Some patients do well without medication. Patients must specifically be asked about counting, checking, washing rituals and intrusive, disturbing thoughts.įirst line treatment: CBT and medication (SSRIs, often in high doses). OCD is the most hidden of the anxiety disorders. Some patients may resist their compulsions, but usually cannot control them. Compulsions are repetitive behaviors (e.g., washing, counting, repeating, checking.) that are performed according to certain rules or in a stereotyped fashion. Violent, sexual, or blasphemous content is common. Typical examples include obsessive thoughts about germ contamination leading to illness, obsessive thoughts about making mistakes that will lead to harm. Obsessions are recurrent, intrusive thoughts, disturbing to the patient, but experienced as uncontrollable, often involving fears of harm coming to self or others. Have you had any of these kinds of fears? Screening question: Some people have an unreasonably strong fear of doing things in front of other people - like speaking in public, using public rest rooms, eating in public, or even talking to people. Some patients need social skills training. Beta-blockers have little direct impact on anxiety but can be helpful in performance situations where physical manifestations of anxiety (e.g., sweating, tremor) undermine the performance or become distractions. Try standard SSRIs or Effexor first MAOIs may be more effective. Medication is used for patients who are not likely to do well with CBT, such as those with extensively generalized or severe symptoms or co-morbid depression. Group CBT is our preferred treatment for those who are candidates for it. May have panic attacks but they are confined to situations in which the patient may be the center of attention.įirst line treatment: CBT. Patients are also generally embarrassed and avoidant, so they often won't disclose their symptoms unless specifically asked. Specific: Anxiety and avoidance of a specific, social performance situation (public speaking, using public restrooms.)Įxtremely common, can be severely debilitating, and is often minimized or ignored because social anxiety is "normal". Generalized: Excessive anxiety/distress in nearly all situations in which subject to attention, social scrutiny or evaluation Did you ever go through a period when being in any of these situations frightened you? Screening questions: Have you ever had a spell or attack when all of a sudden you felt frightened, anxious or very uneasy in situations when most people would not be afraid or anxious? In the past 6 months, have you had a spell or attack when for no reason your heart suddenly began to race, you felt faint, or you couldn't catch your breath? Some people have such an unreasonably strong fear of being in a crowd, leaving home alone, traveling on buses, cars or trains, crossing a bridge that they always get very upset in such situation or avoid it altogether. New data and APA guidelines now support CBT as a first line treatment for Panic Disorder. Must always be evaluated for depression, substance abuse, and suicidality.įirst line treatment: CBT and/or medication (SSRIs). Agoraphobic fears and avoidance help confirm the diagnosis. Temporal course of symptoms (sudden onset, rapid progression to a peak, and recovery over 5 to 30 minutes) is as important as enumeration of specific symptoms in diagnosing panic attacks. Associated with fear/avoidance of crowds, driving, being closed in, being far from home alone, etc. Panic patients become frightened of fear itself and its symptoms. Rapid onset, discrete, episodes of anxiety/distress/discomfort, accompanied by physical symptoms that are often suggestive of cardiac, endocrine or neurologic disorder. These factors are directly addressed in CBT, which is probably why it improves long-term outcomes. Lingering symptoms, vulnerability to "normal" anxiety, and stress-related intensification of symptoms and anxiety contribute to a continuous risk of relapse. When anxiety, obsessional traits, any type of behavioral rituals, significant shyness, depressive symptoms, or substance abuse are detected or suspected, then specific questions, probing for the key features described below, should be asked.Īnxiety disorders cannot be "cured." Full, functional recovery is an achievable goal, but complete resolution of symptoms and invulnerability to relapse are not expected outcomes. Patients will not present complaining of panic attacks, obsessions or compulsions, or social phobia. A significant portion of female alcoholism may be associated with panic and agoraphobia. All patients with depression and substance abuse should be screened for anxiety disorders. They can vary in their presentation and are extensively co-morbid, with other anxiety disorders and with depression and substance abuse. Anxiety disorders only infrequently occur in isolated, pure form.
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