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Understanding Anxiety: Clinical Presentation and Management in Primary Care

This comprehensive overview explores anxiety and its presentation in primary care settings. It details the different types of anxiety disorders, their prevalence, and how they manifest in individuals. Highlighting the factors that contribute to anxiety, including gender, cultural influences, and comorbid conditions, the text delves into diagnostic criteria for various anxiety disorders such as Generalized Anxiety Disorder, OCD, and PTSD. Treatment options, including psychotherapy and pharmacotherapy approaches like benzodiazepines and SSRIs, are also discussed, emphasizing the importance of personalized care.

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Understanding Anxiety: Clinical Presentation and Management in Primary Care

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Presentation Transcript

  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

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