Anxiety Disorders: OCD, PTSD, Panic Attack, Agoraphobia, Phobias, GAD Generalized
Distinguished future physicians welcome to
Stomp on Step 1 the only free videos series
that helps you study more efficiently by focusing
on the highest yield material. I’m Brian
McDaniel and I will be your guide on this
journey through Anxiety Disorders. This is
the 3rd video in my playlist covering Psychiatry
and we are going to review things like Generalized
Anxiety Disorder, PTSD, Phobias andamp; 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 uneasiness
is 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 infarction
or 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 video that will cover all of
pharmacology for the psychiatry section. That
video will cover things like SSRIs, anxiolytics
and cognitive behavioral therapy which can
be used to treat anxiety disorders. However,
during this video 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 anxiety
is 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 onset 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 30
minutes 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 episodes
is 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 avoidance of such experiences
and in severe cases these people never leave
their homes. Agoraphobia is most closely related
to Panic Disorder. In this situation patients
fear having an unexpected panic attack in
a place where they may be embarrassed in front
of other or help may not be available. However,
agoraphobia can be the result of other psychiatric
disorders such as specific phobia.
Specific Phobia is an excessive amount of
anxiety related to a specific situation or
item that interferes. Common examples include
fear of heights, spiders or medical injections.
These individuals can be relatively asymptomatic
in the absence of exposure to what they fear.
Some individuals will adapt quite well and
you won’t even know they have a phobia because
they are good at avoiding the exposure. For
example, somebody afraid of heights may move
to an area with no mountains or high rise
buildings.
Specific phobia can lead to a panic attack.
However, these attacks only occur as a result
of exposure to what they fear. They will not
have panic attack in the absence of external
stimuli. This differentiates it from panic
disorder where the individual will have unprovoked
panic attacks. In extreme cases specific phobia
can lead to Agoraphobia. For example, if somebody
is deathly afraid of spiders they may never
want to leave their house.
Treatment can include Exposure Therapy. Here
the patient creates a hierarchy of fears and
is exposed to them in order of increasing
level of fear. So a person who is afraid of
heights will start with standing on a step
stool and then slowly work their way up to
using an elevator and going to the top of
a sky scraper. By taking “baby stepsâ€
patients are often able to do things they
would have never been able to without the
process. In certain situations benzos may
be used if the feared stimuli is infrequent
and unavoidable. For example, somebody who
is afraid of flying but only takes a few flights
a year may be well controlled with benzos
on an as needed basis.
Social Anxiety Disorder (AKA Social Phobia)
is anxiety in social situations such as public
speaking, eating in public or using public
restrooms. This usually includes an intense
fear of scrutiny and judgment from others.
These patients may be relatively asymptomatic
if they can avoid being the center of attention.
Social Phobia can be thought of as a Specific
Phobia where the fear is related to social
situations. However, despite the similarities
the two disorders are separate diagnoses in
the DSM.
In extreme cases it can lead to panic attacks.
Beta blockers are sometimes used on an as
needed basis for “performance anxietyâ€
of “stage freightâ€. For example, if a
person has to give a big presentation you
can give a beta blocker about 30 minutes before
the meeting in order to block some of the
sympathetic signals. They will still have
the anxiety, but because the physical symptoms
of anxiety are blunted they won’t realize
they are anxious.
Obsessive-Compulsive Disorder is anxiety and
intrusive thoughts that drive the patient
to unusual repetitive actions called Compulsions.
The compulsions temporarily relieve the anxiety
in some patients while others feel like they
“just have to†do their rituals. Common
compulsions include counting their steps,
repetitively washing hands, preoccupation
with certain numbers and rituals such as opening
and closing doors repetitively. The patient
often realizes that their fears and compulsions
are irrational, but there remains a lack of
control.
OCD should not be confused with the similar
sounding Obsessive Compulsive Personality
Disorder (OCPD). There are some similarities
between the two as both can include a preoccupation
with things like order, cleanliness and organization.
However, OCDP patients usually lack the “classicâ€
compulsions found in OCD. OCD patients also
have insight, while OCPD patients do not.
In OCD they view their thoughts and behaviors
as abnormal, unwanted and distressing. In
OCPD they view their way of thinking as normal
and beneficial. They don’t realize they
have a disorder. We will discuss OCPD in much
more detail in a later video covering personality
disorders. If you would like to skip ahead
to that video you can click on this orange
box here
Post-traumatic Stress Disorder is anxiety
related to a traumatic experience that may
include flashbacks, nightmares and avoidance
of certain triggers that remind them of the
experience. These patients may also have hyperarousal
where they have an amplified response to external
stimuli such as loud noises. Classically the
trauma is experiencing or witnessing a life
threatening event or sexual assault. Symptoms
must be present for more than a month in order
to make a diagnosis of PTSD. If these same
symptoms last for less than a month the patient
would more correctly be diagnosed with Acute
Stress Disorder.
That brings us to the end of this video. If
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search results. The next video in the psychiatry
section is going to cover Malingering, Somatoform
Disorder andamp; Factitious Disorder. If you would
like to be taken directly to that video you
can click on this black box here. Thank you
so much for watching and good luck with the
rest of your studying
https://www.youtube.com/watch?v=Ha23BbieZO8
What Panic Attacks Feel Like
(loud white noise)
(peaceful chords)
- [Voiceover] A panic attack goes from
zero to 100 in an instant.
- [Voiceover] It's halfway
between feeling like you're faint
and feeling like you'll die.
- [Voiceover] If you
miss a step on the stairs
and your stomach lurches,
(footsteps)
it feels like that, but
lasts much, much longer.
(footsteps)
(thunder and rain)
- [Voiceover] Fighting for breath,
feeling like the floor's unstable.
- [Voiceover] Trapped in your own head
while floating somewhere outside,
looking back at yourself,
wondering what you're doing.
(peaceful chords and water lapping)
- [Voiceover] A huge fist
grabs hold on my insides.
My heart goes into overdrive, and
I go through the motions on auto-pilot.
- [Voiceover] Like when you're in a dream
and you're screaming but
you can't make any noise.
- [Voiceover] Your entire body
is feeling everything
and nothing at all once.
- [Voiceover] And you just
wanna jump out of your skin,
get away from this feeling.
- [Voiceover] But I just keep thinking,
andquot;This will pass.
andquot;This will pass.andquot;
- [Voiceover] And it usually does.
(peaceful chords and gurgling water)
(whistle and creak)
https://www.youtube.com/watch?v=uPlhgtQqA6c
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