THERE ARE 14 DISORDERS CONTAINED IN THE DSM IV TR SECTION OF
ANXIETY DISORDERS Panic Attack Agoraphobia Panic Disorder without
Agoraphobia Panic Disorder with Agoraphobia Agoraphobia without
history of Panic Disorder Specific Phobia Social Phobia
Obsessive-Compulsive Disorder Posttraumatic Stress Disorder Acute
Stress Disorder Generalized Anxiety Disorder Anxiety Disorder due
to a General Medical Condition Substance-Induced Anxiety Disorder
Anxiety Disorder not otherwise specified``
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GENERAL FACTS ABOUT ANXIETY DISORDER Anxiety disorders are the
most common mental illness in the US more than 23 million Americans
are affected Anxiety Disorders are most common for women, affecting
approximately 30% of the female population at some point in their
lives. Initial Manifestations appear at age 20 to 35 years, but
children and adolescents can be affected. High levels of Anxiety
can exacerbate a wide variety of medical conditions (e.g., gastric
ulcers, asthma, hypertension, and seizure d/o).
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AN INNOCENT FAMILY BBQ OR IS THIS A SITUATION THAT COULD LEAD
TO A SITUATIONAL PHOBIA?
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PANIC ATTACK 1.Palpitations, pounding heart, or accelerated
heart rate 2.Sweating 3.Trembling or shaking 4.Sensations of
shortness of breath or smothering 5.Feeling of choking 6.Chest pain
or discomfort 7.Nausea or abdominal distress 8.Feeling dizzy,
unsteady, lightheaded, or faint. 9.Derealization (feelings of
unreality) or depersonalization (being detached from oneself)
10.Fear of losing control or going crazy 11.Fear of dying
12.Paresthesias (numbness or tingling sensations) 13.Chills or hot
flushes
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GENERALIZED ANXIETY DISORDER (INCLUDES OVERANXIOUS DISORDER OF
CHILDHOOD) DIAGNOSTIC CRITERIA 300.02 Excessive anxiety and worry
occurring more days than not for at least 6 months, about a number
of events or activities (such as work or school performance). The
anxiety and worry are associated with three (or more) of the
following: 1.Restlessness or feeling keyed up or on edge 2.Being
easily fatigued 3.Difficulty concentrating or mind going blank
4.Irritability 5.Muscle tension 6.Sleep disturbance
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GAD INTERVIEWING ISSUES Very little is known about GADs natural
history, etiology and predisposing factors. Some experts believe
that GAD is not a specific disorder, but merely a residual category
for the other specified Anxiety Disorders.
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PANIC DISORDER Panic Disorder runs in families. About 20% of
patients with Panic d/o identify 1 st degree relatives with Panic
d/o. A Panic Attack usually occurs during an unusually stressful
period. Caffeine produces Panic Attacks in 71% of patients with
Panic d/o. Stopping caffeine reduces the frequency and intensity of
Panic Attacks.
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SOCIAL PHOBIA Is a marked and persistent fear of one or more
social or performance situations in which embarrassment or
humiliation may occur.
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SPECIFIC PHOBIA DIAGNOSTIC CRITERIA 300.29 A. Marked and
persistent fear that is excessive or unreasonable, (e.g., flying,
heights, animals, seeing blood, and injections). B. Exposure to
phobic stimulus provokes an immediate anxiety response. C. The
person recognizes that the fear is excessive or unreasonable. Note:
In children this feature may be absent. D. The phobic situation is
avoided or endured with intense anxiety or distress. E. Significant
Interference with the persons normal functioning. F. In individuals
under age 18 years, the duration is at least 6 months. G. The
anxiety, Panic Attacks, or phobic avoidance with specific object or
situation are not better accounted for by another mental
disorder
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OPHIDIOPHOBIA OR OPHIOPHOBIA IS A PARTICULAR TYPE OF SPECIFIC
PHOBIA, THE ABNORMAL FEAR OF SNAKES. FEAR OF SNAKES IS SOMETIMES
CALLED BY A MORE GENERAL TERM, HERPETOPHOBIA, FEAR OF REPTILES
AND/OR AMPHIBIANS. THIS IS A FEAR THAT THIS LADY OBVIOUSLY DOES NOT
HAVE.SPECIFIC PHOBIASNAKESHERPETOPHOBIAREPTILESAMPHIBIANS
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AGORAPHOBIA Anxiety about, or avoidance of places or situations
from which escape might be difficult or embarrassing in which help
may not be available in the event of a Panic Attack or Panic-Like
symptoms.
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POSTTRAUMATIC STRESS DISORDER DIAGNOSTIC CRITERIA 309.81 The
development of symptoms following exposure to an extreme traumatic
stressor that involves actual or threatened death or serious
injury, or witnessing an event that involves actual or threatened
death, or injury
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ANXIETY DISORDER DUE TO A GENERAL MEDICAL CONDITION DIAGNOSTIC
CRITERIA 293.84 Anxiety, Panic Attacks, or obsessions or
compulsions are due to the physiological consequence of a general
medical condition.
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SUBSTANCE-INDUCED ANXIETY DISORDER The Anxiety symptoms are due
to the direct physiological effects of a substance (i.e., drug
abuse, medication, or toxin exposure)
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INTERVIEWING ISSUES One of the most difficult task in
interviewing is differentiating Anxiety from Depression, primarily
because of the frequency of mixed anxiety and depressive symptoms
Patients complaining of anxiety who have definite symptoms of
depressive syndrome should be treated as having depression Patients
with Anxiety disorder are usually seen in medical care or substance
abuse treatment settings, but It is important to recognize anxiety
syndromes in patients in these settings who are not complaining of
it. In diagnosing an anxiety syndrome, there should be a presence
of both psychological and physiological symptoms
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ANXIETY DISORDER {NOT OTHERWISE SPECIFIED} It is all so
important during an interview to distinguish between General
Anxiety disorder and Anxiety disorder Not Otherwise Specified
(NOS).
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REFERENCES American Psychiatric Association. (2000). Diagnostic
and Statistical Manual of Mental Disorders (4 th ed.). Text
Revision. Washington, DC: American Psychiatric Association.
Butcher, J. N., Mineka, S., Hooley, J. M., (2004). Abnormal
psychology (12 th ed.). Boston, MA: Pearson Education, Inc. Maxmen,
J. S., Ward, N. G. (1995). Essential psychopathology and its
treatment (2 nd ed.). Revised for DSM-IV. New York, NY: W.W. Norton
& Company, Inc.