HANDS Tool, Anxiety Disorders, Generalized Anxiety Disorder, Panic
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PHQ-9
assessment that evaluates degree of depression
HANDS
National depression screening day
Screening tools have been created for specific use with certain communities
For example, OU's Health Center uses the National Depression Screening day tool that is comprised of:
HANDS tool for depression, MDQ, Carroll-Davidson GAD (anxiety), Sprint 4 for PSTSD
Anxiety
Anxiety can be a normal and positive response to a threat but becomes a problem when it is persistent
and interferes with daily functioning
,Heredity and life experiences play a role in development
Types: Generalized anxiety disorder (GAD), panic disorders, obsessive-compulsive disorder (OCD), Post
traumatic stress disorder (PTSD)
anxiety disorders physiologic effects of fear
Sympathetic NS stimulation - increases epinephrine and norepinephrine
Parasympathetic NS is inhibited
Increased serotonin and GABA
Stimulation of endocrine system - B endorphins work with sympathetic hormones to produce
physiologic effects
Always rule out other causes of symptoms
Cognitive behavioral therapy is recommended for all types of anxiety disorders
Generalized anxiety disorder
Symptoms of physiologic stress/arousal (sweat, palpitations, SOB) accompanied by a psychological
mood of excessive worry that interferes with normal functioning
Present in 2-4% of population
Generalized anxiety disorder DSM-V classification
Excessive worry or anxiety for at least 6 months
Difficulty controlling worry, with physical or mental distress
Cannot be attributed to medications
With 3 or more of the following:
•Muscle tension
•Restlessness
•Difficulty concentrating
, •Irritability
•Difficulty initiating sleep
•Being easily fatigued
GAD: presentation in primary care setting
Insomnia
Fatigue
Sweating
Pain: abdominal, headache, chest, back
Cardiovascular: palpitations, dizziness, shortness of breath
Presentation of anxiety
Chief Complaint: Somatic Symptoms especially acid reflux, irritable bowel, migraines, muscle tension
Restlessness, key-up, on-edge, tense, wound-up, jumpy, jittery, nervous, worried, or worry wart
Identify the word that resonates with the patient and use that word in the chart.
"on a scale of 0-10, how much do you worry about...Finances?, Marriage? School work? Job?
Always inquire about psychosocial stressors, traumatic incidents...How are their relationships with
spouse/SO, coworkers, friends etc.
HPI/differential diagnosis things to consider - drugs that can cause anxious feelings
Psychiatric medications
Anticholinergics
Corticosteroids
Sympathomimetics
OTCs, diphenhydramine and cold remedies
Alcohol, caffeine, nicotine