F41.9
ANXIETY DISORDERS
DESCRIPTION
Separation anxiety disorder and selective mutism are diagnostic categories previously exclusive to childhood, while social anxiety disorder (social phobia), specific phobia, panic disorder, agoraphobia and generalised anxiety disorder (GAD) present across the lifespan. Anxiety disorders are common in children and adolescents affecting 6-20%.
Medication does not form part of the primary management of separation anxiety disorder and selective mutism.
Anxiety in a child can be misdiagnosed as ADHD, as both conditions may present with increased levels of activity and problems with concentration.
GENERALISED ANXIETY DISORDER (GAD)
F41.1
DESCRIPTION
Excessive anxiety or worry about a number of factors or events, occurring on most days for at least 6 months. The intensity, frequency or duration of the anxiety is out of proportion to the actual likelihood or impact of the anticipated event. The individual finds it hard to control the worry and to keep worrisome thoughts from interfering with attention to tasks. During the course of the disorder the focus of the worry may shift from one concern to another. The worries interfere with psychosocial functioning, are pervasive and distressing and often have no precipitants.
DIAGNOSTIC CRITERIA (DSM 5)
Excessive anxiety or worry that is both difficult to control and associated with 1 of the following 6 symptoms for 6 months:
- restlessness or a feeling keyed up or ‘on edge’
- difficulty concentrating or ‘mind going blank’
- irritability
- muscle tension
- sleep disturbance
- being easily fatigued
GAD causes significant distress or impairment in functioning.
Exclude other psychiatric disorders, general medical conditions or effects of substances.
GENERAL AND SUPPORTIVE MEASURES
These interventions should be performed by a suitably qualified clinician.
- Cognitive behavioural therapy (CBT): aimed at changing pessimistic, anxiety-based cognitions and developing strategies to reduce anxieties and avoidant behaviour patterns.
- Behaviour therapy: relaxation, desensitisation by imagining or exposure to anxiety-provoking situations.
- Psychodynamic/supportive psychotherapy: aimed at promoting self- esteem, assertiveness and autonomy.
MEDICATION TREATMENT
- Fluoxetine, oral, 0.5 mg/kg/day.
- Dose range: 20–40 mg daily.
- Recommended average dose: 20 mg/day.
However, fluoxetine may only be available in 20mg capsules, in which case citalopram tablets can be used initially, titrated to 20mg and then changed to fluoxetine 20mg.
If there is a poor response to fluoxetine after an adequate trial of treatment, i.e. 4–6 weeks consider an alternative SSRI.
- Citalopram, oral, 0.4 mg/kg/day.
- Dose range: 5–40mg daily.
- Recommended average dose: 10–20 mg/day.
REFERRAL
- 12 years and under.
- Failure to respond after 6–8 weeks to an adequate trial of therapy and medication.
- Adverse events to fluoxetine/citalopram.