Anxiety Disorders

  • Onset - “When did you feel anxious?”

 

  • Frequency - “How often does it happen?”

 

  • Physiological - “How did you feel?”

Heart racing, chest tightness, hyperventilation, tingling in hands, collapse etc.

 

  • Duration - “How long has this been going on for?”

 

  • Change - “Is it any worse or better?”

 

  • Cognitive - “What was happening when you felt anxious?”

External stimulus e.g. spider, or internal e.g. obsessional thought.

 

  • Trigger - “Was anything different? Did you experience something?”

 

  • Understanding of anxiety - “What were you thinking when you were anxious?”

 

  • Reaction to anxiety - “What did you do when you were anxious?”

Avoidance, escape from trigger, acting on compulsion.

 

  • Effect on functioning - “How is it affecting you now?”

 

  • Specific questions related to possible anxiety disorder e.g. obsessions and compulsions, or nature of reliving in post-traumatic stress disorder.

 

For example - Agoraphobia

 

It is important to remember there are external triggers - crowds but the patient will have thoughts of a threat (trapped) before experiencing anxiety symptoms but will report the distress. History taking must include both

- their perception of the threat

“What happened before you were anxious? What were do you doing?”- “I was in the shop and felt like I was surrounded and couldn't get out.”

- as well as after the onset of anxiety

“What were you thinking about after you felt anxious?/ What were you thinking when getting out of the shop?”- “I needed to get out of there, I thought I was going to die.”

 

There is a need to separate the thoughts (“I’m surrounded.”- “I need to get out.”) from the symptoms of anxiety- chest tightness, heart racing, breathing quickly and what the patient did before and after the event. Patients can often find it difficult to separate thoughts from emotions.

 

Patient presents with anxiety in crowds

 

  • - When - when I’m out the house.

  • - Where out the house - when in shops, people around.

  • - When was the last time it happened - yesterday, I tried to leave the house and get milk but I couldn’t do it.

  • - What happened - I went in and my heart raced and I felt dizzy and had to leave.

  • - What was happening before you felt dizzy - I went in and saw all the people are had to get out.

  • - What did you think when you saw the people - That I was surrounded and couldn’t get out.

  • - So you felt trapped, what happened then - I felt my heart race, I felt like I couldn’t breathe and I needed to get out.

  • - (Clarify symptoms of panic - including collapse).

  • - What were you thinking then - I needed to get out, I thought if I didn’t get out I was going to die.

  • - That sounds very distressing, what did you do because of that - I went home and locked the door.

  • - How long did you feel that way - I felt terrible for about half an hour but drained all day.

  • - Did it happen again - no just when I came out today.

  • - Would you have come out today if you didn’t have this appointment - no I’ve looked at how to get food delivered to my house, it’s getting worse, I can’t deal with this.

  • - Do you ever get anxious when people are not around or when talking to one person (screen for other anxiety disorder, led by onset of anxiety in situations/triggers).

  • - Screen for depression, substance misuse, self-harm/suicide, effect on functioning and anxiety secondary to psychotic symptoms.

Copyright 2012 RevisePsych

Last updated March 2020

www.elu.sgul.ac.uk

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