- A condition seen MC in women in their mid 20’s
- Symptoms mimic those of an MI (chest pain, palpitations, diaphoresis, nausea, anxiety, sense of impending doom)
- Symptoms usually escalate for approximately 10 minutes and last at least 30 minutes
- This disorder is very unpredictable, if it occurs in the same type of setting then suspect a specific phobia
- Must differentiate from drug use, MI, and other sources of phobias
- Diagnosis of exclusion
- Cognitive-behavioral therapy and/or relaxation training.
- Relaxation is more useful if patient has an agoraphobic tendency
- SSRI’s and benzodiazepines can be prescribed
- Patient fears being in situations where they cannot escape, bringing about a panic attack
- Patients develop agoraphobia because of recurrent and unexpected panic attacks in certain situations
- Is clinical, looking for evidence of social and/or occupational dysfunction
- Exposure desensitization
- b-blockers as prophylaxis from sympathetic activation when in possibly triggering situations
Obsessive-Compulsive Disorder (OCD)
- Patient experiences recurrent thoughts and performs recurrent actions/rituals as a coping mechanism
- Obsessive thoughts provoke anxiety, compulsions are a way of dealing with this anxiety, this anxiety relief is only temporary and thus rituals get performed over and over again.
- Commonly involve cleanliness (fear of contamination) – thus excessive hand-washing is common
- Patient must be aware of the abnormality of their behavior, and must be disturbed by this.
- 1st line treatment is SSRI
- 2nd line is clomipramine
- Patient must undergo psychotherapy as well, where they are forced to overcome their behavior
Post-Traumatic Stress Disorder
- This is the classic “Vietnam vet” patient, who has undergone a traumatic incident that leaves them emotionally scarred
There are 3 key groups of symptoms:
- Avoidance of stimuli – associated with their trauma or numbing of responsiveness because it emits emotional pain
- Re-experiencing the traumatic event – via dreams, thoughts, recollections.
- Increased arousal – seen as sleep disturbances, emotional lability, impulsiveness, anxiety.
- Always differentiate from an acute stress disorder, where symptoms last less than 1 month and occur within 1 month of experiencing the stressor
- Diagnosis requires a traumatic incident and must last longer than 1 month
- When patient is in acute distress, give benzodiazepines to calm them down
- For long-term therapy, give SSRI’s + psychotherapy
Generalized Anxiety Disorder
- Patient worries excessively and/or has poorly controlled anxiety on most days for at least 6 months.
- There is no specific event or reason for this anxiety
- Patient has trouble sleeping, the inability to concentrate, excessive fatigue and restlessness
- Be sure to distinguish from specific phobia/anxieties or other causes of anxiety.
- Must be evidence of social dysfunction (which rules out normal anxiety)
- Psychotherapy teaching patient to recognize their worrying and finding a way to manage through thought patterns and behavior
- Can give SSRI’s, buspirone, and benzodiazepines
- b-blockers to block excessive sympathetic activation