anxiety disorders for ncmhce study
TRANSCRIPT
Review of DSM5 Mental Disorders for NCMHCE Study
1. Agoraphobia2. Generalized Anxiety Disorder3. Panic Disorder4. Separation Anxiety Disorder5. Social Anxiety Disorder (Social Phobia)6. Specific Phobia7. Substance/medication induced anxiety disorder8. Anxiety due to medical condition9. Other specified or unspecified anxiety disorder
AssessmentsBAI Beck Anxiety InventoryPenn State Worry Questionnaire Anxiety Interview ScheduleSIAS Fear of Negative Evaluation and Social Interaction Anxiety Scale
ASEBA Achebach System of Empirically Based AssessmentRCMAS-2 Revised Children Manifest Anxiety Scale
S4. TreatmentMedicationsAnti depressantsAnti-anxietyBenzodiazepine sedatives
TherapyCBT, Cognitive RestructuringAffective Therapy AWAREACT Acceptance Commitment TherapyPCT Panic Control TherapyExposure therapyMindfulnessSocial skills training
Manage anxiety before it escalates1. Mild anxietyCan motivate one to positively perform at a high levelHelps person to focus on the situation at hand2. Moderate anxietyNarrowing of the perceptual fieldTrouble attending to their surroundings Can follow commands/direction
3. Severe anxiety Unable to attend to surroundings except for maybe a detail. Physical symptoms may developAnxiety relief is the goal.4. Panic attackTerror; only concern is to escapeCommunication impossible at this point
DiagnosisExcessive anxiety and uncontrollable, unrealistic worry about a number of topicsOccurs most days for at least 6 monthsWith the following symptoms:
Restlessness Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbances
ComorbidityUnipolar disorder
S1. Find Out S2. Refer or AssessBAI Beck Anxiety InventoryPenn State Worry Questionnaire Anxiety Interview Schedule
S4. TreatmentMedicationsAnti depressantsAnti-anxietyBenzodiazepine sedatives
TherapyCBT, Cognitive RestructuringBehavior thrapyAffective Therapy AWAREACT Acceptance Commitment TherapyExpressive TherapyBehavioral Relaxation training
DiagnosisOverwhelming worry and self consciousness about everyday social situations
In children the anxiety must occur in peer settings and not just during interactions with adults
Fear is out of proportion to the actual threat caused by social situationFear of being judged by others or behaving in a way that would cause embarrassment or lead to ridiculeLasting for more 6 months or more Specify if: performance only
Comorbid:Major Depressive DisorderSubstance Use DisordersOther anxiety disorders
S1. Find Out S2. Refer or AssessSIAS Fear of Negative Evaluation and Social Interaction Anxiety ScaleASEBA Acheback System of Empirically Based AssessmentRCMAS-2 Revised Children Manifest Anxiety Scale
S4. TreatmentMedicationsAntidepressants, SSRIs, SNRIsAntihistamines Beta blockersAnti-anxiety
TherapyCBT, Cognitive RestructuringExposure therapyMindfulnessSocial skills training
S5. Monitoring S6. Termination
Diagnosis1. Feelings of intense fear/discomfort that can occur suddenly (from a calm state) or an anxious stateRecurrent and unexpectedSweating, chest pains and palpitations, as if choking or having a heart attack2. At least 1 attack has been followed by
1 month of: Persistent concern or worry about additional panic attacks or their consequencesSignificant maladaptive change in behavior related to the attacks
Comorbid:AgoraphobiaMajor DepressionBipolar DisordersAlcohol Use Disorder
S1. Find OutMedical history
S2. Refer or AssessADVISBurns Anxiety InventoryMedical evaluation
S4. TreatmentMedicationsAnti anxiety, benzodiazapines (acute panic attack)
TherapyCBT-bestPCT Panic Control TherapyACT Acceptance Commitment TherapyEMDR
Diagnosis1. Fear/anxiety about two or more of:Using public transit; being in open space; being in enclosed places; standing in line or being in a crowd; being outside of the home alone2. Avoidance of these situations because the thoughts that escape may be difficult or help might not be available if symptoms develop
ComorbidityPanic DisorderSocial Anxiety DisorderMajor Depressive DisorderPTSDAlcohol Use Disorder
S1. Find Out S2. Refer or AssessPsychiatric evaluationTestsBAI Beck Anxiety InventoryMobility Inventory for AgoraphobiaAgoraphobic Cognition Questionnaire
S4. TreatmentMedicationsAnti-anxiety
TherapyPCT Panic Control Therapy
Diagnosis1. Intense fear of specific object or situationIn children the fear/anxiety my be expressed by crying, tantrums, freezing or clinging2. Level of fear is inappropriate to the situation and may cause person to avoid common every day situations3. Specify feared stimulus
S1. Find Out S2. Refer or AssessPsychiatric evaluationTestsBeck Anxiety InventoryBurns Anxiety Inventory
S4. Treatment TherapyExposure Therapy--bestRelaxation TrainingBreathing Retraining
Diagnosis1. Excessive fear or anxiety around separation from attachment figuresRecurrent, excessive distress when anticipating or experiencing separationWorry about losing or possible harm to those figuresFear of being alone, refusal to sleep away from home or this attachment figureNightmares and physical symptoms with anxietyReluctance or refusal to go out, away from home, to school, to work for fear of separation2. Lasting at least 4 weeks in children and adolescents or 6 months or more in adults
ComorbidityGADPhobiasPTSDAgoraphobiaSocial Anxiety DisorderOCDPersonality Disorders
S1. Find Out S2. Refer or AssessTestChild Depression InventoryWashington U Schedule for Affective Disorders and SchizophreniaYMRS Young Mania Rating Scale
S4. TreatmentTherapyExposure Therapy—bestCBT—bestCoping Cat manualized
DiagnosisConsistent failure to speak in specific social situations where there is the expectation for speaking (such as school) despite speaking in other situationsInterferes with work or school or with social communicationDuration is at least 1 month Not attributed to lack of knowledge or comfort with the spoken language Not better explained by a communication disorder
Rule OutCommunication disorderSocial phobiaSchizophreniaAutism
ComorbidDepressionOCDOther anxiety
Often with depression, OCD, anxiety.
Rule out SchizophreniaAutism, or other MH.
TreatmentPsychotherapyBehavior modFamily involvement, Medication
S4. Treatment1. PsychotherapyBehavior modFamily involvement, Medication
2. Medication
DiagnosisPanic attacks or anxiety is predominantDeveloped during or soon after substance intoxication or withdrawal or after exposure to a medicationSubstance/medication is capable of producing the symptoms