Anxiety Disorders

by / Wednesday, 09 June 2010 / Published in Psychiatry

Panic Disorder

  • 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:

  1. Avoidance of stimuli – associated with their trauma or numbing of responsiveness because it emits emotional pain
  2. Re-experiencing the traumatic event – via dreams, thoughts, recollections.
  3. 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

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