What is the presentation of anxiety disorder in a twelve-year-old girl?

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Elsevier ClinicalKey Clinical Overview

Diagnosis Hallmark of generalized anxiety disorder is excessive worrying and apprehensive expectation of a wide range of normal events and activities, such as: Work or school responsibilities and interactions Family health and finances In children, worry about competence or quality of their performance Common psychological symptoms related to generalized anxiety disorder include: Being nervous and unable to relax, with poor or disturbed sleep Worrying about trivial or minor matters, with no control over worrying Extreme restlessness and inability to concentrate Irritability Fear of the worst happening and feeling scared in general Feeling that objects are unreal (derealization) or that the self is “not really here” (depersonalization) Sensation of losing control, “going crazy,” or passing out Fear of death Muscle tension and fatigability are highly correlated with generalized anxiety disorder Common physical symptoms related to anxiety include the following, ranked in order of clinical significance: Palpitations Dyspepsia or abdominal discomfort Dizziness Unsteady gait Dyspnea Feeling hot and/or experiencing diaphoresis, regardless of ambient temperature Feeling faint, hands trembling, and face flushing Paresthesia marked by numbness and tingling Choking sensation Other common physical symptoms include: Nausea Diarrhea Cold extremities Xerostomia Bruxism Headache Symptoms are typically more severe in younger adults

Diagnosis Social anxiety disorder (social phobia) Phobic anxiety disorder with concerns about social situations involving unfamiliar people or possible scrutiny Psychological and physical symptoms of anxiety are present in certain social situations Anxiety is specific to social situations Characterized by early onset; typically appears by age 11 years in 50% of patients and age 20 years in 80% of patients Diagnosis can be confirmed by DSM-5-TR criteria: Extreme fear or anxiety related to meeting strangers, speaking in public, or being observed in social situations Social phobia must last for at least 6 months and cause clinically significant impairment in social interactions Panic disorder Marked by recurrent panic attacks or extreme but brief episodes of anxiety, at intervals ranging from 24 hours to several months; may coexist with generalized anxiety disorder Physical signs and symptoms of anxiety (eg, sweating, palpitations, dizziness, tachycardia) are present during a panic attack Intense fear or discomfort of an attack reaches its peak within minutes, unlike the constantly elevated anxiety of generalized anxiety disorder History of childhood trauma or abuse is more likely in patients with panic disorder than in those with generalized anxiety disorder Diagnosis can be confirmed by DSM-5-TR criteria: Extreme panic or anxiety reaching its peak within minutes, manifesting more than 4 somatic symptoms of anxiety At least 1 panic attack preceded by more than 1 month of apprehensive expectation of a similar episode Major depressive disorder Sadness, lethargy, and apathy lasting at least 2 weeks, with reduced interest and pleasure in normal activities; may coexist with generalized anxiety disorder Irritability, fatigue, poor sleep, and digestive symptoms are typically present, as with generalized anxiety disorder Diagnosis can be confirmed by DSM-5-TR criteria: Depressed mood for most days over 2 weeks along with at least 2 characteristic symptoms Anhedonia Change in weight or appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue Feelings of worthlessness or inappropriate guilt

Diagnosis Depressed mood for most days over 2 weeks along with at least 2 characteristic symptoms Anhedonia Change in weight or appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue Feelings of worthlessness or inappropriate guilt Diminished ability to concentrate or indecisiveness Suicidal ideation or attempt Obsessive-compulsive disorder Characterized by continually recurring thoughts or images (obsessions) that increase anxiety and repetitive or ritualistic actions (compulsions) performed to alleviate that anxiety Excessive worrying and some symptoms of anxiety can be present Differentiated by repetitive rituals and behaviors (eg, hand-washing, mental acts of ordering or checking) performed to alleviate anxiety Anxiety relates more to imagined or fantastic events Diagnosis can be confirmed by DSM-5-TR criteria: Obsessive thoughts and compulsive behaviors take up at least 1 hour of the day Patient suffers from clinically significant impairment in an occupational or social setting Posttraumatic stress disorder Psychological disturbance or anhedonic/dysphoric mental state caused by experiencing a serious traumatic event Heightened anxiety is typically present, along with its mental and physical symptoms Main distinguishing criterion is the association of anxiety with a specific event, not with normal daily functioning, and the presence of flashbacks, dreams, and dissociative states relating to that event Diagnosis can be confirmed by DSM-5-TR criteria: Adults and children older than 6 years Traumatic experience (eg, grave injury, sexual violence, threat of death) or such an event affecting a close friend or relative Repeated exposure to circumstances surrounding such events, as with first responders or emergency department personnel Psychological disturbance lasting longer than 1 month, including invasive memories, dreams, flashbacks, avoidance of stimuli associated with such events, irritability, anxiety, and insomnia Patient suffers from clinically significant impairment in an occupational or social setting Children younger than 6 years, specific criteria include: Witnessing traumatic events, especially those affecting a primary caregiver

Synopsis Generalized anxiety disorder is a mental disorder characterized by continuous and uncontrolled worrying without a significant cause Symptoms are present on most days for at least 6 months to confirm the diagnosis Psychiatric symptoms include excessive worrying, nervousness, restlessness, inability to relax, and fear of worst-case scenarios Associated physical signs and symptoms include tachycardia, dyspepsia, tremor, dizziness, hyperhidrosis, and cold extremities Patients with generalized anxiety disorder typically perceive impairments in their physical well-being, social relationships, occupation, and home and family life; they have an increased risk of alcohol and other drug use disorders, as well as suicide attempts DSM-5-TR criteria represent the gold standard for diagnosis Cognitive behavioral therapy is the preferred treatment at both initial diagnosis and relapse, along with patient education and recommendations for a healthy lifestyle Pharmacologic treatment typically consists of antidepressant therapy; supplemental medication (eg, antipsychotics) is added for refractory cases, usually under the care of a psychiatrist Benzodiazepines have immediate effect and may be used as short-term treatment; however, avoid routine use Most patients are prone to relapse 6 to 12 years after initial diagnosis, half in partial remission 5 years after initial diagnosis and treatment

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Elsevier ClinicalKey Clinical Overview

Diagnosis Symptoms typically last for 6 months and cause functional impairment Panic disorder Recurrent, unexpected panic attacks, which are abrupt surges of anxiety, fear, or discomfort that reach their peaks within minutes and any 4 of the following occur: Palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain or discomfort, nausea, dizziness, or lightheadedness, chills or heat sensations, paresthesia, derealization or depersonalization, fear of losing control or dying At least 1 attack has been followed by 1 month of persistent worry that another will occur, or maladaptive behavioral changes related to the attack Agoraphobia Marked fear or anxiety about 2 of the following situations: using public transportation; being in open spaces; being in enclosed places; standing in line, or being in a crowd; or being outside the home alone The fear and avoidance are due to worry about escaping or getting help in these situations, or about developing panic-like symptoms Symptoms typically last at least 6 months GAD (generalized anxiety disorder) Excessive anxiety and difficult-to-control worry, occurring more days than not, about multiple domains (eg, school, safety, future, family, friends), associated with at least 1 of the following Restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance Symptoms must last for 6 months Although there are no global severity specifiers in the DSM-5-TR ( Diagnostic and Statistical Manual of Mental Disorders. 5th ed., Text Revision ) for anxiety disorders, assess the duration and intensity of symptoms and the subsequent functional impairment Any anxiety disorder may also be diagnosed with a specifier "with panic attacks" Panic disorder involves unexpected panic attacks However, panic attacks can occur within the expected feared situation (eg, for someone with social anxiety disorder, experiencing panic attacks in social situations)