ANXIETY DISORDERS




Generalized Anxiety

persistent worry without specific cause

associated with insomnia, drug and alcohol use, poor concentration

more common among woman than men, at least 5% of population will experience

onset commonly in teens or 20s and disorder tends to be life-long


Panic Attacks

sudden, unpredictable, overwhelming episodes of anxiety, that seldom last more than a few hours

associated with tachycardia, palpitations, diaphoresis, chest pain, nausea, pallor, shortness of breath, tremulousness and sense of impending doom (presentation can be identical to heart attack)

many patients fear that they are having a heart attack or going crazy

can be loosely associated with certain situations (crowds, vehicles, being home alone), leading to avoidance of activities, especially those that would be difficult to leave

associated with depression and alcohol and drug use

approximately 1.5% of the population has frequent panic attacks


Phobias

irrational panic in response to certain stimuli (heights, snakes, needles, elevators)

patients often realize that their fear is unreasonable, yet will go to great lengths to avoid stimuli

onset common in childhood or teens

social phobia is very common


Agoraphobia

avoidance of panic-inducing stimuli to the extent that it limits normal life

leads to avoidance of crowds, buses, planes, stores, people.....some patients cannot leave home

untreated panic attacks tend to progress to agoraphobia


Post Traumatic Stress Disorder (PTSD)

occurs after a major traumatic event (war, victim of attempted murder, witness loved ones death)

onset often delayed months after the initial event

persistent, involuntary, hallucinatory recollections of traumatic event (flash-backs)

avoidance of reminders of event to avoid flashbacks

persistent symptoms of anxiety: jumpiness, insomnia, irritability, poor concentration

associated with drug and alcohol abuse (often attempt to "self medicate")


Obsessive-Compulsive Disorder (OCD)

a patient has bizarre compulsions to complete certain tasks (such as counting all the steps, not stepping on sidewalk cracks, hand washing) that the patient realizes are useless and embarrassing

failure to act out compulsions leads to intolerable anxiety

slightly more common in women, onset in childhood or early adulthood


Treatment

Benzodiazepines

Other

Short-acting

Long-acting

Xanax (alprazolam)

Valium (diazepam)

SSRIs

Serax (oxazepam)

Librium (chlordiazepoxide)

Ativan (lorazepam)

Tranxene (clorazepate)

BuSpar

Klonopin (clonazepam)



Side-effects

the benzodiazepines are sedating and addictive





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