By the end of postgraduate training, using a patient-centred approach and appropriate selectivity, a resident, considering the patient’s cultural and gender contexts, will be able to...
Key Feature 2b: When working up a patient with symptoms of anxiety, and before making the diagnosis of an anxiety disorder: Identify:
Phase: Diagnosis, History Key Feature 2c: When working up a patient with symptoms of anxiety, and before making the diagnosis of an anxiety disorder: Assess the risk of suicide. Skill: Clinical Reasoning Phase: History, Diagnosis Key Feature 4: Offer appropriate treatment for anxiety:
Phase: Treatment Key Feature 5: In a patient with symptoms of anxiety, take and interpret an appropriate history to differentiate clearly between agoraphobia, social phobia, generalized anxiety disorder, and panic disorder. Skill: Clinical Reasoning Phase: Diagnosis, History Here I will review the diagnostic criteria per the DSM 5 for 4 of the more common types of anxiety disorders, along with a basic approach to treatment. Agoraphobia
Social Phobia
Generalized Anxiety Disorder
Panic Disorder
Although the diagnostic criteria doesn't mention precipitating or perpetuating factors, it is important to assess whether or not the anxiety is in response to a trigger that is ongoing and that is a very real reason to feel anxiety, such as abuse. Asking about causes and aggravating factors is important in order to get at any modifiable factors, and if there is any underlying abuse, provides an opportunity to help the patient in terms of their safety. It's also important to assess a patient's risk of harming themselves by screening for suicidal ideation. Although it may be more common to think of suicide as a consequence of depression, people with anxiety also can also experience significant suicidal ideation as anxiety, even in the absence of depression, can cause significant deprecation in quality of life. So now you've got a diagnosis of an anxiety disorder. How do you proceed to treat it? The rule of thumb first-line treatment for anxiety disorders is a serotonergic reuptake inhibitor (commonly an selective serotonin reuptake inhibitor [SSRI] because they tend to have less side effects than do the serotonin and norepinephrine reuptake inhibitors [SNRI]) and/or cognitive behavioural therapy [CBT]. Some additional considerations are as follows:
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