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JOURNAL READING

Diagnosis and Management of Generalized


Anxiety Disorder and Panic Disorder in Adults
AMY B. LOCKE, MD, FAAFP; NELL KIRST, MD; and CAMERON G. SHULTZ, PhD, MSW, University of Michigan Medical School, Ann Arbor, Michigan

Pembimbing :
dr. Iwan Sys, SpKJ

Oleh :
Nuzulul Nindya Kirana (201610401011011)
Nur Sofiana (20161040101011021)
SMF ILMU KESEHATAN JIWA
RSJ MENUR SURABAYA
FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANG
2018
Introduction

Panic Disorder • Most common mental disordes in US


(PD) • negatively impact a patient’s quality of life and disrupt important of ADL.
• The rates of missed diagnoses and misdiagnosis of GAD and PD are
high
• The GAD-7 and the Severity Measure for Panic Disorder are free
Generalized diagnostic tools
Anxiety Disorder • Treatment such as SSRI and/or psychotherapy, both of which are highly
effective
(GAD)

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Definition

Panic Disorder is an anxiety disorder by episodic, unexpected panic attacks


that occur without a clear trigger.

Generalized Anxiety Disorder is an anxiety disorder characterized by


persistent and excessive anxiety about a number of different things. The
anxiety is intrusive, causes distress or functional impairment, and often
encompasses multiple domains

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EPIDEMIOLOGY

The 12-month prevalence for GAD and PD among U.S. adults 18 to 64 years of age

GAD : 2.9 % PD : 3.1 %

• 7.7% in women • 7.0% in women


• 4.6% in men • 43.3% in men

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ETIOLOGY

Panic Disorder Generally Anxiety Disorder


 The etiology is not well understood The etiology is not well understood
 The neuroanatomical hypothesis  An underlying theme to several mod-
genetic-environment interaction. els is the dysregulation of worry

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Typical Presentation

Generally Anxiety
Panic Disorder Disorder

 defined
PD byTypical
the rapid onset of intense
Presentation  associated with physical symptoms, such
fear with at least four of the physical and as sleep disturbance, restlessness, mus-
psychological symptoms in the DSM-5 cle tension, gastrointestinal symptoms,
diagnostic criteria and chronic headaches
 worries about further attacks or  Some factors associated include female
modifies his or her behavior in sex, unmarried status, lower education
maladaptive ways to avoid them. level, poor health, and presence of life
 physical symptom : palpitations stressors

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Diagnostic Criteria
Panic Disorder (DSM-5)

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Severity Measure for Panic Disorder

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Diagnostic Criteria
Generally Anxiety Disorder
(DSM-5)

GAD

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GAD-7 Screening Tool

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Differential Diagnosis

• When evaluating a patient for a suspected anxiety disorder, it is important to


exclude medical conditions with similar presentations : endocrine conditions such as
hyperthyroidism, cardiopulmonary conditions, neurologic diseases
• Other psychiatric disorders
• Use of substances
• Substance withdrawal may also present with similar symptoms and should be ruled
out
Complicatio
n

• Additionally, many patients with GAD or PD meet criteria for other psychiatric
disorders, including major depressive disorder and social phobia.
• Evidence suggests that GAD and PD usually occur with at least one other
psychiatric disorder, such as mood, anxiety, or substance use disorders.
• When anxiety disorders occur with other conditions, historic, physical, and
laboratory findings may be helpful in distinguishing each diagnosis and developing
appropriate treatment plans

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Treatment

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EDUCATION

Caffeine Smoking Sleep Exercise


PD may be more sensitive to Smoking cessation leads to Many studies show an Exercising at 60% to 90%
caffeine than the general improved anxiety scores, association between of maximal heart rate for
population because of with relapse leading to disordered sleep and 20 minutes three times
genetic polymorphisms in increased anxiety. anxiety, but causality is weekly has been shown to
adenosine receptors unclear decrease anxiety; yoga is
also effective.
PSYCHOTHERAPY AND RELAXATION
THERAPIE

cognitive behavior therapy


(CBT) meditation
 relaxation Transcendental meditation has similar
effectiveness to other relaxation therapies.
 exposure therapy

 Breathing

 cognitive restructuring

 education.
Evidence indicates that music therapy, aromatherapy, acupuncture,
and massage are helpful for anxiety associated with specific
disease states.

COMPLEMENTARY AND ALTERNATIVE


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MEDICINE THERAPIE
Referral
Prevention
Poor response to treatment
Atypical presentation There is insufficient evidence to support a
Concern for significant concise recommendation on the prevention of
comorbid psychiatric illness PD and GAD in adults.

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