Info
🌱 來自: Huppert’s Notes
Anxiety Disorders🚧 施工中
Anxiety Disorders
• Panic disorder: Recurrent unexpected panic attacks, resulting in a fear of future panic attacks and avoidance of potential panic triggers. Symptoms: Chest pain/tightness, tachycardia, palpitations, which frequently requires ruling out an acute coronary syndrome first. Proposed etiology: Overactive amygdala-hypothalamus circuits. Treatment: Acute: benzodiazepines (lorazepam, clonazepam), but ideally discontinue as soon as possible. If history of substance abuse, consider gabapentin or hydroxyzine. Chronic: 1st-line SSRIs (e.g., escitalopram, sertraline).
• Specific phobia: Fear of specific trigger (animal, heights, flying). Treatment: CBT with exposures; benzodiazepines if exposures cannot be tolerated.
• Agoraphobia: Fear and/or avoidance of situations that are difficult to leave/escape in the event of panic or other embarrassing symptoms. Situations commonly include crowds, shopping areas, public transport, being outside of the home in general. Treatment: CBT and/or SSRIs.
• Social anxiety disorder: Excessive fear of social situations, embarrassment/humiliation. Treatment: SSRI (escitalopram, sertraline), CBT. If for public speaking only, can consider using propranolol 30 min before the event.
• Generalized anxiety disorder: 6+ months with worries/anxiety across multiple domains. Associated with impaired sleep, poor concentration, easy fatigability, irritability, muscle tension, restlessness. Treatment: CBT, SSRI, buspirone.
• Obsessive compulsive disorder (OCD): Obsessions and compulsions that are time consuming, distressing, and/or impair function. Obsession: Recurrent intrusive thought. Compulsion: Conscious repetitive behavior to relieve anxiety. Ego-dystonic (i.e., bothers patient, in contrast to obsessive-compulsive personality disorder). Proposed etiology: Serotonin, glutamate, and dopamine involved. Treatment: SSRI, TCA (e.g., clomipramine). Exposure and response prevention therapy (ERP).
• Body dysmorphic disorder: Preoccupation with body parts that the patient thinks are flawed; very distressing. Surgical correction does not satisfy.
• Trichotillomania: Recurrent pulling out of hair causing distress and/or impairing daily function. May present with bald spots, most commonly scalp, eyebrows, and/or eyelashes. Treatment: CBT, habit-reversal therapy.
• Acute stress disorder: Reaction within 3 days to 1 month of trauma including re-experiencing, negative mood, dissociation, avoidance, and hyper-vigilance. Treatment: Trauma focused cognitive therapy; short-term benzodiazepine if severe.
• Post-traumatic stress disorder (PTSD): Reaction lasting 1+ month. Response to trauma (experienced, threatened, or witnessed) including re-experiences, avoidance, cognitive/emotional disturbances, hyper-arousal, dissociative symptoms. Imaging not required for diagnosis, but MRI brain may show decreased hippocampal volume. Treatment: Trauma-focused CBT (“TF-CBT”), SSRIs (e.g., sertraline, fluoxetine).
• Adjustment disorder: Low mood and/or anxiety within 3 months of a stressor AND does not meet criteria for another disorder (i.e., MDD or generalized anxiety disorder [GAD]) but still causes significant impairment. Treatment: Supportive psychotherapy, cognitive or psychodynamic psychotherapy.