Title ANXIETY DISORDER | OCD ✅

ANXIETY DISORDER DSM-5 CRITERIA - GAD SAD A. Excessive anxiety and worry occur for at least 6 month about a number of event/activity B. Difficult to control worry C. Associated with 3/6 (R.E.C.I.T.S) 1. Restlessness 2. Easily Fatigue 3. Concentration loss 4. Irritable 5. Tension (muscle) 6. Sleep disturbance. D. Impaired social E. Not due to substance/medical condition (hyperthyroidism,pheochromocytoma) F. Not due to other medical illness A. Fear of being scrutinized by others (socials interaction, being observed, performing in front of others) B. Fear she/he will act in a way/show anxiety symptoms that will be negative evaluate C. Social situation almost always provoke fear/anxiety D. Avoid social situation E. Fear out of proportion to actual threat F. >6 month G. Cause clinical significant distress/impaired functioning H. No due to substance/medical condition I. Not due to other medical illness PANIC DISORDER AGORAPHOBIA A. Recurrent unexpected panic attack (an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. 4 of following symptoms occurs: 1. Palpitation 2. Sweating 3. Trembling 4. Sob 5. Feeling of choking 6. Chest pain/discomfort 7. Nausea 8. Feeling dizzy, unsteady 9. chill/heat sensation 10. paresthesia/numbness/tingling 11. Derealization 12. Fear of losing control 13. Fear of dying B. At least one of the attacks has been followed by 1 month of one or both following. 1. Persistent concern/worry 2. Significant maladaptive change in behavior C. Not due to substance/medical condition D. Not due to other mental illness A. Marked fear or anxiety about 2/more of the following 1. Using public transport 2. Being in open spaces 3. Being enclose places 4. Standing in line/crowded 5. Being outside of home alone B. The individual fears or avoid these situations because of thoughts that escape might be difficult/no help available/embarrassing symptoms C. almost always provoke fear or anxiety D. The situation actively avoided, require the presence of a companion or endured with intense fear or anxiety E. Fear or anxiety is out of proportion with actual danger F. The fear/anxiety/avoidance is persistent >6 months G. Cause clinical significant distress/impaired functioning H. If another medical condition is present, the fear anxiety or avoidance are clearly excessive I. Not due to other medical illness
HISTORY TAKING. CC: Presented with episodes of palpitation and SOB for duration of 1 month prior to first psychiatric contact. SYMPTOMS Psychological symptoms Physical symptoms ● Feeling nervous or restless/tired or fatigued ● Sense of impending doom ● Difficulty thinking about anything other than fear or worry ● Feeling to urgent need to leave a situation Low sense of self-worth Feeling very hot and sweating/very cold and shivering Hyperventilation palpitations Headache Nausea Shortness of breath Timing of symptoms ● Depending on the underlying cause of anxiety, symptoms may be triggered by specific situations, come on randomly throughout the day, or they may be constant. ● Determining when the symptoms occur can help you make the eventual diagnosis. Relieving factors Other history: ● History of persistent low mood or loss of interest and symptoms of depression ● History of having suicidal thoughts or any suicide attempt or self harm. ● History of hyperthyroidism (heat intolerance, neck lump) ● History of psychosis (having auditory or visual hallucinations). ● History of having fear of being scrutinized or judged negatively, embarrassed or humiliated. ● History to suggest agoraphobia. ● History of drug abuse or substance abuse. ● Current treatment ○ Name of current medication with dose ○ Compliant or not ○ Complications of treatment ○ Follow up, attend all follow up or not (re-confirm the treatment compliant, if follow up not attend, how to continue medication?) ● Do the etiology formulation (explore the risk factor, predisposing factor, precipating factor and perpetuating factor) ● Complication of the disease toward individual and functioning ○ Functioning ; occupation, family, financial ○ Support; family, partner
Past Psychiatric history Past Medical history ● Diagnosed with psychotic illness ● When, where ● What complaint, associated symptoms; manic, depressive, anxiety ● What medications and doses, compliance, follow up ● Change of medications or its doses, due to side effects/ not effective? ● How many previous admission Possible medical causes: stroke, hypothyroidism, epilepsy Other chronic illness ● Complaint ● Current control or status ● Complication of disease and treatment ● Compliance Not to forget ask about : SYSTEMIC REVIEW FAMILY HISTORY SOCIAL HISTORY PERSONAL HISTORY PREMORBID HISTORY DRUG HISTORY PHYSICAL EXAMINATION + MENTAL STATE EXAMINATION