Anxiety Disorders: OCD, PTSD, Panic Attack, Agoraphobia, Phobias, GAD Generalized
02
September

By Adem Lewis / in , , , , , , , , , , , , , , , , /


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 & 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 steps” 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 anxiety”
of “stage freight”. 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 “classic” 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
you found it helpful please leave a comment below. Feedback from our viewers helps us
improve Stomp On Step 1 and rank higher in search results. The next video in the psychiatry
section is going to cover Malingering, Somatoform Disorder & 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


22 thoughts on “Anxiety Disorders: OCD, PTSD, Panic Attack, Agoraphobia, Phobias, GAD Generalized

  1. Thank you this was very helpful. For those watching this that don't know there is a website he runs with the notes that I find really helpful too. It in the information under the video 🙂 Thank you so much for putting in the time to make these videos and give the HYR

  2. Common treatment solution will trap you in the anxiety disorder, and also, little by little, make your condition even more serious.

  3. Being a sufferer of PTSD, and being somewhat educated on this subject, I thought that I might clarify a few things.

    1. Worry and Anxiety are NOT identical. Excessive worry is a Cognitive function. ANXIETY is the PHYSICAL OUTCOME of the excessive worry of the Patient. Many excessive worriers do not end up with the physical symptoms of GAD.

    2. While PTSD looks nearly identical to GAD, , I have noticed a major difference that may prove useful to a proper diagnosis.
    having PTSD, I am usually DEADLY CALM in extremely dangerous environments and situations. In truth, though I worry incessantly about little things, in a life or death crisis situation I am not only calm, but generally feel "NORMAL" in these situations. This is because having been in the situation that created my PTSD for a number of years, that level of stress BECAME NORMAL for me.

  4. I have some pretty bad anxiety, and wanted to watch this to become more educated, and this is really helping me, so far.

  5. Remember, Aggressive panic attack aka fury panic attack.

    Seeking weapons for protection or getting annoyed with the person (Doctor).

    PTSD

  6. This is a wonderful video!! I do great with spiders, GREAT with heights, I love high up places, and do just fine with injections. My issue is I've had horrible sensory issues, Anything gooey, I can't tolerate it. Sand, I can't stand it under my feet, especially if it's WET sand. I don't know how I survived 2010 when my school was doing a pottery class for a day. We made a pot, and I prayed before It was time, and that's the only way I can guess I didn't pass out. The clay was bad enough, but when it was WETl, I seriously thought I was going to pass out. I DIDN'T, and I'll never forget that, cause, it had to be divine Intervention. I've had this fear all my life, and have never gotten over it. I am just glad I didn't pass out when we were doing that pottery class. I thought I was going to. When It was over, I was not just glad it was over, but glad that I did it without passing out. I took slow deep breaths, and said, "This's not going to hurt me. I'm safe, I'm not going to pass out. I'm GOING TO DO THIS, and DO IT JUST FINE!!

Leave a Reply

Your email address will not be published. Required fields are marked *