anxiety disorders in dsm5 - public-i · dsm 5 anxiety disorders . anxiety disorders separation...
TRANSCRIPT
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
117a & 96 Harley St
02074860506
Thank You
Thank You Very Much