Category: Psychiatry

Panic Attack Specifier

Panic Attack Specifier

Psychiatry

Panic Attack Specifier

Note: Symptoms are presented for the purpose of identifying a panic attack; however, panic attack is not a mental disorder and cannot be coded. Panic attacks can occur in the context of any anxiety disorder as well as other mental disorders (e.g., depressive disorders, posttraumatic stress disorder, substance use disorders) and some medical conditions (e.g., cardiac, respiratory, vestibular, gastrointestinal). When the presence of a panic attack is identified, it should be noted as a specified (e.g., ‘’posttraumatic stress disorder with panic attacks”). For panic disorder, the presence of panic attack is contained within the criteria for the disorder and panic attack is not used as a specified.

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four (or more) of the following symptoms occur:

Note: The abrupt surge can occur from a calm state or an anxious state.

  1. Palpitations, pounding heart, or accelerated heart rate.
  2. Sweating.
  3. Trembling or shaking.
  4. Sensations of shortness of breath or smothering.
  5. Feelings of choking.
  6. Chest pain or discomfort.
  7. Nausea or abdominal distress.
  8. Feeling dizzy, unsteady, light-headed, or faint.
  9. Chills or heart sensations.
  10. Paresthesias (numbness or tingling sensations).
  11. Derealization (feelings of unreality) or depersonalization (being detached from oneself).
  12. Fear of losing control or “going crazy.”
  13. Fear of dying.

Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.

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Separation Anxiety Disorder

Separation Anxiety Disorder

Psychiatry

Separation Anxiety Disorder

Diagnostic Criteria

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

  1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
  2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
  3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
  4. Persistent reluctance or refusal to go out, away from home, to school, to work , or elsewhere because of fear of separation.
  5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
  6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
  7. Repeated nightmares involving the theme of separation.
  8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.

D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.

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Selective Mutism

Selective Mutism

Psychiatry

Selective Mutism

Diagnostic Criteria

  1. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.
  2. The disturbance interferes with educational or occupational achievement or with social communication.
  3. The duration of the disturbance is at least 1 month (not limited to the first month of school).
  4. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  5. The disturbance is not better explained by a communication disorder (e.g., childhood onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

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Generalized Anxiety Disorder

Generalized Anxiety Disorder

Psychiatry

Generalized Anxiety Disorder

Diagnostic Criteria

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) The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item is required in children.

  1. Restlessness or feeling keyed up or on edge.
  2. Being easily fatigued.
  3. Difficulty concentrating or mind going blank.
  4. Irritability.
  5. Muscle tension.
  6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D) The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E) The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F) The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dimorphic disorder, having a serious illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

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Agoraphobia

Agoraphobia

Psychiatry

Agoraphobia

Diagnostic Criteria

A) Marked  fear or anxiety about two (or more) of the following five situations:

  1. Using public transportation (e.g., automobiles, buses, trains, ships, planes).
  2. Being in open spaces (e.g., parking lots, marketplaces, bridges).
  3. Being in enclosed places (e.g., shops, theaters, cinemas).
  4. Standing in line or being a crowd.
  5. Being outside of the home alone.

B)The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).

C) The agoraphobic situations almost always provoke fear or anxiety.

D)The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.

E)The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.

F) The fear, anxiety, or avoidance is persistent, typically for 6 months or more.

G)The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H)  If another medical condition (e.g., inflammatory bowel disease, Parkinson’s disease) is present, the fear, anxiety, or avoidance is clearly excessive.

I)  The  fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder-for example , the symptoms are  not confined to specific phobia, situational  type; do not involve only social situations (as in social anxiety disorder); and are not related exclusively to obsessions (as in obsessive-compulsive disorder), perceived defects or flaws in physical appearance (as in body dimorphic disorder), reminders of  traumatic events (as in posttraumatic stress disorder), or fear of separation (as in separation anxiety 

Note:   Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual’s presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.

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Phobias

Phobias

Psychiatry

Phobias

Phobias are among the most common off all psychiatric disorders. Specific phobias affects 5-10 % of the general population and social phobia affects about 3 %.

A. What are phobias?

Phobias are marked and persistent fear that is excessive or unreasonable which is triggered by the presence or anticipation of a specific object or situation. Exposure to the situation cause intense anxiety and distress. People with phobias avoid the anxiety provoking situation.

There are many kinds of phobias

  1. Blood phobia: runs in the family
  2. Phobias for heights
  3. Phobias for lifts, escalators
  4. Phobias for flying in aircraft
  5. Phobias for enclosed places ETCSocial anxiety disorder or
  6. social phobia is one of the most common psychiatric disorder with a life time prevalence off 12 %. It is more common among women than men but both men and women equally seek help for the problem.

B. What are the symptoms of social Phobia?

There are definite criteria to diagnose social phobia

Some of the symptoms are

  1. A marked and persistent fear of social situations in which person is exposed to unfamiliar people or to possible scrutiny by others.
  2. Fear that he or she will act in way that will be humiliating or embarrassing.
  3. Exposure to the feared social situation provokes anxiety.
  4. The person recognizes that the fear is excessive or unreasonable.
  5. Avoiding the feared social situation.
  6. Impaired socio –occupational functioning.
    Duration of above symptoms should at least be for 6 mont

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