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