Taking a History of Anxiety Disorders 20/11/2007 1. GAD – persistent, no phobic stimulus, must be present for at least 6 months
2. PTSD – symptoms ≥ 1 month after traumatic incident, must last for 1 month -
Trauma
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Re-ex e-expe peri rien enci cing ng:: flash flashbac backs ks,, night nightma mare re
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Avoidance
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Hype Hyperar rarou ousa sall e.g. e.g. hype hyperv rvig igil ilan ance ce
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Blunting of of af affect
3. OCD – unwanted obsessions, compulsions, INSIGHT -
Compul Compulsio sions ns must must inte interfe rfere re with with your your life life for for › 1 hour/ hour/day day
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Takes akes an an averag average e of 9 years years from from onset onset to to diagno diagnosis sis
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17 year years s for for cor correct rect trea treatm tmen entt
4. Phobias – create fear
result in AVOIDANCE
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Agora Ag oraph phob obia ia,, simp simple le pho phobi bia, a, soci social al pho phobi bia a
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Specif Specific ic s stim timulu ulus, s, p pani anic c only only last lasts s for a speci specific fic time time
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Cann Cannot ot be be reas reason oned ed awa away y (e.g (e.g.. plas plasti tic c spid spider er))
5. Panic Disorder – discrete episodes, extreme, symptoms for › 1 month -
Ofte Often nd des escr crib ibed ed as “fear fear of the the fea fear” r”
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Avoid voidan ance ce,, dru drug abus abuse e
History -Always ask WHEN, WHY and HOW it started - Remember SEDATE
S – symptoms E – episodic or continuous
(if episodic, then ≠ GAD)
D – depression, drinking, drugs drug withdrawal)
(ANY symptoms symptoms of anxiety anxiety can be the effects of
A – avoidance or escape T – triggers and timing E – effect on life
Symptoms: Physical - ↑autonomic response -
Hyperventilation
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Sweating
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Palpitation
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Loss Loss of slee sleep/ p/me memo mory ry// con conce cent ntrat ratio ion n
Psychological
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Agitation
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Irrit Irritab able le (e. (e.g. g. do you you feel feel like like a bun bundl dle e of nerves?/jumpy?)
Fear (e.g. (e.g. do you feel feel lik like e some somethi thing ng terrib terrible le is going going to happen?) -
For OCD: -
Ask whethe whetherr though thoughts ts are are THEIR THEIR OWN (psych (psychosi osis…. s….))
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Ask e.g. e.g. do you you ever ever get get any any embarr embarrass assing ing though thought/i t/idea deas s that that you can’t get rid of / that are repeated?
PTSD: -
to elici elicitt bluntin blunting g of affe affect, ct, ask ask e.g. e.g. do do you feel feel that that your your emot emotion ions s are not as strong as they used to be
Drugs: remember to ask about caffeine and smoking also.
Avoidance/escape: Avoidance/escape: ask e.g. os there anything that you used to do that you now find more difficult to do?
Treatment for anxiety disorders:
Gene Genera rall lly y
– CBT CBT (± self self-h -hel elp p meth method ods) s) -SSRIs -TCAs
Guidelines for the History 1) Introducti Introduction, on, establish establish rapport rapport etc (use (use the scenario scenario synopsis) synopsis) 2) Ask open questio questions ns e.g. could could you tell tell me a bit about about what has been been troubling you? 3) Elicit Elicit cont content ent and and attit attitude udes s -
Are Are you you troub troublin ling g by any recurr recurrent ent worr worryin ying g th thoug oughts hts? ?
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Has some somethi thing ng happe happened ned to to you rece recentl ntly y to trig trigger ger thes these e thought thoughts? s? (PTSD)
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Do these these though thoughts ts cause cause you troub troubling ling sleepi sleeping? ng?
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Do you have have recu recurr rrent ent or unex unexpec pected ted panic panic atta attacks cks? ?
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Are Are you you worri worries es about about a signi signific ficant ant chan change ge in behavi behaviour our duri during ng these attacks?
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Do you avoid avoid certain certain activi activitie ties s ((e.g e.g.. meet meeting ing people, people, eating/speaking in public?)
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Have Have you you had had th the e feelin feeling g th that at thin things gs aroun around d you you were were not not real real (derealisation)
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Have Have you you yours yourself elf felt felt unrea unreal/ l/ not not livi living ng in in the the world? world? (depersonalisation)
4) PTSD -
Have Have you you experi experienc enced ed a traumat traumatic ic even eventt in in the the past past? ?
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Do thou though ghts ts of (x) (x) dis distr tres ess s you you? ?
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Do you you find find that that you you re-e re-expe xperie rience nce that that event? event? (flash (flashbac backs, ks, nightmares)
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Do you avoid avoid thinki thinking ng about/ about/tal talking king about about that that event event
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Do you you hav have e any any trou troubl ble e sle sleep epin ing? g?
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Do you you feel feel const constant antly ly on on –edge, –edge, as though though some somethi thing ng terr terribl ible e will happen (hypervigilance)
5) Elicit Elicit phys physiol iologic ogical al change changes s -
When When you you get get thes these e thoug thoughts hts,, or attack attacks, s, do you get i. Tremor ii. Hot fl flashes iii. iii. Palpi alpita tati tion ons s iv. Sweaty v. Dizzy vi. vi. Incr Increas eased ed breat breathi hing ng vii. Nausea viii viii.. Tingl inglin ing g in arms arms/l /leg egs s ix. ix. Sens Sense e of impen impendi ding ng doom doom
6) Elicit past psych psychiatric iatric history history / medical medical Hx -
e.g. e.g. scr screen een for depres depressio sion/ n/ past past psyc psych hd diso isorde rderr
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chronic disease etc
7) Family Hx – psych psychiatric iatric disor disorders ders etc etc
8) Drugs, Drugs, alcohol alcohol,, smoki smoking ng Hx Hx 9) Ass Assess ess for sui suicid cidali ality ty -
E,g, E,g, do you you feel feel that that life life is is wor worth th livin living? g?
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Did Did y you ou eve everr fee feell lik like endi ending ng it all? all?
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What What did did you you thin think k that that you you actu actual ally ly mig might ht do? do?
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Did yo you ac actually tr try iitt
10)Social Hx etc