Anxiety Adults

anxiety

apprehension about a future threat

fear

response to an immediate threat
may save life-fight or flight

DSM-5 Anxiety Disorders

specific phobias, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder

most common

phobias

criteria for each disorder

-symptoms interfere with important areas of functioning or cause marked distress

-not caused by a drug or medical condition

-persist for 6 months or at least 1 month for panic

-fears and anxieties are distinct for the symptoms of another anxiety disorder

phobias

disruptive fear of a particular object or situation
-out of proportion to actual threat
-awareness that fear is excessive

social anxiety disorder

persistent, intense fear and avoidance of social situations, fear of negative evaluation or scrutiny, exposure to trigger leads to anxiety about being humiliated or embarrassed socially

panic disorder

frequent panic attacks unrelated to specific situations

uncued panic attacks

without warning
-panic disorder causes these
-worry about future attacks

cued panic attack

triggered by specific situations
-more like a specific phobia

agoraphobia

anxiety about inability to flee anxiety provoking situations

-crowds, stores, malls, churches, etc

-avoids those situations, require the presence of a companion or are endured with intense fear or anxiety

generalized anxiety disorder

chronic, excessive, generalized uncontrollable worry
-restlessness, poor concentration, tiring easily, irritability, muscle tension

Cecil is a 37 year of male who presents to your clinical for evaluation of his fear of flying. Patient states that he has had a life- long fear of flying and often attempts to avoid flying and instead choosing to travel via car. Patient states that he will often imagine the plane crashing whenever he flies and spends the entire flight in a state of fear. Patient states that this fear has recently began to have a negative impact on him professionally as he recently turned down a promotion as he would be required to take several flights for business meetings. Patient is noticeably anxious in your office when he discusses flying.

specific phobia

Danielle is an 18-year-old female presenting to your office for evaluation of anxiety. Patient states that she is having difficulty adjusting to college citing that she has a hard time talking to other students or professors as she is afraid they will think poorly of her. Patient is unable to eat in the school cafeteria as she becomes anxious that she will spill something on herself and her peers will laugh at her. Patient states that this anxiety has recently had a negative impact on her academically as she received a zero on an assignment after missing class due to anxiety about having to give a presentation. Patient states that she has always had difficulty giving presentations; however, in high school her teachers would often let her write essays or turn in other extracurricular projects in lieu of giving a verbal presentation.

social anxiety disorder

Eric is a 23-year-old male being evaluated in the ED for chest pain. Patient endorses several recent episodes of acute chest pain accompanied by palpitations, diaphoresis, SOA, feelings that he is choking, lightheadedness, paresthesia and fear of dying. Patient endorses significant anxiety that he will have similar episodes and has gone as far as to cancel his gym membership as he fears that exercise many induce another episode. Patient states that he will try to minimize the time spent outside of his house as he is afraid of having another episode.

panic disorder

Felicia is a 67-year-old female presenting to your office for anxiety. Patient endorses significant anxiety when leaving home alone, endorsing the fear that help may not be available should she fall or have an accident. Patient endorses considerable increases in her anxiety when her daughter is unable to drive her to the supermarket and she is forced to use public transportation or when she is in open spaces such as the park. Due to these fears, patient has isolated herself to her home, often only leaving if her daughter or another family member is willing to accompany her.

agoraphobia

Georgina is a 22-year-old female presenting to your office with concerns of anxiety. Patient endorses daily anxiety that has resulted in significant irritability and difficulty concentrating. Patient endorses difficulty falling asleep at night due to ruminating on stressors, often resulting in her feeling fatigued during the day. Patient states that she always feels "on edge" and has developed significant tension in her neck. Patient endorses having these feelings in almost all situations including school, work and social situations. Patient has noticed an impairment academically secondary to this anxiety, and has be reprimanded at work on several occasions.

generalized anxiety disorder

Harry is a 27-year-old male presenting to the ED for evaluation for significant anxiety. Patient endorses several recent episodes of acute chest pain accompanied by palpitations, diaphoresis, SOA, and fear of dying. Patient also endorses increase in daily anxiety level that has resulted in patient isolating himself to the home. Patient's grandfather recently passed away from a heart attack. EKG demonstrates sinus tachycardia, troponins are not elevated, UDS positive for cocaine and TSH wnl.

substance-induced anxiety disorder

substance induced anxiety disorder

-panic attacks or anxiety is the predominant clinical picture
-during or soon after the intoxication or withdrawal

who is more likely to have anxiety as adults?

females

treatment for anxiety disorders

exposure to gain practical evidence

systematic desensitization

cognitive approaches

relaxation training

cognitive behavioral methods (modify thoughts)

meds for treatment of anxiety

-benzodiazepenes: valium, xanax (feel in 15 minutes, calm down, addiction can occur)

-antidepressants: SSRIs, SNRIs, tricyclics (takes a couple weeks to change)

stance on medication

don't fix an internal problem with an external solution