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ANXIETY DISORDERS IN DSM5 - Public-i · DSM 5 Anxiety Disorders . ANXIETY DISORDERS Separation Anxiety Selective Mutism Specific Phobia Social Anxiety Disorder Panic Disorder Agoraphobia

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  • ANXIETY DISORDERS IN DSM5

    Dr Robin Lawrence

    [email protected] 117a & 96 Harley St

    02074860506

  • PLAN FOR THIS EVENING

    Diagnostic Systems ICD10 & DSM5 compared

    A Philosophical Perspective

    Historic Perspective

    The Cook Book approach

    SUGGESTIONS FOR WHAT THE GP SHOULD DO

  • ICD 10 Neurotic, Stress-related and Somatoform Disorders

  • NEUROTIC, STRESS-RELATED & SOMATOFORM

    Phobic Anxiety Disorders Other Anxiety Disorders Obsessive-compulsive disorder Post Traumatic Stress Disorder Dissociative Disorders Somatoform Disorders Other Neurotic Disorders

  • OTHER ANXIETY DISORDERS

    Panic Disorder Generalised Anxiety Disorder Mixed Anxiety & Depression

  • DSM 5 Anxiety Disorders

  • ANXIETY DISORDERS

    Separation Anxiety Selective Mutism Specific Phobia Social Anxiety Disorder Panic Disorder Agoraphobia Generalised Anxiety Disorder Medication Anxiety Disorders Anxiety due to Medical Condition Other Specific Anxiety Disorder Unspecific Anxiety Disorder

  • A BIT OF PHILOSOPHY AND HISTORY

    From DSM III to DSM5 Sought to make Diagnostic Categories.

    Platonic Idealism

  • Generally, even complex diagnoses are considered against an imaginary ideal/perfect case for a diagnosis to be made.

    From DSMIII to DSM-5 the Chinese Menu approach to diagnosis remains.

  • GENERALISED ANXIETY DISORDER DSM 5

    A.  Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

    B.  The individual finds it difficult to control the worry. C.  Three or more of the following six symptoms

    A.  i)Restlessness or feeling keyed up or on edge.

    B.  ii) Being easily fatigued.

    C.  iii)Difficulty concentrating or mind going blank.

    D.  vi)Irritability.

    E.  v)Muscle tension

    F.  vi)Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

    D.  Clinically significant distress or impairment in social, occupational, other important function

    E.  Not caused by drugs, medication, or a medical condition (eg Hyperthyroidism)

    F.  Not better explained by any other mental illness (eg Panic disorder or PTSD)

  • ANXIETY DISORDER ICD 10

    A condition marked by excessive worry and feelings of fear, dread, and uneasiness that last six months or longer. Includes being restless, being tired or irritable, muscle tension, not being able to concentrate or sleep well, shortness of breath, fast heartbeat, sweating, and dizziness.

    • An anxiety disorder characterized by excessive and difficult-to-control worry about a number of life situations. The worry is accompanied by restlessness, fatigue, inability to concentrate, irritability, muscle tension, and/or sleep disturbance and lasts for at least 6 months.

  • ANXIETY DISORDER ICD 10

    An anxiety disorder [is] characterized by free-floating, persistent, and excessive worry for at least six months.

    • Apprehension of danger and dread accompanied by restlessness, tension, tachycardia, and dyspnea unattached to a clearly identifiable stimulus.

    • Apprehension or fear of impending actual or imagined danger, vulnerability, or uncertainty.

    • Fear and anxiety are part of life. Types include

    ◦ panic disorder ◦ obsessive-compulsive disorder ◦ post-traumatic stress disorder ◦ phobias ◦ generalized anxiety disorder

  • IN DSM5

    Panic disorder is included

    Phobias are included

    Post Traumatic Stress disorder is excluded

    Obsessive-Compulsive Disorder is excluded

  • THE BEST LONGITUDINAL STUDIES

    The typical history of a forty five year-old alcoholic male

    Starts with separation anxiety (5-13)

    Proceeds with Social Anxiety Disorder - and preloading before social events (13 - 22)

    Proceeds to Generalised Anxiety Disorder (22-32)

    Continues to Major Depressive Disorder (32-42)

    Develops into Addictive Compulsive Disorder (42 and above) Most commonly Alcoholism

  • IN DSM5

    Has a developmental approach: 1.  Separation Anxiety 2.  Selective Mutism 3.  Specific Phobia 4.  Social Anxiety Disorder 5.  Panic Disorder 6.  Agoraphobia 7.  Generalised Anxiety Disorder

  • HISTORY

    DSM 2 (in 1952) and DSM III (1968) copied ICD 6

    Modified to the Chinese Menu approach (prescriptive diagnostic categories):

  • NOW

    ICD 10 was to be replaced with ICD11 in 2015 To harmonise ICD with the latest DSM Not yet published

  • SUGGESTIONS FOR THE GP

    Use ICD 10 and DSM 5 together: How long has this been going on for? (six months or more) Does it cause you any trouble? Yes or no to the following 6 symptoms i)Restlessness or feeling keyed up or on edge ii) Being easily fatigued. iii)Difficulty concentrating or mind going blank vi)Irritability v)Muscle tension vi)Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

  • MAKE THE DIAGNOSIS

    CHANGE TO ICD10

    Is this any specific kind of Anxiety?

    Panic disorder?

    Phobias?

    Post Traumatic Stress Disorder?

    Obsessive-Compulsive Disorder?

    Generalized Anxiety disorder?

  • SPECIFIC QUESTIONS

    DO YOU HAVE PANIC ATTACKS?

    DOES ANYTHING SPECIFIC BRING IT ON? (PHOBIAS)

    DO YOU HAVE NIGHTMARES/TRY CONSTANTLY

    TO REMOVE THE THOUGHT FROM YOUR MIND? (PTSD)

    ARE YOU A CHECKER – DO YOU RUMINATE?

    WHAT, IF ANYTHING MAKES THIS BETTER (OCD)

    IS THIS FEELING WITH YOU MOST OF THE TIME? (GAD)

  • AND THEN?

    Refer

  • ANXIETY IS MUCH HARDER TO TREAT

    THAN DEPRESSION

    Because although SSRIs are good for both – Anxiety sufferers more often have side-effects. Generally thay can make the patient feel worse before

    they get better. There are subtle differences between drugs in the same

    categories Mirtazepine and Seroxat have a special role in PTSD Seroxat has a special role in OCD

  • OTHER DRUGS?

    MAY WANT TO USE PREGABALIN

    MAY WANT TO USE BENZODIAZEPINES

    PERHAPS ONLY DURING THE BAD

    SYMPTOMS OF SSRI INDUCTION

    MAY WANT TO USE BETA BLOCKERS

    MAY USE MOOD STABILISERS

  • OTHER TREATMENTS?

    EMDR

    Cognitive Behavioural Therapy

    Schema Therapy

    Integrative Therepy

    Transference or Psychodynamic Therapy

  • SO TONIGHT YOU SHOULD HAVE LEARNED

    Diagnostic Systems ICD10 & DSM5 compared

    A Philosophical Perspective

    Historic Perspective

    The Cook Book approach

    SUGGESTIONS FOR WHAT THE GP SHOULD DO

  • ANXIETY DISORDERS IN DSM5

    Dr Robin Lawrence

    [email protected] 117a & 96 Harley St

    02074860506

    Thank You

    Thank You Very Much