Generalized Anxiety Disorder
Diagnostic criteria for GAD according to DSM-5
What is excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities, with difficulty controlling the worry, and associated with three or more of the following symptoms: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
DSM-V Diagnostic Criteria for Panic Disorder.
A. Recurrent unexpected panic attacks
●B. At least one of the attacks has been followed by a month or more of one or both of the following:
•1. Persistent concern or worry about additional panic attacks or their consequences (eg, losing control, having a heart attack, "going crazy").
•2. A significant maladaptive change in behavior related to the attacks (eg, behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
●C. The disturbance is not attributable to the physiological effects of a substance (eg, medication or illicit drug) or another medical condition (eg, hyperthyroidism, cardiopulmonary disorders).
●D. The disturbance is not better explained by another mental disorder. As examples, the panic attacks do not occur only in response to:
•Feared social situations, as in social anxiety disorder
•Circumscribed phobic objects or situations, as in specific phobia
•Obsessions, as in obsessive-compulsive disorder
•Reminders of traumatic events, as in posttraumatic stress disorder (PTSD)
•Separation from attachment figures, as in separation anxiety disorder
Diagnostic criteria for SAD
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.
Diagnostic criteria for somatic symptom disorder
One or more somatic symptoms that are distressing or result in significant disruption of daily life, with excessive thoughts, feelings, or behaviors related to the symptoms.
Diagnostic criteria for OCD
Presence of obsessions (recurrent and persistent thoughts, urges, or images) and/or compulsions (repetitive behaviors or mental acts) that are time-consuming or cause significant distress or impairment.
First-line pharmacological treatment for GAD
What are Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, or serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine extended release.
First-line treatment for panic disorder.
What are SSRI + CBT +/- benzodiazepines (gabapentin if substance abuse d/o) if unable to wait for medication to take effect.
Pharmacological options for SAD
SSRIs such as sertraline or paroxetine.
Classes of medications that can be used in managing somatic symptom disorder
SSRIs, SNRIs, low dose tricyclic antidepressants.
First-line pharmacological treatment for OCD
SSRIs such as fluoxetine or sertraline.
Adequate Response: minimum of 35 percent decrease on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score
Supratherapeutic dose if inadequate response to a target dose of an SSRI.
-Caution- older patients (age >65)
-Avoid escitalopram in older pts (cardiac concerns)
-Failed 2 SSRI- clomipramine (caution heart disease, long qt)- baseline EKG
Cognitive-behavioral therapy (CBT) techniques for GAD
What are cognitive restructuring, relaxation training, and exposure therapy.
Key features of panic attacks.
Abrupt surge of intense fear or discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur: palpitations, sweating, trembling, sensations of shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills or heat sensations, paresthesias, derealization or depersonalization, fear of losing control, and fear of dying.
CBT techniques for SAD
Exposure therapy, cognitive restructuring, and social skills training.
Psychotherapeutic approaches for somatic symptom disorder
CBT and mindfulness-based therapy.
CBT techniques for OCD
Exposure and response prevention (ERP) therapy.
Common comorbidities with GAD
What are depression, substance abuse, and other anxiety disorders.
Behavioral interventions for panic disorder
What are panic-focused CBT, including interoceptive exposure and cognitive restructuring.
Impact of SAD on quality of life
Impaired social and occupational functioning, increased risk of depression.
Common comorbidities with somatic symptom disorder
Depression and anxiety disorders.
Common comorbidities with OCD
Depression, other anxiety disorders, and tic disorders.
Long-term management strategies for GAD
What are a combination of pharmacotherapy (SSRIs/SNRIs) and cognitive-behavioral therapy (CBT).
Differential diagnosis for panic disorder
Hyperthyroidism, cardiac arrhythmias, and substance use disorders.
Long-term management of SAD
Combination of SSRIs and CBT.
Strategies for managing chronic symptoms
Regular follow-up appointments, strong therapeutic alliance, and limited diagnostic testing.
Long-term management strategies for OCD
Combination of SSRIs and ERP (exposure and response prevention) therapy.