GAD and Panic and case

"optimal anxiety"

for psychogenic anxiety diagnosis but exclusde other disorders, medical disorders and substances

leavin g alone schizhrophrenia, mania and adhd golden rule is that treatment of choice is behavioral therapy

irrational, unpredictable, relief

Meta worrying = worrying about worrying

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Casebook

2019

Add from ward classes done below

Anxiety disorders

highly comorbid

Hopc must write something salient that indicate anxiety... Feeling of apprehensive If you know the icd criteria then can ask history properly.

3 main criteria Feeling of apprehension Muscle tension - headaches.. Unable to relax.. Fidgeting.. Kneading and fugetting Autonomic hyperactivity

Autonomic features - the sweating

Cinitniud feeling of nervousness

Panic attacks diagnostic criteirra

Phobia vs panic attacks.. In phobia there's a specific trigger so only panic when there's object But phobia can have panic attacks as well So panic disorder vs phobia..

Panic disorder no specific trigger and no objective danger even for other people. Phobia other people can understand threat.

Panic disorder.. Feelings of relief between episodes. vs gad

Cognitive errors .. Feeling of lose control. Feeling of going mad. Feeling die..

Need to know cognition to do cognitive behavioural therapy..

So therapy needed so take history to know how to approach tehroay.. Like problem list targeting therapy needed.

Phobias.

For phobias must see whether there's any underlying delusions or phydtoicd... So must make sure there's no other mental diseases because that will take precedence.

Phobia will have avoidance.... Apprehensive and anticipating symptoms.. Fear that they won't be able to escape. Panic attack associated with a place and then associated that with can't escape. Eg avoid going in trains. Agairophobia can cause panic attacks but not panic disorder.

Crowded place.. Travelling away from home.. Four places.. But have atleast two to diagnose agaraphobia....

Social phobia.. You're getting highlight.. Possibility of getting scritized... In Agairophobia no center of attention... In social phobia the cognition is bad scrutiny (and not able to escape)... So can have Agairophobia even by being in a corner and social phobia only with people.

And there's the usual features of phobia like avoidance. Eh

Anxiety more often comorbif.. One type of anxiety they have other types of anxiety as well. It's mostly co existing so must ask.

Presenting complain... Some form of autonomic feature and always there etc put autonomic feature and put when it's there.. In presenting complain not only. Salient feature of anxiety but the particular case of anxiety.

Hopc must have the criteria icd 10 of anxiety.

Agairophobia and social phobia yes. Panic disorder yes many patients. But gad and specific phobias not that common.

Comorbidities..

Impact of these on family, personal and social life. Level of distress.

Secondary depression can be present. So must ask depressive crteira as well. (augmented with low dose anti oshycoticd)

Can have association with abuse. Can take substance to avoid anxiety and then anxiety can result from substance.. Also withdrawal can minmuc anxiety....

Family history - and family history of OCD, anxiety and depression. Personal history - and aietoloficak factors of anxiety. Find out autoilgicial factors. Child hood a xketies.. Seoetayion rkm parents. Over protected.... Won't get exposed so won't be able to handle yourself.

Ovedprotection and neglect.

Emotionally deoresived relationships with people and parents.

Raised I a dominant and authoritative environment. Parents are too dominant and stuff and striyc.

Can also have dependant personality.. Straits.

Past medical history - thyrotoxicosis.. Pheochromocytoma... Hypoglycemia.... Angina...

Premorbid personality - dependent.. Anxious Avoidant... Ocd... Nirrotic disorder... Harm Avoidant

Mse -

Ssirribg in the edge of chair... Weaving.. Fidgeting.. Tense posture.. Sagging if corners of.. Sweating.. Trembling.. Tenors..

Neurotic oatienvets and not phydcotic..

Mood anxious.

Anxious foreboding. Fearful anticipation Worrying thoughts. Depressive cogniditoknd..

Thoughts....

Cognitive errors.

Cognition? Attention and concentration impaired some of the time.

Insight... Most of the time good.

Medical examination.. Goitre. Tremor.. Pulse.. Cardiovascular system exam vital...

Problem list..

Management anxiety general..

Most of the time out patient management. Condier risk and comordities.. Problems. Etc Must say adequate support and give reasons why anxiety disorder can be managed out patient.

Bio psycho social model..

Investigate first and see....

Anxieties durg management comes at the bottom.. Mainly. Oshcithersoy and oshcieducstion

Benzo is only symptomatic treatment.

Addiction to benzo.

Not beyond 2 weaks. Deoendant and withdrawal.

Alprazolam Clonazepam

No need dosages.

Gaba stuff.. Mist know oharcology for this... Important..

Ssris can be given.

Benzodiaoezimes and ssri

Fkucixetibe works for anxiety but depression our population responds well for sertraline..

For OCR high dose. For depression and anxiety medium dose.

Psychitheraoy is important for anxiety because patient has insight so very good.

CBT also.

In ocd exposure and response therapy.

In social phobia and anxiety etc graded exposure.

Graded exposure.. Always avoiding. So won't desentisie..

Must keep long enough for they themselves to realise the reality that it will comr down.

Anxiety will first go up and then reduce down after a while.

Graded exposure that will be enough.. Flooding.. Specific phobia can do flooding also.

...............

Must buy short Oxford handbook of pshycotry also.

Cignition of anxiety.. Like in panic disorder.. There is a vicious cycle.. First trigger and then anxiety.. All cognitive errors that causes and sustains this cycle.. So CBT aims to break off this cycle.

Pdhco education... Reassure.. Etc Syston diary very important....

Sometimes anxiety there is a root cause. . For anxiety must always involve the patient because have good insight unlike other oshycoticd patients... So involve patients a lot.

Oxford core text. Buy short Oxford handbook.