Anxiety Disorders: OCD, PTSD, Panic Attack, Agoraphobia, Phobias, GAD Generalized

  Distinguished future physicians welcome to Stomp on Step 1 the only free articles series that helps you study more efficiently by focusingon the highest yield material. I will be your guide on this journey through Anxiety Disorders.We are going to review things like Generalized Anxiety Disorder, PTSD, Phobias & Panic attacks.

 Anxiety is uncontrolled fear, nervousness and/or worry about trivial or non-existent things. It is an unpleasant fear of future events that are unlikely to occur. Some patients have insight and realize that their uneasinessis illogical, but that does not alleviate symptoms. A certain level of anxiety is considered normal in many situations, but frequent anxiety or anxiety that inhibits function is pathologic. 

During anxiety sympathetic nervous system activation can result in physical symptoms such as Palpitations, Tachycardia, Shortness of breath, Muscle tension, Restlessness, Lack of focus, Sweating or chills and Changes in sleeping pattern. In order to make a diagnosis of anxiety, one must rule out other potential causes of these symptoms.

 The differential diagnosis for anxiety includes other psychiatric disorders, cardiac abnormalities (such as myocardial infarctionor valvular disease), endocrine disorders (like hyperthyroidism) and respiratory disease(such as asthma or Pulmonary Embolism). Substances such as street drugs and prescribed medications must also be ruled out as a potential cause of the symptoms. 

We are going to hold off on discussing most of the different treatment options for anxiety until a later article that will cover all of pharmacology for the psychiatry section. That article will cover things like SSRIs, anxiolyticsand cognitive behavioral therapy which can be used to treat anxiety disorders. However,during this article I will mention a couple treatment options that are used for specific anxiety disorders. 

We will start our discussion with Generalized Anxiety Disorder or GAD. You can see here in the top right corner I give GAD a high yield rating of 2. For those of you who aren’t familiar with the High Yield Rating it is a scale from 0 to 10 that gives you an estimate for how important each topic is for the USMLE Step 1 Medical Board Exam. 

GAD is a prolonged period of near constant anxiety. Their anxietyis not linked to a specific item, person, or situation (AKA it isn’t a phobia). They usually worry about a wide variety of things including school/work performance, finances, health, friends and/or family members.Their anxiety is “generalized” across many situations. Their anxiety frequently presents with “physical” symptoms and may be severe enough to impair function. 

A Panic Attack is sudden on set period of extremely intense anxiety accompanied by numerous signs and symptoms of anxiety. The attack is often associated with a sense of impending doom. These “episodes” usually last 10 to 30minutes and are disabling. The patient returns to their normal level of function soon after the panic attack. They may be brought on by an inciting event or be completely unprovoked.I’d like to stop here for a moment to clarify the difference between generalized anxiety disorder and a panic attack. 

GAD can be thought of as a constant moderate level of anxiety while panic attacks are short periods of severe anxiety. Panic Disorder is recurrent panic attacks that are unprovoked and have no identifiable trigger. The onset of these anxiety episodesis unpredictable. Patients may be relatively asymptomatic between attacks, but often have anxiety about having more attacks.

 Their fear is related to the panic attacks themselves rather than a particular external stimuli. This differentiates Panic Disorder from Panic attacks that are caused by things like phobias. Agoraphobia is anxiety related to open spaces and/or crowded places. These people are afraid of being helpless or embarrassed in a situation that is difficult to “escape” from. This often leads to avoid.