Taking a History of Anxiety Disorders

20/11/2007

1. GAD – persistent, no phobic stimulus, must be present for at least 6

months

2. PTSD – symptoms ≥ 1 month after traumatic incident, must last for 1

month

- Trauma

- Re-experiencing: flashbacks, nightmare

- Avoidance

- Hyperarousal e.g. hypervigilance

- Blunting of affect

3. OCD – unwanted obsessions, compulsions, INSIGHT

- Compulsions must interfere with your life for › 1 hour/day

- Takes an average of 9 years from onset to diagnosis

- 17 years for correct treatment

4. Phobias – create fear  result in AVOIDANCE

- Agoraphobia, simple phobia, social phobia

- Specific stimulus, panic only lasts for a specific time

- Cannot be reasoned away (e.g. plastic spider)

5. Panic Disorder – discrete episodes, extreme, symptoms for › 1 month

- Often described as “fear of the fear”

- Avoidance, drug abuse

History

-Always ask WHEN, WHY and HOW it started

- Remember SEDATE
S – symptoms

E – episodic or continuous (if episodic, then ≠ GAD)

D – depression, drinking, drugs (ANY symptoms of anxiety can be the effects of

drug withdrawal)

A – avoidance or escape

T – triggers and timing

E – effect on life

Symptoms:

Physical - ↑autonomic response

- Hyperventilation

- Sweating

- Palpitation

- Loss of sleep/memory/ concentration

Psychological

- Agitation

- Irritable (e.g. do you feel like a bundle of

nerves?/jumpy?)

- Fear (e.g. do you feel like something terrible is going to

happen?)

For OCD:

- Ask whether thoughts are THEIR OWN (psychosis….)

- Ask e.g. do you ever get any embarrassing thought/ideas that

you can’t get rid of / that are repeated?
PTSD:

- to elicit blunting of affect, ask e.g. do you feel that your emotions
are not as strong as they used to be

Drugs: remember to ask about caffeine and smoking also.

Avoidance/escape: ask e.g. os there anything that you used to do that you now
find more difficult to do?

Treatment for anxiety disorders:

Generally – CBT (± self-help methods)

-SSRIs

-TCAs

Guidelines for the History

1) Introduction, establish rapport etc (use the scenario synopsis)

2) Ask open questions e.g. could you tell me a bit about what has been
troubling you?

3) Elicit content and attitudes

- Are you troubling by any recurrent worrying thoughts?

- Has something happened to you recently to trigger these thoughts?

(PTSD)

- Do these thoughts cause you troubling sleeping?

- Do you have recurrent or unexpected panic attacks?

- Are you worries about a significant change in behaviour during

these attacks?
 - Do you avoid certain activities (e.g. meeting people,
eating/speaking in public?)

- Have you had the feeling that things around you were not real
(derealisation)

- Have you yourself felt unreal/ not living in the world?

(depersonalisation)

4) PTSD

- Have you experienced a traumatic event in the past?

- Do thoughts of (x) distress you?

- Do you find that you re-experience that event? (flashbacks,

nightmares)

- Do you avoid thinking about/talking about that event

- Do you have any trouble sleeping?

- Do you feel constantly on –edge, as though something terrible will

happen (hypervigilance)

5) Elicit physiological changes

- When you get these thoughts, or attacks, do you get

i. Tremor

ii. Hot flashes

iii. Palpitations

iv. Sweaty

v. Dizzy

vi. Increased breathing

vii. Nausea

viii. Tingling in arms/legs

ix. Sense of impending doom

6) Elicit past psychiatric history / medical Hx

- e.g. screen for depression/ past psych disorder

- chronic disease etc

7) Family Hx – psychiatric disorders etc

8) Drugs, alcohol, smoking Hx

9) Assess for suicidality

- E,g, do you feel that life is worth living?

- Did you ever feel like ending it all?

- What did you think that you actually might do?

- Did you actually try it

10)Social Hx etc