Anxiety_Disorders_PIPC

Anxiety_Disorders_PIPC - PIPC ® P sychiatry I n P rimary C...

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Unformatted text preview: PIPC ® P sychiatry I n P rimary C are ANXIETY DISORDERS Robert K. Schneider, MD Departments of Psychiatry, Internal Medicine and Family Practice The Medical College of Virginia at the Virginia Commonwealth University Richmond, Virginia PIPC ® Goals • Effectively recognize, diagnose and treat mental illness in primary care • Bring the psychiatry skills and knowledge base of the primary care physician on par with other medical specialty knowledge bases Outline • PIPC 1 – Introduction – PIPC ® Interview – MAPS-O ® – Mood Disorders – Suicide Outline • PIPC 2 – Anxiety Disorders • PIPC 3 – Neurotransmitters – The 3 Phases and the 5Rs – Medications – Cases and Discussion MAPS-O ® MAPS-O ® Mood Disorders Anxiety Disorders Psychotic Disorders Substance Abuse Other MAPS-O ® Mood Disorders Major Depression, Dysthymia, Bipolar Disorder Anxiety Disorders Psychotic Disorders Substance Abuse Other MAPS-O ® Mood Disorders Anxiety Disorders GAD, Panic Disorder, PTSD, OCD, Phobias (Social/Specific) Psychotic Disorders Substance Abuse Other MAPS-O ® Mood Disorders Anxiety Disorders Psychotic Disorders Schizophrenia, Schizoaffective Substance Abuse Other MAPS-O ® Mood Disorders Anxiety Disorders Psychotic Disorders Substance Abuse Alcohol, Cocaine, Nicotine, Other Psychoactive Substances Other MAPS-O ® Mood Disorders Anxiety Disorders Psychotic Disorders Substance Abuse Other “Organic”: Stroke, Dementia, HIV, TBI Other Psych: Personality Disorders, ADHD, Somatization,Eating Disorders ANXIETY DISORDERS Normal vs. Pathological Anxiety • A biological warning system that is activated by perceived danger • Distressing and usually associated with bodily discomfort • Normal levels prepare one for a protective response • High levels can be disorganizing, counter– productive, and cause impairment • Abnormal when disproportionate to the potential for harm or when it occurs in situations reasonably deemed to be harmless Importance Of Anxiety Disorders as a Group • Are the most common mental disorders – lifetime prevalence for any AD is 24.9% • Tend to be chronic (more chronic and non-remitting than major depression) • Have substantial comorbidity • Carry a burden of distress and impairment similar to chronic medical disorders Comorbidity Comorbidity is the rule – Depressive disorders (50-70%) – Substance abuse – Other anxiety disorders – Comorbidity predicts: • chronicity, disability, increased suicide risk, and poorer treatment response Risk Factors • Female gender: F:M~2:1 (except OCD M=F) • Family history: Odds ratios 4-6 • Trauma (abuse, assault, accidents, etc.) • Stressful Life Events (unemployment, illness, death of loved one, marital conflict, etc.) Note: These are the same risk factors seen in Major Depression - whenever you consider someone at increased risk for depression, they are also at increased risk for an AD Somatic Symptoms and Mental Disorders # of Symptoms Mood D/O (%) Anxiety D/O (%) 0-1 2 1 2-3 12 7 4-5 23 13 6-8 44 30 > 9 60 48 Medical Mimics of Anxiety...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Anxiety_Disorders_PIPC - PIPC ® P sychiatry I n P rimary C...

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