.g,S haking, 5 hortness of breath. Plus: persistent concern of additional attacks + worrying about its consequences + related behavioral changes In acute situations: Alprazolam SSRI (V choice) TCAs: Irnipramine Clonazepam If hyperventilation: CO2 (breath in a paper bag) Keep la for 6-12m Phobias Specific Phobias > 6months Anxiety when faced with identifiable object or situation_ Pt tries to avoid it_ Disabling fear Systematic desensitization. Assertiveness training. Agoraphobia Fear of open spaces from which escape would be difficult in the event of panic symptom 5 S-ocial Anxiety Disorder Former Social Phobia_ Fear of embarrassment in social situations_ Stage fright! SSRI Beta Mockers: stage fright Obsessive Compulsive Disorder (OCD) Body Dysrnorphic D. Obsession: intrusive thought 3- ]contamination, rdoubt, guilt, aggression, sex, etc_ Compulsion: repetitive action rhand washing, rchecking, organizing, counting, praying, etc. Pt is EGO DYSTONIC (they hate doing all the rituals} Frontal lobe: INCREASED metabolism Caudate nucleus: increased metabolism Erodv Dvsrnorphic Disorder Behavioral psychotherapy: relaxation training, guided imagery, exposure & response prevention. SSRI: flume-tine, flu oxamine TCAs: Clomipramine SOCII Individual psychotherapy Antidepressants. Pt truly believes that some part is abnormal, defective, or misshapen when NOT (e.g. facial flaws) 3 impairment in level of functioning. Constant mirror-checking, hide "deformity", housebound, avoid social events. Acute Stress Disorder & Post- Traumatic Stress Disorder (PTSD) Acute > 2days, lrnonth Severe anxiety symptoms followed by a threatening event that caused feelings of fear, helplessness or horror (right after or years after event. The sooner, the better the px) Re-experience of the event: recurrent dreams, flashbacks Phobic avoidance (pt was raped in school, pt drops out of school) Increased anxiety. Sleep disruption or excess. Group therapy Constant counseling SSRIs improve functional level Antidepressants BZD Best choice: pharmacotherapy '(`REM Latency 4,Amount of REM I ,,I,Sta.ge 4 Adjustment Disorder < 6 months Maladaptative reactions to an identifiable psychosocial stressor Presence of IDENTIFIABLE STRESSOR (can't be grief) within 3 months of onset Anxiety, depression or emotional turmoil with significant social, academic and/or occupational IMPAIRMENT Supportive psychotherapy Anxiolytics, antidepressants Generalized Anxiety Disorder (GAD) > 6 months Excessive, poorly controlled anxiety about life circumstances. Physio & Psychological sx. Behavioral therapy: relaxation training, biofeedback SSRI- SNI9.1: Venlafaxine Buspirone BZD Physiologic component Psychologic component Worry that's difficult to control Autonomic hyperactivity: * shortness of breath * diaphoresis * tremor Hypervigilanc e Restlessness Sleep disturbances Difficulty concentrating Motor tension