Showing posts with label anxiety. Show all posts
Showing posts with label anxiety. Show all posts

Tuesday, 24 January 2023

ICD-11 Criteria For Panic Attacks in Mood Episodes

Foundation URI : http://id.who.int/icd/entity/1383708356

ICD-11 Criteria For Panic Attacks in Mood Episodes

 6A80.1

Description

In the context of a current mood episode (manic, depressive, mixed, or hypomanic), there have been recurrent panic attacks (i.e., at least two) during the past month that occur specifically in response to anxiety-provoking cognitions that are features of the mood episode. If panic attacks occur exclusively in response to such thoughts, panic attacks should be recorded using this qualifier rather than assigning an additional co-occurring diagnosis of panic disorder. If some panic attacks over the course of the depressive or mixed episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts, a separate diagnosis of panic disorder should be assigned.

Exclusions

  • Panic disorder (6B01)

Diagnostic Requirements

This specifier can be applied if, in the context of a current Episode, there have been panic attacks during the past month that occur specifically in response to depressive ruminations or other anxiety-provoking cognitions. If panic attacks occur exclusively in response to such thoughts, the ‘with panic attacks’ specifier should be applied rather than an additional co-occurring diagnosis of Panic Disorder. If some panic attacks over the course of the Depressive or Mixed Episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts and the full diagnostic requirements for Panic Disorder are met, a separate diagnosis of Panic Disorder should be assigned.

Reference:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

Saturday, 9 January 2021

Treatment Guidelines for Generalized Anxiety Disorder

Psychotherapy     

Reassurance

Self-help and psychoeducation

à Pure self-help, guided self-help, group psychoeducation

Relaxation therapy

à applied relaxation, progressive muscle relaxation, deep breathing exercises

Cognitive behavior therapy

Exercise

Pharmacotherapies

Indications of pharmacotherapy

While on psychotherapy, short-term

Psychotherapy ineffective,

Psychotherapies not available

First-line       

Selective Serotonin Reuptake Inhibitors

àThese and SNRIs may initially exacerbate symptoms; a lower starting dose is often required.  Fluoxetine and sertraline are preferred options.  Sertraline is the most tolerable and cost effective, recommended as first choice by NICE. Fluoxetine is most effective choice.

Effexor (venlafaxine) SR up to 225 mg/day

Dulan/Duron (duloxetine) up to 60 mg/day

pregabalin 150–600 mg/day

Second-line choices           

Agoviz (agomelatine) 25 mg                2 x nocte

Agoviz (agomelatine) 25 mg                4 x nocte

Busron (buspirone) 5 mg                      1 x TDS

Steer (buspirone) 10 mg                       2 x TDS

Atarax (hydroxyzine) 25 mg                 1 x BD

Atarax (hydroxyzine) 25 mg                1+ 1 + 2

Qusel (quetiapine)  

Tofranil (imipramine)

Clomixet (clomipramine)

Ramargon (mirtazapine)

Beta-blockers for somatic symptoms, Vortioxetine 2.5–10 mg

Thursday, 7 January 2021

Psychodynamic Themes in Panic Disorder


  • Difficulty tolerating anger.

  • Physical or emotional separation from a significant person both in childhood and in adult life 

  • Situations of increased work responsibilities may trigger it 

  • Perception of parents as controlling, shocking, cynical, and demanding 

  • Internal representations of relationships involving sexual or physical abuse 

  • A chronic sense of feeling trapped 

  • A vicious cycle of anger at parental rejecting behavior followed by anxiety that the fantasy will destroy the tie to parents.

  • Failure of signal anxiety function in ego related to self fragmentation and self-other boundary confusion 

Sunday, 12 June 2016

Vignette: Most Effective Treatment for a Man with Sudden Episodes of Anxiety

Vignette: Most Effective Treatment for a Man with Sudden Episodes of Anxiety

A 30-year-old man presented with episodes of sudden anxiety, palpitations, chest tightness, and a feeling of impending doom. These episodes occur about 4-5 times per month for the last 7 months and last about 10 minutes on average. They have carried his physical examination and laboratory evaluation out, which is inconclusive about biological causation for his condition. 

What would be the most effective treatment option?
  1. Cognitive therapy 
  2. Fluoxetine
  3. Imipramine
  4. Amitriptyline 
  5. Cognitive Behavior Therapy

Controlled studies have shown that cognitive therapy is at least as effective as antidepressant medication in the treatment of the panic disorder (Mitte, 2005). Combined treatment with medication and psychotherapy may cause a better response in the acute phase than either treatment modality given alone, but probably not in the longer term. In the longer-term medication alone may have a less good outcome than either psychotherapy alone or combined treatment. However, not all studies agree on this point (Furukawa and Watanabe, 2006; van Apeldoorn et al., 2010).



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