Lecture Notes on Anxiety Disorders

Introduction

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• Content Focus: Anxiety Disorders which include:
  • Generalized Anxiety Disorder (GAD)
  • Adjustment Disorder
  • Panic Disorder
  • Specific Phobia
  • Agoraphobia
  • Social Anxiety Disorder
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive-Compulsive Disorder (OCD)

Generalized Anxiety Disorder (GAD)

• Timeline: 6+ months
• Symptoms: Excessive worry, irritability, fatigue, tension, decreased concentration, restlessness.
• Key Point: Worry is generalized, not specific to one event.
• Treatment: SSRIs, SNRIs, Cognitive Behavioral Therapy (CBT).

Adjustment Disorder

• Trigger: Specific event causing mood symptoms.
• Timeline: 0-5 months.
• Transition: Converts to GAD if symptoms persist 6+ months.
• Treatment: Start with CBT, SSRIs/SNRIs if necessary.
• Mnemonic: Adjustment Disorder is "A-just" 0-5 months.

Panic Disorder

• Timeline: 1+ months
• Symptoms: Panic attacks, palpitations, shortness of breath, feeling of impending doom.
• Key Point: Fear of future attacks, behavioral changes to avoid attacks.
• Treatment: SSRIs/SNRIs plus therapy (maintenance), Benzodiazepines for acute attacks.

Specific Phobia

• Timeline: 6+ months
• Symptoms: Intense fear of a specific object or situation.
• Treatment: Systematic desensitization (exposure therapy).

Agoraphobia

• Fear: Public spaces, crowds, closed spaces.
• Symptoms: Often comorbid with panic disorder.
• Mnemonic: "I don't want to 'a-go' anywhere".

Social Anxiety Disorder

• Fear: Embarrassment in social situations.
• Treatment:
  • Maintenance: SSRIs, CBT
  • Performance Subtype: Beta blockers for sympathetic symptoms
  • Acute: Benzodiazepines

Post-Traumatic Stress Disorder (PTSD)

• Trigger: Life-threatening event leading to trauma symptoms.
• Symptoms: Hyperarousal, avoidance, intrusive thoughts, cognitive changes.
• Timeline: 1+ months; if less, called Acute Stress Disorder.
• Treatment: SSRIs, therapy, Prazosin for nightmares.

Obsessive-Compulsive Disorder (OCD)

• Concept: Obsessions (intrusive thoughts) → Distress → Compulsions (rituals).
• Examples: Checking locks, washing hands excessively.
• Key Difference: OCD vs. OCPD (Obsessive-Compulsive Personality Disorder)
  • OCD: Ego-dystonic (aware and struggles with it).
  • OCPD: Ego-syntonic (unaware, doesn’t mind it).

Conclusion

• Review of all anxiety disorders covered.
• Encouragement to study and apply knowledge in exams like USMLE or COMLEX.