PSYCHIATRY II

Summary of Anxiety Disorders (DSM-5) S1T1

OUTLINE D. The failure to speak is not attributable to a lack of knowledge of,
I. Separation Anxiety IX. Anxiety Disorder or comfort with, the spoken language required in the social
situation.
II. Selective Mutism Due to Another E. The disturbance is not better explained by a communication
III. Specific Phobia Medical Disorder disorder (e.g., childhood onset fluency disorder) and does not
IV. Social Anxiety Disorder X. Other Specified occur exclusively during the course of autism spectrum disorder,
V. Panic Disorder Anxiety Disorder schizophrenia, or another psychotic disorder.
VI. Agoraphobia XI. Unspecified Anxiety
III. SPECIFIC PHOBIA
VII. Generalized Anxiety Disorder
DIAGNOSTIC CRITERIA
Disorder XII. Summary Table of A. Marked fear or anxiety about a specific object or situation (e.g.,
VIII. Substance/Medication- Anxiety Disorders flying, heights, animals, receiving an injection, seeing blood).
induced Anxiety XIII. Summary Table of
Disorder Treatment of Note: In children, the fear or anxiety may be expressed by crying,
Anxiety Disorders tantrums, freezing, or clinging.

B. The phobic object or situation almost always provokes

I. SEPARATION ANXIETY DISORDER
DIAGNOSTIC CRITERIA
A. Developmentally inappropriate and excessive fear or anxiety
concerning separation from those to whom the individual is
attached, as evidenced by at least three of the following:
1. Recurrent excessive distress when anticipating or experiencing
separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment
figures or about possible harm to them, such as illness, injury,
disasters, or death.
3. Persistent and excessive worry about experiencing an
untoward event (e.g., getting lost, being kidnapped, having an
accident, becoming ill) that causes separation from a major
attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to
school, to work, or elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being
alone or without major attachment figures at home or in other
settings.
6. Persistent reluctance or refusal to sleep away from home or to
go to sleep without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated complaints of physical symptoms (e.g., headaches,
stomachaches, nausea, vomiting) when separation from major
attachment figures occurs or is anticipated.
B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks
in children and adolescents and typically 6 months or more in
adults.
C. The disturbance causes clinically significant distress or
impairment in social, academic, occupational, or other important
areas of functioning.
D. The disturbance is not better explained by another mental
disorder, such as refusing to leave home because of excessive
resistance to change in autism spectrum disorder; delusions or
hallucinations concerning separation in psychotic disorders; refusal
to go outside without a trusted companion in agoraphobia; worries
about ill health or other harm befalling significant others in
generalized anxiety disorder; or concerns about having an illness in
illness anxiety disorder.
II. SELECTIVE MUTISM
DIAGNOSTIC CRITERIA
A. Consistent failure to speak in specific social situations in
which there is an expectation for speaking (e.g., at school) despite
speaking in other situations.
B. The disturbance interferes with educational or occupational
achievement or with social communication.
C. The duration of the disturbance is at least 1 month (not limited to
the first month of school).
immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with
intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger
posed by the specific object or situation and to the sociocultural
context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6
months or more.
F. The fear, anxiety, or avoidance causes clinically significant
distress or impairment in social, occupational, or other important
areas of functioning.
G. The disturbance is not better explained by the symptoms of another
mental disorder, including fear, anxiety, and avoidance of situations
associated with panic-like symptoms or other incapacitating
symptoms (as in agoraphobia): objects or situations related to
obsessions (as in obsessive-compulsive disorder); reminders of
traumatic events (as in posttraumatic stress disorder);
separation from home or attachment figures (as in separation
anxiety disorder); or social situations (as in social anxiety
disorder).
IV. SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)
DIAGNOSTIC CRITERIA
A. Marked fear or anxiety about one or more social situations in
which the individual is exposed to possible scrutiny by others.
Examples include social interactions (e.g., having a conversation,
meeting unfamiliar people), being observed (e.g., eating or
drinking), and performing in front of others (e.g., giving a speech).
Note: In children, the anxiety must occur in peer settings and not
just during interactions with adults.
B. The individual fears that he or she will act in a way or show
anxiety symptoms that will be negatively evaluated. (i.e., will be
humiliating or embarrassing: will lead to rejection or offend others).
C. The social situations almost always provoke fear or anxiety.
Note: In children, the fear or anxiety may be expressed by crying,
tantrums, freezing, clinging, shrinking, or failing to speak in social
situations.
D. The social situations are avoided or endured with intense fear
or anxiety.
E. The fear or anxiety is out of proportion to the actual threat
posed by the social situation and to the sociocultural context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6
months or more.
G. The fear, anxiety, or avoidance causes clinically significant
distress or impairment in social, occupational, or other important
areas of functioning.
H. The fear, anxiety, or avoidance is not attributable to the
physiological effects of a substance (e.g., a drug of abuse, a
medication).

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 PSYCHATRY II
Summary of Anxiety Disorders (DSM 5)
I. The fear, anxiety, or avoidance is not better explained by the
symptoms of another mental disorder, such as panic disorder,
body dysmorphic disorder, or autism spectrum disorder.
J. If another medical condition (e.g., Parkinson’s disease, obesity,
disfigurement from bums or injury) is present, the fear, anxiety,
or avoidance is clearly unrelated or is excessive.
Specify if:
Performance only: If the fear is restricted to speaking or performing
in public.
V. PANIC DISORDER
DIAGNOSTIC CRITERIA
A. Recurrent unexpected panic attacks. A panic attack is an abrupt
surge of intense fear or intense discomfort that reaches a peak
within minutes, and during which time 4 (or more) of the
following symptoms occur:
Note: The abrupt surge can occur from a calm state or an anxious
state.
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization
(being detached from oneself).
12. Fear of losing control or “going crazy.”
13. Fear of dying.
Note: Culture-specific symptoms (e.g., tinnitus, neck soreness,
headache, uncontrollable screaming or crying) may be seen. Such
symptoms should not count as one of the four required symptoms.
B. At least one of the attacks has been followed by 1 month (or more)
of one or both of the following:
1. Persistent concern or worry about additional panic
attacks or their consequences (e.g., losing control, having
a heart attack, “going crazy”).
2. A significant maladaptive change in behavior related to the
attacks (e.g., behaviors designed to avoid having panic
attacks, such as avoidance of exercise or unfamiliar
situations).
C. The disturbance is not attributable to the physiological effects
of a substance (e.g., a drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism, cardiopulmonary
disorders).
D. The disturbance is not better explained by another mental disorder.
● e.g., The panic attacks do not occur only:
o in response to feared social situations, as in social anxiety
disorder;
o in response to circumscribed phobic objects or situations, as
in specific phobia;
o in response to obsessions, as in obsessive-compulsive
disorder;
o in response to reminders of traumatic events, as in
posttraumatic stress disorder; or
o in response to separation from attachment figures, as in
separation anxiety disorder.
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VI. AGORAPHOBIA
DIAGNOSTIC CRITERIA
A. Marked fear or anxiety about two (or more) of the following five
situations:
1. Using public transportation (e.g., automobiles, buses,
trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces,
bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
B. The individual fears or avoids these situations because of
thoughts that escape might be difficult or help might not be
available in the event of developing panic-like symptoms or other
incapacitating or embarrassing symptoms (e.g., fear of falling in the
elderly, or fear of incontinence).
C. The agoraphobic situations almost always provoke fear or
anxiety.
D. The agoraphobic situations are actively avoided, require the
presence of a companion, or are endured with intense fear or
anxiety.
E. The fear or anxiety is out of proportion to the actual danger
posed by the agoraphobic situations and to the sociocultural
context.
F. The fear, anxiety, or avoidance is persistent, typically lasting for 6
months or more.
G. The fear, anxiety, or avoidance causes clinically significant
distress or impairment in social, occupational, or other important
areas of functioning.
H. If another medical condition (e.g., inflammatory bowel disease,
Parkinson’s disease) is present, the fear, anxiety, or avoidance is
clearly excessive.
I. The fear, anxiety, or avoidance is not better explained by the
symptoms of another mental disorder.
For example:
● The symptoms are not confined to specific phobia,
situational type;
● do not involve only social situations (as in social anxiety
disorder); and
● are not related exclusively to obsessions (as in obsessive-
compulsive disorder), perceived defects or flaws in physical
appearance (as in body dysmorphic disorder), reminders of
traumatic events (as in posttraumatic stress disorder), or
fear of separation (as in separation anxiety disorder).
Note: Agoraphobia is diagnosed irrespective of the presence of panic
disorder. If an individual’s presentation meets criteria for panic disorder
and agoraphobia, both diagnoses should be assigned.
VII. GENERALIZED ANXIETY DISORDER
DIAGNOSTIC CRITERIA
A. Excessive anxiety and worry (apprehensive expectation), occurring
more days than not for at least 6 months, about a number of events
or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with 3 (or more) of the
following 6 symptoms (with at least some symptoms having been
present for more days than not for the past 6 months).
Note: Only one item is required in children.
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 (difficulty falling or staying asleep, or
restless, unsatisfying sleep).
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Summary of Anxiety Disorders (DSM 5)
D. The anxiety, worry, or physical symptoms cause clinically significant
distress or impairment in social, occupational, or other important areas
of functioning.
E. The disturbance is not attributable to the physiological effects of a
substance another medical condition.
F. The disturbance is not better explained by another mental disorder.
Examples of Another Medical Condition:
• anxiety or worry about having panic attacks in panic disorder
• negative evaluation in social anxiety disorder [social phobia]
• contamination or other obsessions in obsessive-compulsive
disorder
• separation from attachment figures in separation anxiety
disorder
• reminders of traumatic events in posttraumatic stress disorder
• gaining weight in anorexia nervosa
• physical complaints in somatic symptom disorder
• perceived appearance flaws in body dysmorphic disorder
• having a serious illness in illness anxiety disorder
• content of delusional beliefs in schizophrenia or delusional
disorder
VIII.SUBSTANCE/MEDICATION-INDUCED ANXIETY DISORDER
DIAGNOSTIC CRITERIA
A. Panic attacks or anxiety is predominant in the clinical picture.
B. There is evidence from the history, physical examination, or
laboratory findings of both (1) and (2):
1. The symptoms in Criterion A developed during or soon after
substance intoxication or withdrawal or after exposure to a
medication.
2. The involved substance/medication is capable of producing the
symptoms in Criterion A.
C. The disturbance is not better explained by an anxiety disorder
that is not substance/ medication-induced. Such evidence of an
independent anxiety disorder could include the following:
• The symptoms precede the onset of the
substance/medication use
• The symptoms persist for a substantial period of time (e.g.,
about 1 month) after the cessation of acute withdrawal or
severe intoxication
• There is other evidence suggesting the existence of an
independent non-substance/medication-induced anxiety
disorder (e.g., a history of recurrent non-
substance/medication-related episodes).
D. The disturbance does not occur exclusively during the course
of a delirium.
E. The disturbance causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
Coding note: Include the name of the other medical condition within the
name of the mental disorder. The other medical condition should be
coded and listed separately immediately before the anxiety
disorder due to the medical condition.
X. OTHER SPECIFIED ANXIETY DISORDER
DIAGNOSTIC CRITERIA
• This category applies to presentations in which symptoms
characteristic of an anxiety disorder that cause clinically
significant distress or impairment in social, occupational, or
other important areas of functioning predominate but do not meet
the full criteria for any of the disorders in the anxiety disorders
diagnostic class.
• The other specified anxiety disorder category is used in situations
in which the clinician chooses to communicate the specific
reason that the presentation does not meet the criteria for any
specific anxiety disorder.
• This is done by recording “other specified anxiety disorder” followed
by the specific reason (e.g., “generalized anxiety not occurring
more days than not”).
• Examples of presentations that can be specified using the “other
specified” designation include the following;
1. Limited-symptom attacks.
2. Generalized anxiety not occurring more days than not.
3. Khyâl cap (wind attacks)
4. Ataque de nervios (attack of nerves)
XI. UNSPECIFIED ANXIETY DISORDER
DIAGNOSTIC CRITERIA
• This category applies to presentations in which symptoms
characteristic of an anxiety disorder that cause clinically significant
distress or impairment in social, occupational, or other important
areas of functioning predominate but do not meet the full criteria for
any of the disorders in the anxiety disorders diagnostic class.
• The unspecified anxiety disorder category is used in situations in
which the clinician chooses not to specify the reason that the
criteria are not met for a specific anxiety disorder, and includes
presentations in which there is insufficient information to make
a more specific diagnosis (e.g., in emergency room settings).
REFERENCES
• DSM-V

Note: This diagnosis should be made instead of a diagnosis of

substance intoxication or substance withdrawal only when the
symptoms in Criterion A predominate in the clinical picture and they
are sufficiently severe to warrant clinical attention.

IX. ANXIETY DISORDER DUE TO ANOTHER MEDICAL CONDITION

DIAGNOSTIC CRITERIA
A. Panic attacks or anxiety is predominant in the clinical picture.
B. There is evidence from the history, physical examination, or
laboratory findings that the disturbance is the direct
pathophysiological consequence of another medical
condition.
C. The disturbance is not better explained by another mental
disorder.
D. The disturbance does not occur exclusively during the course
of a delirium.
E. The disturbance causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.

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Summary of Anxiety Disorders (DSM-5) S1T1
XII. SUMMARY TABLE OF ANXIETY DISORDERS
Anxiety Definition
Disorder
Separation Developmentally inappropriate and
anxiety excessive fear or anxiety concerning
separation from those to whom the
individual is attached.
Selective Consistent failure to speak in social
mutism situation in which there is an expectation to
speak even though the individual speaks in
other situations
Specific ▪ Fearful or anxious about or avoidant
phobia of circumscribed objects or
situations.
▪ Irrational fear
Social ▪ Involves the fear of social situations,
anxiety including situations that involve
disorder scrutiny or contact with strangers.
▪ The fear in social anxiety disorder is
of the embarrassment that may occur
in the situation, not of the situation
itself.
Panic An acute intense attack of anxiety
disorder accompanied by feelings of impending
doom that reach a peak within minutes
accompanied by physical and/or
cognitive symptoms
Agoraphobia Refers to a fear of or anxiety regarding
places from which escape might be difficult
(open spaces, enclosed spaces, standing
in line/being in crowd, being outside alone)
Generalized Excessive anxiety and worry (apprehensive
Anxiety expectation) about a number of events or
Disorder activities (such as work or school
performance)
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Required No. of Duration Differential Diagnosis Other Remarks
Symptoms
3 or more ▪ At least 4 ▪ Autism Spectrum Disorder Onset of separation anxiety disorder
weeks in ▪ Generalized anxiety disorder may be as early as preschool age
children and ▪ Panic disorder and may occur at any time during
adolescents ▪ Agoraphobia childhood and more rarely in
▪ At least 6 ▪ Illness Anxiety Disorder adolescence.
months in
adults
None At least 1 month ▪ Communication disorders In clinical settings, children with
▪ Neurodevelopmental disorders selective mutism are almost always
▪ Schizophrenia and other given an additional diagnosis of
psychotic disorders another anxiety disorder-most
▪ Social anxiety disorder commonly, social anxiety disorder
None At least 6 months ▪ Agoraphobia Specific phobia tends to run in
▪ Social anxiety disorder families. The blood-injection-injury
▪ Separation anxiety disorder type has a particularly high familial
▪ Panic disorder tendency.
▪ Obsessive-compulsive disorder
None At least 6 months ▪ Normative shyness Social anxiety disorder tends to
▪ Agoraphobia have its onset in late childhood or
▪ Panic disorder early adolescence. Existing
▪ Generalized anxiety disorder prospective epidemiological findings
▪ Separation anxiety disorder indicate that social anxiety disorder
▪ Specific phobia is typically chronic, although
▪ Selective mutism patients whose symptoms do remit
▪ Major depressive disorder tend to stay well.
▪ 4 or more in At least 1 month ▪ Medical conditions The attack often begins with a 1 0-
criterion A ▪ Hyperthyroidism minute period of rapidly increasing
▪ At least 1 in ▪ Hyperparathyroidism symptoms. The major mental
criterion B ▪ Pheochromocytoma symptoms are extreme fear and a
▪ Vestibular dysfunctions sense of impending death and
▪ Seizure disorders doom. Patients usually cannot
name the source of their fear; they
may feel confused and have trouble
concentrating.
2 or more in Criterion A At least 6 months ▪ Specific phobia, situational type It can be the most disabling of the
▪ Separation anxiety disorder phobias because it can significantly
▪ Social anxiety disorder interfere with a person's ability to
▪ Panic disorder function in work and social
situations outside the home.
3 or more At least 6 months ▪ Panic disorder Most often coexists with another
▪ Social anxiety disorder mental disorder such as social
▪ Obsessive-compulsive disorder phobia, specific phobia, panic
▪ Separation anxiety disorder disorder, or a depressive disorder.
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 PSYCHATRY II
Summary of Anxiety Disorders (DSM 5)
XIII. SUMMARY TABLE OF TREATMENT OF ANXIETY DISORDERS

ANXIETY DISORDER PHARMACOLOGICAL TREATMENT NON-PHARMACOLOGICAL TREATMENT

Specific phobia If associated with panic attacks: • Behavior therapy
• Beta-adrenergic receptor antagonists o Most studied and most effective for phobias in general
• Benzodiazepines • Exposure therapy
o Alprazolam (Xanax); initial dose 0.25 mg TID; daily dose 1-4 mg o Common treatment for specific phobia
o Lorazepam (Ativan); initial dose 0.5 mg TID; daily dose 2-6 mg o Desensitizes patients by using gradual, self-paced exposures to the
phobic stimuli, and they teach patients techniques (breathing control,
relaxation and cognitive approaches) to deal with it
• Insight-oriented psychotherapy
• Hypnosis, supportive therapy and family therapy
Social anxiety disorder • 1st line: SSRI - Paroxetine • Combination of behavioral & cognitive technique
• 2nd line: SNRI - Venlafaxine (Effexor) o Desensitization
o 75 to 150mg once daily o Rehearsal during sessions
o Should be taken with food. o Homework assignments
o Useful in panic disorder with depression.
o DOC for mixed anxiety-depressive disorder.
• 3RD line: MAOIs
o Moclobemide 300-600 mg daily
o Phenelzine, Tranylcypromine
• Augmenting agent:
o Benzodiazepines (Alprazolam, Lorazepam)
• Buspirone (additive)
Panic disorder • 1st line: SSRI • Cognitive therapy
From Kaplan: o Paroxetine (Seroxat) o The two major foci of cognitive therapy for panic disorder are
• Begin treatment ▪ 5 or 10mg a day for 1-2 weeks; increase dosage by 10mg a instruction about a patient's false beliefs and information about
with paroxetine, day every 1-2 weeks to a maximum of 60 mg panic attacks.
sertraline, o Fluoxetine (Prodin) o The instruction about false beliefs centers on the patient's tendency to
citalopram, or ▪ Initially 20mg daily, may be increased up to 60mg daily misinterpret mild bodily sensations as indicating impending panic
fluvoxamine in ▪ Effective for panic with co-morbid depression. attacks, doom, or death.
isolated panic ▪ Ci: severe hepatic & renal failure. o The information about panic attacks includes explanations that when
disorder. o Escitalopram (Lexapro) panic attacks occur, they are time limited and not life threatening.
• If rapid control of ▪ Initially 5mg daily for the 1st week then increase to 10mg daily. • Behavior Therapy
severe symptoms ▪ Max: 20mg daily. o Techniques include positive and negative reinforcement, systematic
is desired: • 2nd line SNRI: Venlafaxine (Effexor) desensitization, flooding, implosion, graded exposure, response
alprazolam prevention, stop thought, relaxation techniques, panic control therapy,
• Benzodiazepines
concurrently with self-monitoring, and hypnosis.
o Alprazolam most widely used; equal efficacy with Lorazepam
the SSRI followed • Combination of cognitive or behavior therapy with pharmacotherapy is more
by slowly tapering o Alprazolam (Xanax); initial dose 0.25 mg TID; daily dose 1-4 mg
effective than either approach alone.
use of the o Lorazepam (Ativan); initial dose 0.5 mg TID; daily dose 2-6 mg
benzodiazepine. o Can be used as the first agent for treatment of panic disorder while
• In long-term use, a serotonergic drug is being slowly titrated to a therapeutic dose
fluoxetine (Prozac) o After 4 to 1 2 weeks, benzodiazepine use can be slowly tapered
for panic with (over 4 to 1 0 weeks) while the serotonergic drug is continued.
comorbid • Alternative:
depression o TCA: Clomipramine (Anapranil): 25 to 100mg/day
• 8-12 months tx o MAOI: Phenelzine, Tranylcypromine
duration

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Summary of Anxiety Disorders (DSM 5)
ANXIETY DISORDER PHARMACOLOGICAL TREATMENT NON-PHARMACOLOGICAL TREATMENT

Agoraphobia • Tricyclic and tetracyclic drugs • Supportive psychotherapy

• Benzodiazepines have o Clomipramine and imipramine are the most effective in the treatment of these disorders. o Adaptive defenses are encouraged and
the most rapid onset of o Dosages must be titrated slowly upward to avoid overstimulation (e.g., "jitteriness" syndrome), strengthened, and maladaptive ones are
action against panic. o Full clinical benefit requires full dosages and may not be achieved for 8 to 1 2 weeks. discouraged.
• Benzodiazepines o The therapist assists in reality testing and may
o Alprazolam (Xanax) and Lorazepam (Ativan) are the most commonly prescribed offer advice regarding behavior.
benzodiazepines. • Insight-oriented psychotherapy
o Alprazolam (Xanax); initial dose 0.25 mg TID; daily dose 1-4 mg o goal is to increase the patient's development of
o Lorazepam (Ativan); initial dose 0.5 mg TID; daily dose 2-6 mg insight into psychological conflicts that, if
o Clonazepam (Klonopin); initial dose 0.25 mg bid; daily dose 1-3 mg unresolved, can manifest as symptomatic
o Potential for dependence, cognitive impairment, and abuse, particularly with long-term use. behavior.
o Side Effects: mild dizziness and sedation • Behavior therapy
• SSRI • Cognitive therapy
o Help reduce or prevent relapse from various forms of anxiety, including agoraphobia. o Treatment is short term and interactive, with
o Effective doses are essentially the same as for the treatment of depression, although it is assigned homework and tasks to be performed
customary to start with lower initial doses than in depression to minimize an initial anxiolytic between sessions that focus on correcting
effect, which is almost always short lived, and to titrate upward somewhat slower toward a distorted assumptions and cognitions. The
therapeutic dose. emphasis is on confronting and examining
o Side Effects: sleep disturbance, drowsiness, lightheadedness, nausea, and diarrhea situations that elicit interpersonal anxiety and
associated mild depression.
• Virtual therapy
o Computer programs have been developed that
allow patients to see themselves as avatars who
are then placed in open or crowded spaces (e.g., a
supermarket).
Generalized anxiety • Benzodiazepines (DOC) • Cognitive-behavioral therapy
disorder o Alprazolam, Clonazepam, Lorazepam • Supportive therapy
From Kaplan: • Antidepressants • Insight-oriented therapy
• The decision to o Fluoxetine (Prozac); initial dose 5mg/day; daily dose 20-80mg; can transiently increase anxiety
prescribe an anxiolytic and cause agitated states.
to patients with o For this reason, the sertraline, citalopram, or paroxetine are better choices in patients with
generalized anxiety high anxiety disorder.
disorder should rarely o Venlafaxine: for insomnia, poor concentration, restlessness, irritability, and excessive muscle
be made on the first tension in GAD
visit. Because of the • Buspirone
long-term nature of the o Reduces cognitive symptoms of GAD; but takes 2-3 weeks for effects to be evident
disorder, a treatment • Although drug treatment is sometimes seen as a 6- to 12-month treatment, some evidence indicates
plan must be carefully that treatment should be long term, perhaps lifelong.
thought out.

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