Anxiety and Stress 1

Anxiety Disorders DSM-IV-TR information on relative co-morbidity & associated features added DSM-5: Major changes to this section. A grouping of these disorders will be termed Obsessive-Compulsive Spectrum Disorders Delete Agoraphobia without history of panic disorder Numerous clarifications and changes to almost all diagnoses in this category

Anxiety Disorders Social Phobia: now includes avoidant disorder of childhood. Specific Phobia was called Simple Phobia: must now have marked excessive or unreasonable fear. Based on research, now added sub-types.

Anxiety Disorders Obsessive-Compulsive Disorder: the definition between the obsession and compulsion has been clarified, the obsession causes distress and the compulsion is a way to try to handle it.

DSM-5 Obsessive-Compulsive Disorder New Name: Anxiety and Obsessive-Compulsive Spectrum Disorders Will also include trichotillomania and possible other conditions Obsessions to be described as urges rather than impulses Term “impulses” is problematic as how do you distinguish them from impulse control disorders, so will change term

Anxiety Disorders Panic Disorder With or Without Agoraphobia: recent attacks involving at least one month of consistent concern, the thresholds have been changed for both. Agoraphobia with History of Panic Disorder: fear of being in places where escape may be difficult. Generalized Anxiety Disorder: now includes over-anxious disorder.

Anxiety Disorders Post-Traumatic Stress Disorder: symptoms must last at least one month, if more that 6 months after event should specify delayed onset (no longer must be must be outside of range of usual experience, often relive situation, now has acute and chronic specified, must cause distress). Acute Stress Disorder: This new category was added into the DSM-IV to address acute reactions to extreme stress (occurring within four weeks of the stressor and lasting from 2 days to 4 weeks). This may help predict the development of PTSD.

DSM-5 Acute Stress Disorder The trauma experienced in acute stress disorder will not include: Witnessing events on television Witnessing events through electronic media Will also drop the criteria that the person must experience intense fear Symptoms may no longer need to involve feelings of dissociation

DSM-5 and PTSD Developmental manifestations of PTSD are still being developed. The term 'developmental manifestation' in DSM-5 refers to age-specific expressions of one or another criteria that is used to make a diagnosis across age groups. For children, inclusion of loss of a parent or other attachment figure is being considered. The optimal number of required symptoms for both adults and children will be further examined with empirical data.

New Anxiety-Related Disorder New disorder proposed: Hoarding Disorder

Serax/Clorazepate), Tranxene/Diazepam, Klonopin/Clonazepam GENERIC/BRAND DURATION OF ACTION DOSE (MG) Librium/Temezepam Long Acting, 15-75 mg day Valium/Diazepam Long Acting, 4-30 mg day Dalmane/Flurazepam Long Acting, 15-30 mg day Xanax/Alprazolam Short Acting, 0.5-1.5 mg day Restoril/Temazepam Short Acting, 15 - 30 mg day Halcion/Triazolam Short Acting, 0.125 - 0.5 mg Serax/Clorazepate), Tranxene/Diazepam, Klonopin/Clonazepam 11

Side Effects and Interactions with Anti-Anxiety Medications The benzodiazepine is a central nervous system depressant so do not mix it with alcohol or significant depression can result. Consider Buspar (Buspirone HCL) if history of drug seeking or abuse behavior is suspected. 12