Anxiety and its Presentation in Primary Care

1. Anxiety and its Presentation in Primary Care Kara Z. McDaniel, NCC, LPC Emory Family Medicine/Behavioral Medicine

2. Pathophysiology and Clinical Presentation • What is anxiety? • What is pathologic anxiety? • Manifestation of anxiety

3. Most common of all mental disorders. May occur independently or in conjunction with other disorders, most specifically Mood Disorders and Substance-Related Disorders. More than one type of anxiety disorder may occur at the same time. Anxiety Disorders

4. Prevalence • Anxiety disorders are more common in women than in men with men presenting 40-45% of the time. • It is estimated that 5% of the population will experience an anxiety disorder at some time during the life span.

5. Prevalence, cont’d • There is a family association with anxiety disorder. Although environment is certainly a factor, twin studies indicate a genetic contribution as well. • The expression of anxiety is influenced by culture. It is critical that the cultural background of the person presenting be considered when completing evaluations.

6. Adjustment Disorder with Anxious Mood • Adjustment Disorder with Anxious Mood • Age • Gender • Culture • Diagnostic Criteria

7. Generalized Anxiety Disorder • GAD • Gender • Etiology • Comorbidity • Diagnostic Criteria

8. Obsessive Compulsive Disorder • OCD • Onset • Clinical Course • Comorbidity • Familial Pattern • Diagnostic Criteria • Symptoms of OCD • Obsessions • compulsions

9. Panic Disorder • Panic Disorder • Gender • Onset • Comorbidity • Cultural and familial effects • Diagnostic Criteria

10. Post-traumatic Stress Disorder • PTSD • develops after exposure to a traumatic event • also termed shell shock or battle fatigue • reported in persons who have experienced • rape • fire • abuse • war • motor vehicle accidents

11. Post-traumatic Stress Disorder, cont’d • PTSD • Diagnostic Criteria • Categorization of symptoms • Acute • Chronic • Delayed onset

12. Specific Phobias • Simple phobias • Specific Phobias • Age • Familial pattern • Environmental • Sex ratio • Comorbidity • Diagnostic Criteria • Sub-types of Specific Phobias • Symptoms

13. Social Phobia • Social Phobia • Onset • Sex ratio • Familial pattern • Comorbidity • Diagnostic criteria • Distinguish social phobia from performance anxiety

14. Substance Abuse • Substance abuse • Used for relief from the anxiety • Most likely to be alcohol, marijuana, or benzodiazepines. • Can exacerbate anxiety when not being used • Prevalence of anxiety 50% higher in alcoholics • Patients struggling with anxiety disorder are 50% more likely to be alcoholic

15. Anxiety Due to a General Medical Condition • Anxiety Due to a General Medical Condition • Diagnostic Criteria • Medical conditions that may cause anxiety symptoms • Endocrine • Cardiovascular • Respiratory • Metabolic • Neurological

16. Treatment via Therapy • Psychotherapy • Types of treatment • Insight-oriented therapy • Behavioral Therapy • Relaxation Techniques • Cognitive-behavioral therapy

17. Pharmacotherapy • Benzodiazepines • Most frequently prescribed for anxiety • Side effect profile • Withdrawal symptoms • Contraindications • SSRIs • FDA approved uses • Advantages • Side effect profile

18. Pharmacotherapy, cont’d • Buspirone (Buspar) • Medication uses • Side effect profile • Advantages

19. Pharmacotherapy, cont’d • Beta-Blockers • Helpful in managing symptoms associated with anxiety • Frequently used in treatment of performance anxiety • Caution • Side effect profile

20. Questions or Comments