0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

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TABLE 16.6. Anxiety Disorders (Continued)

DISORDER SYMPTOMS/EXAM DIFFERENTIAL DIAGNOSIS TREATMENT

Age of onset usually late

adolescence to mid-30s.

Phobic disorder Clinically significant Panic disorder, PTSD, GAD Same as for GAD CBT (exposure-response

anxiety provoked by prevention therapy),

exposure to a specific desensitization, SSRI,

feared object or short-acting benzodiazepines,

situation leading to β-blockers (eg, propanolol),

avoidance behavior anxiolytic agents

(eg, alprazolam)

Obsessive Repetitive thoughts Delusional disorder, Same as for GAD CBT (exposure-response

compulsive (obsessions) that schizophrenia, GAD. prevention therapy), SSRI,

disorder (OCD) cause marked anxiety clomipramine; higher

or distress and/or doses than those for

mannerisms depression usually required

(compulsions) that

serve to neutralize

and relieve anxiety

(but only temporarily)

Posttraumatic Reexperiencing an Depression, GAD, Same as for GAD CBT, individual/

stress disorder extremely traumatic adjustment disorder group therapy (especially

event accompanied (patients have stress, helpful), SSRI, sleep

by symptoms of anxiety, behavioral changes agents, long-acting

increased arousal, that are related to a specific benzodiazepines.

hypervigilance, and trigger but do not have

by avoidance of reexperiencing, avoidance,

stimuli associated and increased arousal).

with the trauma;

patients typically

have no history of

panic attacks.

A 15-year-old girl presents to the ED after seeing a friend hit by a car and

reports sudden paralysis of the left leg immediately after the incident. She

was not involved in the accident. Her neurologic exam is significant for no

voluntary movement of the left leg although sensation is intact. Upon motor

exam, she has a positive thigh adductor test (when the examiner places her

hands on the patient’s bilateral inner thighs and asks her to adduct against resis-

tance, both of legs adduct). What is her diagnosis?

Conversion disorder.

“La belle indifference”

(patient unconcerned about

condition) no longer

diagnostic of conversion

disorder but can be seen.

Somatoform Disorders

See Table 16.7.