Presented with an anxious patient:
A good way of taking a history is using SEDATE:
- Physical (increased autonomic response, hyperventilation, sweating, palpitations, loss of sleep/memory/concentration)
- Psychological (Agitation, irritable)
- Depression, drinking, drugs (including caffeine and smoking)
- Triggers and timing
- Effect on life
To Differentiate between:
- GAD– persisten, no phobic stimulus, must be present for at least 6 months
- PTSD– symptoms >1 month after traumatic incident, at least lasting 1 month
- Re-experiencing: flashbacks, nightmares
- Hyperarousal e.g. hypervigilance
- Blunting of affect
- OCD– unwanted obsessions, compulsions, INSIGHT
- Compulsion should interfere with life for >1hr /day
- Takes an average of 9 years from onset to Dx and a further 9 years on average to successfully treat
- Phobias- create fear -> result in avoidance
- Panic disorder- discrete episodes, extreme, symptoms for >1 month
- Often described as ‘fear of fear’
- Avoidance, drug abuse
- 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 duringthese 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)
Consider also asking about suicide if appropriate.
- May be a bit unorganised/dishevelled
- May seem irritable, may be fidgeting
- Hypervigilance, hyperalert
- May have increased rate of speech, reduced volume
- May be low, may be irritable
- May be blunted (PTSD) or expansive (during a panic attack).
- Thought process
- May have a racing thought process (possibly flight of ideas)
- May have obsessions (OCD)
- Almost always preserved unless associated with psychosis
NB Anxiety as a primary disorder rarely presents with disorders of perception (hallucinations/illusions/delusions). However, anxiety may present secondary to a psychosis or delirium in which these features may be present.