Anxiety is a commonly experienced symptom as part of the body’s reaction to stress. It becomes a mental health disorder if exaggerated, lasts >3 weeks and interferes with daily life.
Contents
Features
- Psychological:
- Dread
- Tension
- Poor concentration
- Depersonalisation/derealisation
- Physical:
- Insomnia
- Loss of appetite
- Globus
- Diarrhoea
- Urinary urgency
- Panic:
- Palpitations
- Dizziness
- Diaphoresis
- Breathlessness
- Chest pain
- Tetany
- Co-morbid: depression, self-harm, substance misuse
Differential diagnoses
- Psychiatric: generalised anxiety disorder, panic disorder, PTSD, OCD, phobic anxiety disorder, acute stress reaction
- Endocrine: hyperthyroidism, hypoglycaemia, phaeochromocytoma
- Cardiac: ACS, arrhythmia
- Drug-induced: withdrawal
Generalised Anxiety Disorder (GAD)
- Persistent and generalised anxiety for >6 months which is not situation dependent
- Most common anxiety disorder
Panic disorder
- Recurrent and unpredictable panic attacks
- May avoid places or people that cause previous attacks
- Associated with agoraphobia
Post-traumatic stress disorder (PTSD)
- Symptoms of acute stress response to traumatic event persist for >4 weeks
- Triggers can include: abuse (physical, emotional, sexual), trauma, war, severe illness
- Features:
- Hyperarousal
- Hypervigilance
- Re-living (flashbacks, nightmares)
- Avoidance of reminders
- Emotional numbness
- Specific management: trauma-focused CBT or eye movement desensitisation reprocessing (EMDR)
Obsessive-compulsive disorder (OCD)
- Obsessions (intrusive distressful thoughts, impulses or images) lead to compulsions (ritualistic acts) to provide temporary egodystonic relief
- Usually begins in childhood or teens
- Differentiate from obsessive-compulsive personality disorder (OCPD) where rituals are egosyntonic (desirable)
- Co-morbid: depression, eating disorders, substance misuse, self-harm, Tourette’s
- Specific management: CBT including exposure and response prevention
Phobic anxiety disorders
- Agoraphobia: ‘fear of the market place’ – fear of public spaces
- Social phobia: significant fear and avoidance of social situations involving meeting people e.g. going shopping, telephone calls, eating in public
- Specific management: CBT including graded exposure therapy
Questions to consider in an anxiety history
- Confirming symptoms: “Tell me what happens when you feel anxious.” “
- Ideas: “Can you think of any reason for feeling like this?”
- Type:
- “Are you anxious all the time or certain times?”
- “Do you get intrusive thoughts you find hard to resist?
- Screen for co-morbidites: depression, substance misuse
- Risk assess: “Sometimes people who feel this overwhelmed feel the need to harm themselves, has this happened to you?”
Management (BioPsychoSocial)
- Bio:
- SSRIs
- Propranolol for physical symptoms
- Buspirone/benzodiazepines for short-term
- Psycho:
- Psychoeducation
- Self-help
- Counselling
- Individual CBT
- Social:
- Social support e.g. groups
- Financial aids
Written by Dr Muhammad Zain Haq, Psychiatry Lead (F2)
Reviewed by Dr Patrick Ezeani (Consultant Psychiatrist)
