Anxiety Disorders

What is the treatment for body dysmorphic disorder?

Treatment typically involves therapy, such as cognitive-behavioral therapy (CBT), and may include medications like selective serotonin reuptake inhibitors (SSRIs) to help alleviate symptoms.

Normal stress reactions are distinguished by 

lower severity and absence of marked distress or significant functional impairment.

Meta-analyses have shown that prazosin, an alpha-1 adrenergic receptor antagonist, is effective for treatment of 

PTSD-related nightmares

Features suggestive of posttraumatic stress disorder (PTSD) include

sleep disturbance (poor sleep, panicked awakening), dissociation (eg, momentarily staring and unresponsive), negative mood, and hypervigilance/increased startle response (eg, when nearby door slams).

recent onset of behavioral changes following a traumatic event (motor vehicle collision, a profound traumatic event) is suggestive of

posttraumatic stress disorder (PTSD) 

GAD is effectively treated with

SSRI, cognitive-behavioral therapy (CBT), or a combination of the two; if SSRI is not an option, SNRIs work too

Abrupt change in behavior, which is temporally associated with exposure to the new class pet (snake) a month ago (ie, leaving the classroom abruptly, becoming distant and distracted, subsequently avoiding school), with symptoms not observed outside of school, is concerning for 

a specific phobia; First-line treatment of specific phobia is with exposure therapy

Measurement of thyroid functioning is the first step in management of patients with 

new-onset anxiety and physical symptoms

Neuropsychiatric manifestations of Cushing syndrome include 

depressed or labile mood, anxiety, irritability, insomnia, memory deficits, and fatigue

Malingering should be suspected when a patient is 

reluctant to be examined

When evaluating anxiety disorders, see if there’s a thought that is distressing to them and

an accompanying action that they spend a lot of time doing

RLS is diagnosed clinically; however, serum

iron studies should be obtained

This patient's history of feeling easily overwhelmed by anxiety and multiple worries (eg, pain of labor, impact of baby on marriage and health), accompanied by nonspecific physical symptoms (eg, muscle aches, fatigue, and sleep disturbance that began before the pregnancy), is consistent with 

generalized anxiety disorder (GAD)

preoccupation with somatic symptoms despite negative workup is suggestive of 

 somatic symptom disorder (SSD); when you diagnose SSD, tell the patient that you understand their concerns but tell them nothing is wrong from an organic standpoint

For insomnia from GAD, short-term or as-needed treatment with 

zolpidem can be used as an adjunct to sleep hygiene and psychotherapy to help obtain the restorative sleep needed to function.

Always rule out organic causes if there are

physical symptoms for an anxiety disorder; in other words, the first test you should get is an EKG

Patients with anxiety disorders are more sensitive to

activating adverse effects of SSRIs and may benefit from a temporary dose reduction