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Anxiety
Disorders
By Anu Ganapathy and Shivany Vignarajan
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Introduction

Anxiety: universal human characteristic involving tension,

apprehension or even terror due to a suspected threat

Anxiety Disorder: response to a vague or unknown threat causing

fear resulting in a functional impairment
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GENERALISED ANXIETY DISORDER
About
▪ M:F 1:2, ~30yo
▪ Presence of circumstantial thinking
▪ Tx:
▪ Lifestyle: avoidance of caffeine, EtOH,
sleep hygiene, nutrition and exercise
▪ Psychological: CBT (insight
oriented/behaviour therapy) with
relaxation techniques and mindfulness
▪ Pharmacological:
▪ SSRI or SnRI
▪ Bupropion
▪ Add on benzodiazepines
DSM V Criteria
A. Excessive anxiety and worry
occurring more days than not for
at least six months
B. The individual finds it difficult to
control the worry
C. >= 3: C-FIRST: Concentration
difficulty, fatiguability, irritability,
restlessness, sleep disturbance,
tension of muscle
D. Causes clinically significant
distress or impairment
E. Not attributed to medical
condition or substance
F. Not better explained by another
mental disorder
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PANIC DISORDER
About
▪ M:F 1:2-3, early-mid 20yo
▪ Risk factors: genetics, physical/sexual
abuse, smoking, life stressors
▪ Chronic condition but episodic with
psychosocial stressors
▪ Tx:
▪ Psychological: CBT (interoceptive
exposure,) with relaxation
techniques
▪ Pharmacological:
▪ SSRI or SnRI for up to 1 year
DSM V Criteria
A. Recurrent unexpected panic
attacks, peak reached within
10 minutes and >=4:
STUDENTS FEAR the 3 Cs
B. >=1mo of anxiety about
panic attacks
C. Not attributed to medical
condition or substance
D. Not better explained by another
mental disorder
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CASE

▪ CM 41yo F
▪ PC: anxiousness about persistent headaches
▪ HOPC: daily episodes of anxiety associated with nausea,
unilateral tingling, sweating, dyspnoea, chest pain; persistent
intermittent headache in occiput for the last few weeks which
has been a stressor, recently loss brother in law to a brain
tumour
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CASE Cont.

▪ Past Psych Hx: diagnosed with anxiety disorder in March this year following
a meeting with boss at work regarding excessive leave, following the
meeting CM had a severe panic attack requiring ED admission
▪ PMHx: unremarkable
▪ FHx: mother had anxiety
▪ Social Hx:
▪ First child at 20yo, raised daughter with support of her parents, 17yo partner
unsupportive; has two young boys <6yo born 16mo apart with current partner
▪ Admin at Bathurst Hospital
▪ Nil smoker or EtOH
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TREATMENT

▪ CBT and consistent connection with psychologist

▪ SSRI - Escitalopram
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SOCIAL ANXIETY DISORDER
▪ Underlying fear of negative evaluation

▪ DSM V Criteria
A. Marked fear/anxiety about >= 1 social situation where individual exposed to
scrutiny by others
B. Fears that they will act in a way/show anxiety symptoms that will be
negatively evaluated
C. Social situation almost always provokes fear/anxiety
D. Social situations are avoided with intense fear/anxiety
E. Fear/anxiety is out of proportion to actual threat posted by the social situation
F. Fear/anxiety persistent >= 6mo typically
G. Causes clinically significant stress
H. Not attributed to medical condition or substance
I. Not better explained by another mental disorder
J. If another med condition is present the anxiety is excessive or clearly
unrelated
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AGORAPHOBIA
▪ F:M 2:1
▪ Can occur in childhood but peaks in adolescents and early adulthood
▪ Severe form: individuals completely housebound, dependent on others for
assistance

▪ DSM V Criteria
A. Marked fear/anxiety about >= 2: using public transport, being in open spaces,
being in enclosed spaces, standing in a line/being in a crowd, being outside
home alone
B. Fears these situations because thinks escape might be difficult/help may not
be available
C. Agoraphobic situations almost always provoke fear/anxiety
D. Agoraphobic situations actively avoided
E. Fear/anxiety out of proportion; typically lasts >=6mo
F. Causes clinically significant stress
G. Not attributed to medical condition or substance
H. Not better explained by another mental disorder