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