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• 2. Benzodiazepines
• a. Alprazolam (2 to 6 mg)
• b. Clonazepam (0.5 to 3 mg)
• 3. Psychotherapy ( CBT )
Specific phobia
• Irrational fear of a specific object, place, or situation that is
out of proportion
• Recognized by patient to be unreasonable
• Dx is made if impairs daily activities or cause significant
distress
• Subtypes: animal type, natural environment type, blood-
injection-injury type, situational type and other type
• Treated with systematic desensitization
• No role for medication
Social Anxiety Disorder
criteria
• A. Marked and persistent fear of being humiliated or embarrassed in one
or more social situations.
• B. Exposure to the feared social situation provokes anxiety or panic attack.
• C. Person recognizes that fear is excessive or unreasonable.
• D. Social situations are avoided or endured with intense anxiety or
distress.
• E. social, occupational, academic impairment.
• F. If under 18 y/o duration at least 6 months.
• G. The fear is not due to drugs, meds, physical or mental disorder
Types of social anxiety
• generalized social phobia: fear most social
situations; fearful of initiating conversations in
many settings, dating or participating in most
group activities or social gatherings, and
speaking with authority figures.
• specific social phobia: fear specific,
circumscribed social situations, e.g. public
speaking
Differential diagnosis
• differentiation of social phobia and
agoraphobia
• social isolation that accompanies other
psychiatric disorders as depression and early
stages of psychotic disorders
Social Anxiety Disorder
treatment
• Treated with SSRI, benzodiazepines, beta-blocker.
• Psychotherapy(CBT)
1. Exposure: patients face social situations so that habituation and
extinction can occur.
2. Cognitive restructuring: challenging maladaptive assumptions and
beliefs.
3. Social skills training: skills required in social situations.
Generalized Anxiety Disorder
Criteria
• A. Excessive anxiety and worry over every aspect of life for at least
6 months
• B. Difficulty controlling the worry
• C. Anxiety and worry are associated with THREE or more of the following
symptoms:
1. restlessness
2. Being easily fatigue
3. Difficulty concentrating or mind going blank
4. Irritability
5. muscle tension
6. Sleep disturbance(difficulty falling or staying sleep)
Generalized Anxiety Disorder
Criteria Cont…
• D. The focus of the anxiety and worry is not due to: social phobia, OCD,
separation anxiety disorder, anorexia nervosa, somatization disorder,
hypochondriasis, or is not during PTSD.
• Psychotherapy
• 1. CBT is probably the best
• 2. Relaxation therapy
Post Traumatic Stress Disorder
PTSD Epidemiology
• Pulmonary disorders
-pulmonary embolism
-hypoxemia, asthma, COPD
Illnesses that cause anxiety
• Disorders of the endocrine system
-hypoglycemia
-hyperthyroidism
-hypocalcaemia
-Cushing syndrome
Illnesses that cause anxiety
• Tumors
-insulinoma
-characinoid tumor
-pheochromocytoma
• Neurologic disorders
-multiple sclerosis
-temporal lobe epilepsy
Question#1
• A patient with panic attack can become
agoraphobic if:
A. the patient has deep-seated conflicts
B. medications side effects predominate
C. a stressful experience occurs
D. patient becomes frightened of situations in
which panic attacks were experienced
Answer #1
• (A) Hypochondriasis
• (B) Obsessive-compulsive disorder
• (C) Panic disorder
• (D) Generalized anxiety disorder
• (E) Acute stress disorder
Which of the following additional signs or
symptoms is this patient most likely to show?
• (A) An antidepressant
• (B) psychotherapy
• (C) a Benzodiazepines
• (D) buspirone
Answer #9
• This patient is most likely to be suffering from
generalized anxiety disorder(GAD).