ANXIETY….

Approach to patient – rapport, empathy

Good elicitation of anxiety symptoms
Psychological symptoms
Physical symptoms

Circumstances of anxious symptoms
Busy or crowded places
Generalised anxiety?
Social phobia?

Presence of panic disorder
Symptoms present
Frequency

Other symptoms
Avoidance
Anticipatory anxiety

Impacts on life
Restrictions on activities
General functioning

Presence of mood symptoms
General screening questions for presence of depressive symptoms
Establishes whether depressive symptoms are primary or secondary

Diagnosis of agoraphobia with panic attacks




D/D of ANXIETY DISORDER
Psychiatric disorders:
Depression
Schizo
Dementia
Drug/alcohol dependence
BDZ withdrawal

Physical disorders
Hyperthyroidism
Hypoglycaemia
Phaeochromocytoma

Manangement…
Psychological – reassurance, relaxation training, psychotherapy
Drugs – beta-blockers, BDZ
Clinical features of anxiety…
Phyiscal:
GI – dry mouth, dysphagia, epigastric pain, flatulence, diarrhoea
Respi – sensation of chest constriction, difficulty inhaling, over-breathing
CVS – palpitations, chest pain
Genitourinary – frequency, failure of erection, lack of libido
Nervous system – tinnitus, blurred vision, dizziness, headache, sleep disturbance
Psychological – apprehension and fear, irritability, difficulty concentrating, distractibility, restlessness, sensitivity to noise, depression, depersonalization, obsessional thoughts