anxiety
ANXIETY

Anxiety disorders are disorders wherein the patient experiences uncontrollable fear or anxiety with behavioral disturbances that affects normal functioning.

Generalized anxiety disorder is having excessive anxiety and worry occurring for at least 6 months about several events or activities. The person finds it difficult to control the worry.
Panic disorder is when the person experienced recurrent unexpected panic attacks.
Social anxiety disorder is marked and persistent fear of social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

Diagnosis

Diagnostic Criteria

Generalized Anxiety Disorder (GAD)

  • Generalized anxiety disorder as described in DSM-5 is an excessive anxiety and worrying about a number of events or activities for at least 6 months
  • Patients who have generalized anxiety disorders have problems controlling their worries
  • The worrying and anxiety is accompanied by 3 or more of the following 6 symptoms in adults (1 in children) for the past 6 months of the disturbance:
    • Restlessness or feeling on edge
    • Easy to get fatigue
    • Hard to focus or mind gone blank
    • Irritability
    • Muscle tension
    • Sleep disturbances including having problems falling or staying asleep or having unsatisfying sleep
  • Symptoms cause clinically serious distress or deterioration in social, occupational, or other important areas of functioning
  • Disturbance has not been an effect of any medication, substance of abuse or another medical condition
  • Signs and symptoms are not suggestive of other mental disorders

Panic Disorder (PD)

  • Panic disorder as described in DSM-5 is recurrent unexpected sudden surge of intense fear or intense discomfort peaking within minutes, and during which time 4 or more of the following symptoms occur:
    • Tachycardia or feelings of pounding heart or heart beating fast
    • Diaphoresis
    • Trembling or shaking
    • Shortness of breath or feeling of smothering
    • Feelings of choking
    • Chest pain or discomfort
    • Nausea or abdominal distress
    • Feeling dizzy, unsteady, lightheaded, or faint
    • Chills or heat sensations
    • Paresthesias (ie, numbness or tingling sensations)
    • Feelings that one’s surroundings are not real or being an observer of oneself
    • Fear of losing control or “going crazy”
    • Fear of dying
  • Some observed symptoms are specific to cultures (eg neck pain, headache, tinnitus, uncontrollable screaming or crying) and should not be included as 1 of the 4 required symptoms stated above
  • At least 1 of the attacks has been followed by any or both of persistent worrying of having additional attacks or there is maladaptive change in the behavior relative to the attacks of ≥1 month duration
  • Disturbance has not been an effect of any medication, substance of abuse or another medical condition
  • Signs and symptoms are not suggestive of other mental disorders

Social Anxiety Disorder (SAD)

  • Social anxiety disorder as described in DSM-5 is the fear or anxiety of 1 or more social situations that will expose the patient to possible scrutiny like during social interactions, when being observed, or when performing in presence of an audience
    • For children, the disturbance is observed when interacting with peers as well as with adults
  • The patient has fears that the anxiety symptoms will manifest and that others may perceive it negatively that may lead to rejection by others
  • Social situations always trigger fear or anxiety in the patient, and generally avoided or endured with great uneasiness by the patient
  • There is greater fear or anxiety than to actual threat brought by the social situation and to the socio-cultural context
  • The distress lasts for ≥6 months
  • The symptoms cause clinically serious distress or deterioration in social, occupational, or other important areas of functioning
  • Disturbance has not been an effect of any medication, substance of abuse or another medical condition
  • Signs and symptoms are not suggestive of other mental disorders
  • It has been ruled out that the anxiety is not due to certain comorbidities (eg Parkinson’s disease, disfigurement due to burns/injury, morbid obesity), or if patient showed excessive anxiety due to these situations

Screening

Tools

  • Generalized Anxiety Disorder (GAD) 7-item scale
    • A quick and useful screening tool for generalized anxiety disorder and other anxiety disorders (eg panic disorder, social anxiety disorder)
    • May also be used as a monitoring response to treatment
    • A score of ≥8 is highly suggestive of anxiety disorder
    • Total score of ≥10 indicates a probable diagnosis of generalized anxiety disorder
    Hospital Anxiety and Depression Scale (HADS)
    • A self-reported 14-item screening test that measures anxiety and depression in hospitalized non-psychiatric patients
    • A score of 8-10 suggests presence of anxiety disorder
    • A score of >11 indicates probable mood disorder
  • Clinical Global Impression Scales
    • May be used to measure illness severity and treatment progress during consultation
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