Anxiety disorders

Acute vs chronic Posted by Ahmad Azizov on August 31, 2020

Anxiety disorders

Anxiety is something experienced by everyone. However, sometimes this feeling can get out of hand and start to interfere with the daily tasks. Some people describe anxiety as fear or over-worrying accompanied by increased heart rate, dyspnea and diaphoresis. These feelings and physical signs can lead someone to develop mood disorders such as depression. Patients experiencing these issues may end up self-medicating with alcohol

In general females, experience more anxiety disorders than males and most patients experience them in their late teens and early 20s

Panic disorder

Panic attacks are acute, overt and catastrophic events. 

  • Symptoms 
    • Mnemonic - STUDENTS PANIC
      • SOB
      • Trembling 
      • Unsteady 
      • Depersonalization 
      • Excessive heart rate 
      • Numbness
      • Sweaty 
      • Palpitations 
      • Abdominal pain 
      • Nausea
      • Intense fear of death 
      • Chest pain 
    • Many of these overlap with acute coronary syndrome (ACS), hyperthyroidism and asthma  
      • Rule out ACS with an EKG
        • Unlikely in younger patients 
      • Rule out hyperthyroidism - T4 levels 
      • Rule out asthma - history and wheezing 
    • Agoraphobia 
      • Fear of the public
      • Present in some patients with panic attacks 
      • Afraid of not being able to escape from public spaces
    • Social anxiety disorder 
      • Similar presentation to agoraphobia, however, these patients are scared of being embarrassed by the people in public
      • In theory, they can go to public visits that are free of people
  • Treatment 
    • Medications > psychotherapy 
    • Benzodiazepines 
    • Chronic medications
      • SSRIs can reduce the frequency of panic attacks but do not stop acute instances  
    • Psychotherapy 
      • Can train patients to use certain tactics to use to escape the attack 

Generalized anxiety disorder (GAD)

Chronic, low amount of anxiety about most things, most of the time.

  • Diagnostic criteria:
    • State of constant worry about most things about most days at least 6 months in duration with somatic complaints
      • Fatigue, weight changes, sleep change, irritation, loss of concentration
    • Diagnosis is clinical without any tests of inclusion
  • What makes this condition is not just that they worry but that the worry impairs their day-to-day function
  • Treatment 
    • Psychotherapy > medications 
    • Medications 
      • SSRIs
  • Panic attacks 
    • Patients with GAD may experience panic attacks
    • Treatment 
      • Since acute, use benzodiazepines 

Phobia 

Exaggerated, irrational fear of specific things or situations. 

  • Specific
    • Spiders, snakes, heights, flying, clowns
    • Treatment 
      • Cognitive behavioural therapy 
        • Flooding 
          • Less effective, quick 
          • Keep the patient calm and overwhelm them with their fear 
        • Desensitization 
          • More effective, slow 
          • Incrementally increase the amount of dear slowly 
      • Can use benzodiazepines to control the anxiety under CBT 
  • Social 
    • Public speaking, public urination 
      • Non-selective beta-blockers 
        • Propranolol 

All information provided on this website is for educational purposes and does not constitute any medical advice. Please speak to you doctor before changing your diet, activity or medications. 


Written by
Ahmad Azizov Member since April 2020
Interested in Vascular surgery resident at Western U

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