Generalized anxiety disorder (GAD) Persons with generalized anxiety disorder (GAD) experience excessive and persistent worry which interferes with daily activities. This worry is often focused on everyday tasks and responsibilities, such as work, career, or school matters; family health; household chores; appointments; or car repairs. Worry may be accompanied by physical symptoms, including feeling on edge, fatigue, insomnia, restlessness, and muscle tension (Muskin, 2021). Per the DSM-5 , diagnostic criteria for GAD are as follows (Munir & Takov, 2022): ● The patient experiences excessive anxiety and worry for at least 6 months. ● The patient has difficulty controlling the worrying. ● The anxiety causes significant impairment or distress in social and occupational life. ● The anxiety is not attributable to a physical cause. Panic disorder (PD) Panic disorder (PD) is characterized by recurrent panic attacks. During a panic attack, the patient experiences a combination of physical and psychological distress. Several symptoms occur in combination and can include (Muskin, 2021): ● Chest pain. ● Chills or hot flashes. ● Dizziness or lightheadedness. ● Fear of dying. ● Fear of losing control. ● Feeling that you are choking, shortness of breath, or experiencing smothering sensations. ● Feeling detached. ● Numbness or tingling. ● Nausea or abdominal pain. ● Palpitations or rapid heart rate. ● Shaking or trembling. ● Sweating. Specific phobias Specific phobia is an excessive and persistent fear of a specific object, situation, or activity that is otherwise considered not harmful. Common examples include a fear of flying and fears around public speaking. Persons with a specific phobia are aware that the fear is excessive or unwarranted. In some cases, the fear is severe Agoraphobia Agoraphobia is the fear of being in a situation where escape may be embarrassing or difficult or help may not be available if panic symptoms appear. To classify as agoraphobia, the fear must be: 1. Out of proportion to the actual situation; 2. Present consistently for at least 6 months; and 3. Problematic enough to interfere with normal daily activities and functioning (Muskin, 2021). Left untreated, agoraphobia can become so severe that it prevents the person from leaving their home. Specific situations which may be feared by a person with agoraphobia include: ● Being in enclosed places. ● Being in open spaces. ● Being outside the home while alone. Social anxiety disorder (SAD) Social anxiety disorder (SAD) creates significant anxiety and discomfort in social interactions. A person with SAD worries about being embarrassed, humiliated, looked down on, or rejected by others in social settings. This often leads to the
● Anxiety experienced by the patient is accompanied with three or more of the following symptoms, for at least 6 months: ○ Feelings of restlessness, being “on edge” or “keyed up”. ○ Being easily fatigued. ○ Concentration difficulties, or feeling the “mind going blank”. ○ Muscle tension ○ Sleep disturbances. ○ Irritability. Treatment for GAD involves two main modalities: cognitive behavioral therapy (CBT) and pharmacotherapy. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are considered first-line agents for treating GAD. Benzodiazepines are often used when immediate symptomatic treatment is required (Munir & Takov, 2022). Due to the severity of symptoms, some people experiencing a panic attack may believe they’re having a heart attack or other life-threatening condition. Panic attacks may be expected, such as in response to a triggered memory or to a feared object. They may also be unexpected, seeming to occur for no reason. Panic attacks may occur with other mental disorders such as depression or post-traumatic stress disorder (PTSD). Panic disorder is treated with both psychological and pharmacological treatment (Cackovic et al., 2022). CBT is the primary psychological treatment, and breath training or techniques can also be beneficial. With respect to pharmacotherapy, antidepressants and benzodiazepines are the main treatments. SSRIs are considered first-line treatment, but a benzodiazepine may be useful in patients with severe symptoms, or for short-term use until clinical effects of the SSRI take hold (Cackovic et al., 2022). enough to cause distress to the point that the patient will go to extreme lengths to avoid exposure to what they fear. Behavioral therapy is one of the most effective treatments for specific phobia (Samra & Abdijadid, 2021). Pharmacotherapy currently has a limited role, but beta blockers and benzodiazepines may be used when the phobia is associated with panic attacks (Samra & Abdijadid, 2021).
● Being in a crowd or standing in line. ● Using public transportation.
Agoraphobia most commonly occurs along with panic disorder, but not always. With the revision of the DSM-IV to the DSM-5 , agoraphobia is now diagnosed independently of panic disorder. There has been little study of treatment for agoraphobia outside of patients with comorbid panic disorder and agoraphobia. In general, the treatment of agoraphobia should follow current guidelines for the treatment of panic disorder. (Shin et al., 2020). Currently, there is no clear “drug of choice” treatment for AG. Research to date shows the most consistent results with paroxetine, sertraline, citalopram, escitalopram, and clomipramine, but more research is needed (Perna et al., 2011).
person avoiding social interactions or enduring it despite extreme anxiety. In order to classify as SAD, the anxiety around social interaction must interfere with everyday functioning and must be present for at least 6 months (Muskin, 2021).
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Book Code: RPTTX2024
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