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    Taking A History of Anxiety Disorders

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    Prarthana Thiagarajan
    The document provides information on taking a history for various anxiety disorders: 1) It describes the diagnostic criteria for generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), phobias, and panic disorder. 2) It provides guidance on taking a thorough history, including asking about symptoms, triggers, avoidance behaviors, depression/substance use, and impact on life. 3) Recommended treatment options for anxiety disorders generally include cognitive-behavioral therapy (CBT) and medication with SSRIs or TCAs.

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    Taking A History of Anxiety Disorders

    Uploaded by

    Prarthana Thiagarajan
    13K views5 pages
    The document provides information on taking a history for various anxiety disorders: 1) It describes the diagnostic criteria for generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), phobias, and panic disorder. 2) It provides guidance on taking a thorough history, including asking about symptoms, triggers, avoidance behaviors, depression/substance use, and impact on life. 3) Recommended treatment options for anxiety disorders generally include cognitive-behavioral therapy (CBT) and medication with SSRIs or TCAs.

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    Includes post traumatic stress disorder and OCD

    Original Title

    Taking a History of Anxiety Disorders

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    The document provides information on taking a history for various anxiety disorders: 1) It describes the diagnostic criteria for generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), phobias, and panic disorder. 2) It provides guidance on taking a thorough history, including asking about symptoms, triggers, avoidance behaviors, depression/substance use, and impact on life. 3) Recommended treatment options for anxiety disorders generally include cognitive-behavioral therapy (CBT) and medication with SSRIs or TCAs.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    13K views5 pages

    Taking A History of Anxiety Disorders

    Uploaded by

    Prarthana Thiagarajan
    The document provides information on taking a history for various anxiety disorders: 1) It describes the diagnostic criteria for generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), phobias, and panic disorder. 2) It provides guidance on taking a thorough history, including asking about symptoms, triggers, avoidance behaviors, depression/substance use, and impact on life. 3) Recommended treatment options for anxiety disorders generally include cognitive-behavioral therapy (CBT) and medication with SSRIs or TCAs.

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    Taking a History of Anxiety Disorders

    20/11/2007

    1. GAD – persistent, no phobic stimulus, must be present for at least 6


    months

    2. PTSD – symptoms ≥ 1 month after traumatic incident, must last for 1


    month

    - Trauma

    - Re-experiencing: flashbacks, nightmare

    - Avoidance

    - Hyperarousal e.g. hypervigilance

    - Blunting of affect

    3. OCD – unwanted obsessions, compulsions, INSIGHT

    - Compulsions must interfere with your life for › 1 hour/day

    - Takes an average of 9 years from onset to diagnosis

    - 17 years for correct treatment

    4. Phobias – create fear  result in AVOIDANCE

    - Agoraphobia, simple phobia, social phobia

    - Specific stimulus, panic only lasts for a specific time

    - Cannot be reasoned away (e.g. plastic spider)

    5. Panic Disorder – discrete episodes, extreme, symptoms for › 1 month

    - Often described as “fear of the fear”

    - Avoidance, drug abuse

    History

    -Always ask WHEN, WHY and HOW it started

    - Remember SEDATE
    S – symptoms

    E – episodic or continuous (if episodic, then ≠ GAD)

    D – depression, drinking, drugs (ANY symptoms of anxiety can be the effects of


    drug withdrawal)

    A – avoidance or escape

    T – triggers and timing

    E – effect on life

    Symptoms:

    Physical - ↑autonomic response

    - Hyperventilation

    - Sweating

    - Palpitation

    - Loss of sleep/memory/ concentration

    Psychological

    - Agitation

    - Irritable (e.g. do you feel like a bundle of


    nerves?/jumpy?)

    - Fear (e.g. do you feel like something terrible is going to


    happen?)

    For OCD:

    - Ask whether thoughts are THEIR OWN (psychosis….)

    - Ask e.g. do you ever get any embarrassing thought/ideas that


    you can’t get rid of / that are repeated?
    PTSD:

    - to elicit blunting of affect, ask e.g. do you feel that your emotions
    are not as strong as they used to be

    Drugs: remember to ask about caffeine and smoking also.

    Avoidance/escape: ask e.g. os there anything that you used to do that you now
    find more difficult to do?

    Treatment for anxiety disorders:

    Generally – CBT (± self-help methods)

    -SSRIs

    -TCAs

    Guidelines for the History

    1) Introduction, establish rapport etc (use the scenario synopsis)

    2) Ask open questions e.g. could you tell me a bit about what has been
    troubling you?

    3) Elicit content and attitudes

    - Are you troubling by any recurrent worrying thoughts?

    - Has something happened to you recently to trigger these thoughts?


    (PTSD)

    - Do these thoughts cause you troubling sleeping?

    - Do you have recurrent or unexpected panic attacks?

    - Are you worries about a significant change in behaviour during


    these attacks?
    - Do you avoid certain activities (e.g. meeting people,
    eating/speaking in public?)

    - Have you had the feeling that things around you were not real
    (derealisation)

    - Have you yourself felt unreal/ not living in the world?


    (depersonalisation)

    4) PTSD

    - Have you experienced a traumatic event in the past?

    - Do thoughts of (x) distress you?

    - Do you find that you re-experience that event? (flashbacks,


    nightmares)

    - Do you avoid thinking about/talking about that event

    - Do you have any trouble sleeping?

    - Do you feel constantly on –edge, as though something terrible will


    happen (hypervigilance)

    5) Elicit physiological changes

    - When you get these thoughts, or attacks, do you get

    i. Tremor

    ii. Hot flashes

    iii. Palpitations

    iv. Sweaty

    v. Dizzy

    vi. Increased breathing

    vii. Nausea

    viii. Tingling in arms/legs

    ix. Sense of impending doom

    6) Elicit past psychiatric history / medical Hx

    - e.g. screen for depression/ past psych disorder

    - chronic disease etc

    7) Family Hx – psychiatric disorders etc


    8) Drugs, alcohol, smoking Hx

    9) Assess for suicidality

    - E,g, do you feel that life is worth living?

    - Did you ever feel like ending it all?

    - What did you think that you actually might do?

    - Did you actually try it

    10)Social Hx etc

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