Anixety

• -Phobia
• -Paanic
• -Social
• -OCD
• -PTSD
• -GAD

• Anxiety
•   lifetime prevalent rate is 14.6%
•   young onset (chidhood-early adult)
•   can hav somatic symptoms
•   Can be debilitating

Pathological anxiety;excessiveness, irrationality, and physiological and/or functional impairment  

Nonpathological is a regulated adaptive behavior

hypothalmic-pituitary-adrenal axis

have been linked to genetic predisposition

Look for Family Hx of anxiety disorders.

Is tributed to enviormental influences

• GAD=exposure in early childhood.
• PTSD= a significant event

• insomnia
• chest pain or palpation
• nausea/vomiting/diarrhea= GI distress
• dyspnea
• tremors
• dizziness
• myalgia
• H/A
• hyperhydrosis
• dialted pupil
• tachycardia/>BP
• Cold/clammy

• PE
• Hyperthyroidism

• Methylphenidate (ritalin), aderal
• theophylline

• Herbal
•   Ephera

• Social drugs
•   Caffiene
•   cocaine
•   amphentamine
•   nicotine

Think of any drugs that are stimulus can cause anxiety

20% of dx anxitey disorder abuse drug as attempt to self medicate.

Clinician must first r/o any and all possible pathological and pharmological causes before estabilshing this as the dx.

• Must r/o hypoxia, hypoglycemia.
• No drug causing condition (withdraw)
• Do toxicology study

• Education
• combination of medication and therapy is most effective.
• -SRRI (first line)
•    tritrated to high dose than in depression
• -Benzodiazipine (concern of abuse)
•    rapid response
•    ideal with panic disorder with infrequent exposure
•   -specfic phobia  and in desentizing therapy
•   -use with SSRI at beggining of therapy for coverage while SSRI is being titrated. 
• Buspirone
•   -with SSRI if concern of benzo abuse or if needing to stop Ben and SSRI is inadequate
•   -SSRI and Bus for GAD and social anxiety
•   -slow acting (2-6 week) compared to Ben
•  Pyschotherapy
•    cog-behhavioral

• Alprazolam-xanax (short)
• Chloridiazepoxide-Librum (long)
• Clonazapam-Klonopin (long)
• Diazepam-Valium (long)
• Lorezapam-ativan(mid-duration)
• Oxazepam-serax (short)

• Failure to make diagnosis
• Inadequate treatment

• OCD-ritual
• Panic-agorapobia
• PTSD-sleep distrubance=functional impairment
• GAD-sleep distrubance=functional impairment
• Social-isolation

consider quality of life if anxiety is not regulated

Anxiety are at risk for depression, sub abuse, and suicide