ANXIETY

Anxiety disorders often cause chest pain and dyspnea. Always get an EKG

With all Anxiety Disorders, treatment largely consists of CBT and SSRIs for long-term maintenance, plus or minus Benzos to abort panic attacks. 

GENERALIZED ANXIETY DISORDER - They have a constant level of anxiety all the time about most things. They also need to meet 2 / 5 physical symptoms for 6 months: Restless, Fatigue, Aches, Absentminded, Pissy and Altered sleep. “Keyed up.” Stratify with the GAD-7 questionnaire. The treatment is therapy plus an SSRI. 

PANIC DISORDER - Most of the time they’re fine. But they intermittently have panic attacks that come out of the blue. This leads to some understandable worry and frustration. To meet criteria for Panic Disorder, the patient must exhibit a fear that another panic attack will return, and this constant fear is wrecking their life. Panic attacks are obviously embarrassing and dangerous (if driving), which is why this can (understandably imho) lead to agoraphobia. They are treated with  SSRI and CBT, and Benzos are used to abort panic attacks.

PANIC ATTACK - An acute, catastrophic episode of anxiety. “I feel like I’m going to die!”  It comes on out of the blue. Panic attacks can look a lot like heart attacks, but the patient will usually be a nervous looking young female. Healthy 20 year old females just don’t get heart attacks. But panic attacks can occur with any age or gender! Panic attacks are pretty obvious, but the symptoms can be remembered with the mnemonic STUDENTS PANIC. SOB, Trembling, Unsteady, Depersonalization, Elevated HR, Numbness, Tingling (perioral), Sweating, Palpitations, Abdominal pain, Nausea, Intense fear of death, Chest pain. Panic attacks are aborted with Benzos. 

SOCIAL ANXIETY DISORDER - fear of being judged by others. The key is that they have insight into this problem, where patients with Avoidant Personality Disorder do NOT have insight. Treated with CBT (assertiveness training) and SSRIs.

PHOBIAS - exaggerated / irrational fear brought about by a particular object, animal or situation. Treated with specialized CBT that works by exposing them to their fear, using a timeline that is either gradual (systematic desensitization) or rapid (flooding). The fear of public speaking is treated differently than the other phobias, the physical symptoms of fear (twitchy, sweaty, tachycardic) respond well to Beta-Blockers as needed.

SELECTIVE MUTISM - kids who refuse to talk in certain circumstances. Often caused by a childhood trauma.

SEPARATION ANXIETY DISORDER - kids who fear separation from their family. They may fake illnesses to avoid school, have bad grades, get depressed or pick fights. Treatment is focused on identifying triggers using CBT, but anxiolytics help too.