Snapshot A 24-year-old medical student presents to her primary care physician for an annual routine visit. She reports that over the past year, she has had difficulty sleeping, increasing fatigability, and difficulty concentrating. Combined with the increasing responsibilities as a medical student, she reports feeling anxious. She denies any specific triggers or situations that causes these symptoms. Her physician suggests referral to psychiatry for likely combination of cognitive behavioral therapy and pharmacotherapy. Introduction Overview generalized anxiety disorder (GAD) is a type of anxiety disorder, which also includes panic disorder, phobia disorders, and obsessive-compulsive disorder GAD is characterized by anxiety lasting > 6 months unrelated to any specific triggers or if identifiable stressor has ended Epidemiology incidence very common risk factors genetic susceptibility environmental instability Pathogenesis mechanism unclear but mediators of anxiety in the brain appear to be norepinephrine, serotonin, dopamine, and GABA some patients may also have genetic predisposition to anxiety Associated conditions other mood disorders major depressive disorder substance abuse disorders Presentation Symptoms excessive anxiety and persistent worrying at least 3 of the following restlessness fatigue difficulty concentrating irritability muscle tension sleep disturbance Physical exam excitation/hyperactivity tremors rapid heartbeat sweating restlessness dry mouth cold and clammy hands shaking Differential Adjustment disorder key distinguishing factors anxiety or other mood changes with onset within 3 months of an identifiable stressor or trigger, lasting < 6 months once that stressor has ended treatment also consists of cognitive behavioral therapy and selective serotonin reuptake inhibitors Treatment Lifestyle cognitive behavioral therapy indications all patients may often need pharmacotherapy as well Medical selective serotonin reuptake inhibitors (SSRIs) indications first-line drugs fluoxetine paroxetine sertraline escitalopram serotonin-norepinephrine reuptake inhibitors (SNRIs) indication first-line drugs venlafaxine duloxetine tricyclic antidepressants (TCA) indication second-line due to worse adverse effect profile benzodiazepines indication second-line due to potential for addiction and short-lived effects Complications Complications decreased quality of life substance abuse
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PY.13.25) A 45-year-old woman presents to her primary care physician with complaints of muscle pains, poor sleep, and daytime fatigue. When asked about stressors she states that she "panics" about her job, marriage, children, and finances. When asked to clarify what the "panics" entail, she states that it involves severe worrying. She has had these symptoms since she last saw you one year ago. What is the most likely diagnosis? Tested Concept QID: 100025 Type & Select Correct Answer 1 Generalized anxiety disorder 84% (16/19) 2 Social phobia 0% (0/19) 3 Adjustment disorder 0% (0/19) 4 Panic disorder 0% (0/19) 5 Obsessive-compulsive disorder 0% (0/19) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (2) Login to View Community Videos Login to View Community Videos Summary of anxiety disorders Keshav Mudgal Psychiatry - Generalized Anxiety Disorder E 11/14/2015 31 views 3.0 (1) Login to View Community Videos Login to View Community Videos Generalised Anxiety Disorder Keshav Mudgal Psychiatry - Generalized Anxiety Disorder E 11/14/2015 17 views 0.0 (0)