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Generalized Anxiety Disorder (GAD)
- Excessive, uncontrollable worry about everyday issues; duration ≥6 months.
- Symptoms occur more days than not.
Clinical Presentation
- Restlessness
- Fatigue
- Muscle tension
- Sleep disturbances
- Irritability
- Difficulty concentrating
- Physical symptoms (nausea, diarrhea, chest pain, dizziness, dry mouth)
Labs, Studies & Imaging
- Clinical diagnosis based on DSM-5 criteria
- Rule out organic causes (thyroid disorders, cardiac conditions)
Treatment & Management
- First-line: SSRIs (fluoxetine, sertraline), SNRIs (duloxetine, venlafaxine)
- Second-line: TCAs (imipramine, clomipramine), pregabalin, gabapentin
- CBT and supportive psychotherapy
- Benzodiazepines short-term only (alprazolam)
Panic Disorder
- Recurrent, unexpected panic attacks; fear of future attacks lasting ≥1 month.
Clinical Presentation
- Sudden onset anxiety (typically peaks in minutes, duration <1 hour)
- Palpitations, chest pain, dizziness, shortness of breath, choking sensation, numbness/tingling, fear of dying or losing control
Labs, Studies & Imaging
- Clinical diagnosis
- ECG and labs to exclude medical causes (arrhythmia, hyperthyroidism)
Treatment & Management
- First-line: SSRIs (fluoxetine, sertraline), SNRIs (duloxetine, venlafaxine)
- Second-line: TCAs (imipramine, clomipramine)
- CBT
- Benzodiazepines short-term or PRN (alprazolam)
- Reduce caffeine intake
Phobias
- Persistent, unreasonable fear triggered by specific objects or situations causing avoidance.
Clinical Presentation
- Immediate anxiety or panic response upon exposure
- Patient aware fear is irrational
- Avoidance behavior interferes with daily life
Labs, Studies & Imaging
- Clinical diagnosis based on patient history
Treatment & Management
- First-line: Exposure therapy (systematic desensitization, flooding)
- CBT
- Beta-blockers (propranolol, labetalol) for situational anxiety
- Benzodiazepines short-term only (alprazolam)
Obsessive-Compulsive Disorder (OCD)
- Presence of obsessions, compulsions, or both causing significant distress or impairment.
Clinical Presentation
- Obsessions: intrusive, repetitive thoughts
- Compulsions: repetitive behaviors performed to reduce anxiety
Labs, Studies & Imaging
- Clinical diagnosis (DSM-5 criteria)
Treatment & Management
- First-line: High-dose SSRIs (sertraline, fluoxetine)
- CBT with Exposure and Response Prevention (ERP)
High-Yield Facts
- Differentiate GAD from Panic Disorder by duration and pattern of symptoms.
- Use benzodiazepines cautiously; suitable only for short-term use to avoid dependency.
