Anxiety disorders

Excessive or persisting fear/anxiety beyond developmentally appropriate periods
Persistent, usually >6mo (1mo for panic disorder)
SX not attributable to physiological effects of a substance/medication/medical condition
Not better explained by another mental disorder

Fear - Emotional response to real or perceived imminent threat

Surges of autonomic arousal (fight or flight) and thoughts of immediate danger ➔ escape behavior

Anxiety - Anticipation of future threat

Preparation for future dangers ➔ muscle tension and vigilance ➔ cautious/avoidant behaviors

Separation anxiety disorder

Developmentally inappropriate fear or anxiety about separation from attachment figures
Persistent fear or anxiety about harm coming to attachment figures
Persistent fear or anxiety about events that could lead to loss of or separation from attachment figures
Reluctance to go away from attachment figures
SX of distress when separation occurs or is anticipated (nightmares, headaches, stomachaches)
SX develop in childhood but can be expressed throughout adulthood
Adults 6mos of sx for dx but 4wks for children
TX: CBT > SSRI

Consistent failure to speak in social situations when there is an expectation to speak (even though they speak in other situations)
Significant consequences on achievement in academic/occupational/social settings

TX:

Uncontrollable, persistent and excessive anxiety and worry about work/school performance
At least 3 (1 in children) for 6 months, more days than not
- Restlessness
- Irritability
- Easily fatigued
- Sleep disturbance
- Difficulty concentrating
- Muscle tension
GAD - 7 used for screening

Associated with etOH use disorder
Unexpected panic attacks AND
At least 1 month of:
- Worried about having panic attacks
  - OR
- Panic attacks ➔ maladaptive behavior ∆'s

At least 4:

Palpitations, tachy

Chest pain

Dizzy/light-headed

Sweating

Trembling/shaking

SOB "feeling smothered"

Choking sensation

Nausea/GI complaint

Derealization/depersonalization

Fear of losing control "going crazy"

Fear of dying

Paresthesias

Fearful and anxious about at least two:
- Using public transportation
- Being in open spaces
- Being in enclosed places
- Standing in line/being in a crowd
- Being outside of the home alone
Fear they won't be able to escape or have have help if they develop panic/embarrassing sx
Situations are avoided and/or require a companion (out of fear of panic)

Patients with other anxiety disorders (agoraphobia) that meet panic disorder get both dx (panic disorder with agoraphobia )

Fearful or anxious about or avoidant of circumscribed objects or situations (persistent and out of proportion to actual risk posed)
Animals, natural environments, needles

CBT with exposure therapy (systematic desensitization for pts that refuse in vivo exposure)

Fearful or anxious about or avoidance of situations that involve possibility of being scrutinized
- Cognitive ideation of being negatively evaluated by others (embarrassed, humiliated, rejected, offending people)
- Meeting unfamiliar people, observed eating or drinking, performing in front of others
- SAD DX only when impact on social or job - don't be fooled by question with normative shyness
TX
- CBT > SSRI
- Performance only SAD (public speaking/performing): β-blocker > benzo (for the event)

Not obsessive compulsive personality disorder (OC personality disorder is a cluster C personality disorder that is egosyntonic)
Was an anxiety disorder in DSM IV

SSX

Obsessive thoughts: intrusive, unwanted, recurrent and persistent thoughts, urges or images that cause anxiety or distress
Compulsive behavior: repetitive behaviors (hand washing, checking) or mental acts (praying, counting, repeating words) in response to obsession

Obsessions or compulsions are time consuming or cause clinically significant distress or impairment at work/home/school
Egodystonic - behavior/thoughts are ↑nsistent with self (they dont like they are this way)