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:

For OCD:

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?)
-

Ask whether thoughts are THEIR OWN (psychosis.)

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