let's talk about anxiety anxiety is an unpleasant mental state where you worry about the possibility of future dangers or upsetting events anxiety manifests physiologically psychologically and behaviorally with specific signs and symptoms including an increased heart rate pessimistic thought patterns and avoidance of particular places or situations while it's definitely unpleasant anxiety is not intrinsically harmful or pathological in fact anxiety is often adaptive by allowing us to predict possible negative outcomes and take steps to avoid them like someone who begins going to the gym and eating a better diet due to anxiety about becoming unhealthy in this way anxiety is similar to pain both are experienced as distressing and unpleasant but both serve a practical purpose by motivating us to avoid harmful things or situations however for some people anxiety becomes extreme and excessive to the point that it's no longer helpful but instead causes the person to act in a way that's maladaptive these people are said to be suffering from anxiety disorders in this video we'll talk about how to recognize anxiety and then discuss how to diagnose and treat various anxiety disorders that each present differently anxiety is both a state and a trait meaning that it can be both an immediate mental state in response to current circumstances as well as a chronic and enduring disposition towards anxiety anxiety can also manifest differently depending on whether it's experienced as an acute state or as a chronic trait we'll look at each of these in turn acute anxiety presents with both physiological signs like a fast heartbeat or excessive sweating as well as psychological symptoms including racing thoughts or feelings of impending doom the complete list of signs and symptoms in acute anxiety are in the mnemonic student sphere seas which stands for sweating trembling unsteadiness or dizziness dissociation elevated heart rate nausea tingling shortness of breath fear of dying losing control or going crazy chest pain chills and choking sensations all of these symptoms are seen during a panic attack which we will discuss further later in this video you can easily link this mnemonic to anxiety by thinking of a med student having a panic attack because they think that they've gotten c on their test in contrast the signs and symptoms of chronic anxiety are less immediate but can still be highly distressing you can remember these using the mnemonic miserable which stands for muscle tension irritability difficulty with sleep low energy restlessness and poor attention other psychological symptoms including ruminative thoughts and somatic complaints are very common as well keep both students fear seized and miserable in mind as each one will pop up again as we talk about the specific anxiety disorders that are seen in clinical practice for the time being however we're going to lump all anxiety disorders together and talk about who gets them what happens once they're diagnosed with it and what forms of treatment we can offer after that we'll separate them out into their individual disorders anxiety disorders are common with over 10 of people having met criteria for one within the past year and up to 30 percent of all people meeting criteria for one during their lifetime this makes anxiety disorders the most common group of mental disorders although depression is still the most common single mental disorder this gives anxiety a high base rate in the population making it liable to under diagnosis as with depression women are diagnosed with anxiety disorders more than twice as often as men anxiety disorders often begin during childhood and adolescence with almost all cases beginning before the age of 25. without treatment anxiety disorders tend to become chronic and persist throughout life rather than being episodic in the same way that mood disorders are while some degree of anxiety is almost always present for someone with an anxiety disorder there is often a natural waxing and waning of severity from day to day or even year to year the overall severity of symptoms often tends to level off with aging as the prevalence of clinically significant anxiety disorders begins to decrease after the age of 55 however some degree of impairment often remains even into old age while anxiety disorders are associated with the lower risk of suicide compared to mood disorders the risk is still present in addition untreated anxiety disorders can potentially lead to even more social and occupational disability than mood disorders by virtue of there being a chronic rather than episodic disorder the disability associated with depression for example often resolves once the depressive episode ends whereas for an anxiety disorder the dysfunction can continue unabated for years on end when talking about treatment it's important to note that the goal in diagnosing and treating anxiety disorders is not to eliminate anxiety altogether as a life that is completely free of anxiety would likely be equally problematic instead the goal should be to restore a pattern in which anxiety is a helpful signal rather than a harmful one as with most mental disorders treatment involves either psychotherapy and or medications however in contrast to depression where either medications therapy or both are appropriate or bipolar disorder in schizophrenia where medications are almost always used with therapy being more of an add-on for anxiety disorders therapy should almost always be the first line treatment cognitive behavioral therapy or cbt is considered to be the most effective treatment for the majority of anxiety disorders and it's associated with enduring improvements that last even long after the patient has completed therapy medications should be used more sparingly as they tend to have smaller and more transient effects on anxiety antidepressants like ssris are the most commonly used as they not only help to reduce the intensity of chronic anxiety but also help to reduce the frequency and severity of acute anxiety and tax however research shows that they are only about half as effective as cpt a different class of medication known as benzodiazepines are often used for acute treatment of panic attacks as they are incredibly effective at rapidly inducing a state of calm however they should not be used for chronic treatment of any anxiety disorder as they tend to actually worsen long-term outcomes the problem with benzos is that the brain gets used to them and starts relying on them ultimately making the patient more susceptible to anxiety when they're off the drug they're also memory impairing which can interfere with the patient's ability to engage in and learn from cbt because of this benzo should be avoided for chronic treatment of anxiety in most cases thus far we've treated anxiety disorders as a group but now let's split them apart into their individual disorders as defined in the dsm including generalized anxiety disorder panic disorder specific phobias and social anxiety disorder to learn about generalized anxiety disorder or gad let's use the mnemonic to diagnose gid think of the phrase eek ads i'm miserable the first part captures the core thought patterns seen in this disorder specifically that the patient experiences excessive and generalized anxiety that is chronic occurring on most days for at least six months what does it mean for anxiety to be excessive and generalized it means that it's clearly out of proportion to the level of anxiety that most people experience and that involves worries in multiple areas of life including work home family friends finances health politics and transportation for example someone with uad may end up having problems with romantic relationships due to anxiety about being cheated on difficulty at work due to worries about being fired trouble getting around due to nervousness about car crashes and even difficulty buying a house due to fear of earthquakes or hurricanes these worries are not only distressing to the patient but can also result in significant impairment as they can prevent someone from engaging in the very parts of life that most people find the most meaningful the second part of the mnemonic the phrase i'm miserable will remind you that patients with gad also suffer from the physical and psychological symptoms of chronic anxiety that we talked about earlier including muscle tension irritability impaired sleep low energy restlessness and poor attention the dsm requires three or more of these symptoms to be present to diagnose gad the fact that this phrase is split into two parts will help you remember that there are two key components of gid you need both the anxious thought patterns and the specific symptoms without treatment gid tends to persist for years if not decades treatment for gid consists of cbt which is very effective medications can be used as well with ssris and a medication known as buspirone both being effective although to a lesser extent than cbt next let's talk about panic attacks a panic attack is a brief period of intense mental and physical discomfort that results from sudden and overwhelming activation of the fear response symptoms during the panic attack include all the symptoms from the student sphere seize mnemonic that we talked about earlier in fact these symptoms are so linked to panic attacks that the dsm lists these as the core diagnostic criteria these symptoms tend to follow a crescendo decrescendo pattern where they peak within a few minutes and then slowly subside after that panic attacks typically last for five to ten minutes although they can be as short as one minute or as long as an hour panic attacks are common with over 25 percent of all people having had one in their lifetime however while they're incredibly uncomfortable panic attacks are not automatically an anxiety disorder and many people will have only a few panic attacks in their lifetime and not be severely affected as a result however for about one in six people who have panic attacks they become frequent and severe enough that the patient's life begins to be affected as a result including living in fear of the next attack or avoiding places where they've had attacks before including work school or the grocery store this is when panic disorder emerges as the constant anxiety and avoidance of places can become incredibly impairing and directly impact one's ability to lead a normal life you can remember the overall pattern of panic disorder by thinking of the word surprise which stands for sudden unexpected and recurrent panic attacks that give rise to excessive and dysfunctional anxiety even between attacks just having panic attacks is not enough for this diagnosis you need both the serp and the rise on an acute basis benzodiazepines are very effective at rapidly ending panic attacks however despite their efficacy for short-term treatment over the long term chronic use of benzos often makes panic attacks more frequent and severe like most anxiety disorders the best treatment for panic disorder is cbt with the vast majority of patients achieving full remission from panic attacks within several months of starting treatment and maintaining these benefits even years after finishing therapy ssris are moderately helpful for reducing the frequency and severity of panic attacks when taken daily but they should generally be used in conjunction with cbt for maximum effect to finish off our discussion of panic disorder let's talk about agoraphobia this is a specific response to having panic attacks where somebody begins to avoid going out at all preferring to stay in the safety of their own home where they feel less vulnerable to panic attacks in severe cases someone with agoraphobia may not have left their house for several years agoraphobia develops in around a quarter of all people with panic disorder it's generally considered to be a marker of severe panic disorder with a lower recovery rate and less effect from treatment nevertheless the same treatment strategy should still be tried with cbt being the gold standard the next anxiety disorder we'll talk about is a specific phobia these are characterized by an intense fear of a specific object or situation that approaches the level of or can even turn into a full-blown panic attack specific phobias involve a variety of feared objects each with its own fun to memorize name like ophidiophobia or fear of snakes the lassophobia or fear of the ocean nyctophobia or fear of the dark and trypanophobia or fear of needles many people with a specific phobia will put forth significant effort to avoid any situation that could possibly result in exposure to the feared stimulus such as a person with the fear of bridges driving two extra hours per day to avoid going over the bridge that's the shortest route between their home and their work specific phobias are common with around 10 percent of people having one at some point during their life they usually begin in childhood or adolescence and affect women twice as often as men treatment consists of a specific type of cbt known as exposure therapy in which the patient is intentionally exposed to the object of their fear with gradually increasing intensity for example someone with a fear of birds may first draw a silly picture of a bird until they no longer feel afraid looking at it at which point they may progress to playing with the toy bird until they are desensitized to that as well at which point they would then progress to looking at pictures of real birds the goal of exposure therapy is to make the patient feel uncomfortable but not overwhelmed so that they can gradually be able to tolerate being in the presence of the object of their fear exposure therapy is extremely effective at treating specific phobias with a robust effect and benefits that last even after the therapy is completed in contrast to gad and panic disorder medications do not play a significant role in treating specific phobias finally the last anxiety disorder we'll talk about is social anxiety disorder unlike generalized anxiety disorder the anxiety and social anxiety disorder is focused entirely around one specific area the possibility of interpersonal judgment or rejection people with social anxiety disorder constantly worry that they will say or do something embarrassing leading to severe discomfort during even routine social situations this leads the patient to develop specific beliefs such as the thought that i'm unlikable boring and stupid as well as coping strategies like avoiding most or even all social situations people with social anxiety disorder often have particularly pronounced anxiety about specific situations like public speaking or musical performance that could potentially invite criticism for many people at once social anxiety disorder is common affecting around 10 of the population it must be carefully differentiated from introversion or shyness which are completely normal personality traits diagnosing social anxiety disorder can have positive effects by providing a pathway for treatment as cbt for social anxiety disorder is very effective and produces long-lasting results antidepressants like ssris can also help but should generally be seen as a second line intervention and that's it those are the main anxiety disorders you'll need to know take a moment to compare and contrast the disorders we've learned about here with a particular focus on evaluating whether they're constant or episodic and whether they're specific or generalized if you're interested in learning more about anxiety disorders and how they compare to other disorders in psychiatry consider picking up my book memorable psychiatry on amazon it includes some practice questions to help test your knowledge as well the link is in the description below if you like these videos consider subscribing as well thanks for watching and see you again 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