Management of GAD/ Panic Disorder/ Phobia

* Manage as OUTPATIENT 

INVESTIGATION
1) BIO :
    TFT, RBS, FBC (Hb),
    Urine for Drugs,
    ECG

2) PSYSCO:
    Collaborative hx from relatives, colleague, employer etc (find the stressor)

TREATMENT
1) BIO
    SSRi (1st line) ----> (Panic 1/2 dose AD, GAD = dose MDD)
    T. Escitalopram (Lexapro) 10-20 mg OM
    T. Sertraline ( Zoloft) 50-200 mg OM
    T. Fluoxantine (Proxac) 10-20 mg OM ---> DOC OCD/ Social Phobia
    Anxiolytic (BDZ)
    GAD ---> T. Diazepam 5 mg OD (Long Acting)
    Panic ---> T. Alprazolam 0.25-0.5 mg PRN (Ultra short) ----> xcont > 2 weeks can cause dependent 
     +/- Beta Blocker


2) PSYCHOSOCIAL
    PsychoEducation (pt & family)
    - Reassurance --> not going to die/ be crazy
    - Nature of d/s ---> stress --> +CNS & increase adrenaline ---> phy symptoms
                                   if no stress ---> no symptoms
    - Important to identify the stressor & anticipate

    CBT
    - Cognitive : Modify & correct misinterpretation (catastrophic thinking)
                       eg: List down +ve VS -ve quality you have
    - Behaviour: Relax/Breathing technique
                       Distraction technique
                       Stress Mx: Share!!!
                       Problem Solving (table)

    PsychoTx (Dynamic) ----> only for PHOBIA
    - Systemic Desensitization (with relaxation)
    - Gradual Exposure
    - Flooding

3) SPIRITUAL
     - Pray & Read Quran ----> can find piece (go back to your God)
     - Good deeds that you have ---> utilize it
     - I will pray for my patient

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This is all a collection of what I have learnt during my medical student years, most of them are already a simplified version, very clinical, and comes from what my Lecturer had thought.... I love to make notes in my own way, so that I can have a better understanding on what I have seen.... I hope, this will benefit all people, especially medical students... so that you will get this right... but just bear in mind... I'm a human too... so, mistakes is still in my dictionary of life.... so, please correct me if I'm wrong... Really2x appreciate that....

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Just a simple guy with a lot of things going on his mind... love to please others and help others who in need... Hoping that every nice moment in his life could be shared with others as well...(coz it's not much)