Clinical Manual for Management of the HIV-Infected ... - myCME.com
Clinical Manual for Management of the HIV-Infected ... - myCME.com
Clinical Manual for Management of the HIV-Infected ... - myCME.com
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Anxiety Disorders<br />
Background<br />
Anxiety symptoms can develop because <strong>of</strong> a patient’s<br />
uncertainty about <strong>HIV</strong> infection and treatment<br />
or because <strong>of</strong> issues unrelated to <strong>HIV</strong>. Symptoms<br />
can include mild distress, full-blown panic attacks,<br />
generalized anxiety disorder, or o<strong>the</strong>r disorders. The<br />
criteria <strong>for</strong> a diagnosis <strong>of</strong> generalized anxiety disorder<br />
include unrealistic or excessive worry about 2 or more<br />
life circumstances <strong>for</strong> more than 6 months, and at least<br />
6 <strong>of</strong> <strong>the</strong> subjective <strong>com</strong>plaints listed below.<br />
It is important to differentiate between anxiety with and<br />
without panic attacks. Symptoms <strong>of</strong> anxiety can mimic<br />
symptoms <strong>of</strong> physical illness, and an appropriate workup<br />
should be per<strong>for</strong>med to rule out o<strong>the</strong>r illnesses.<br />
(For more in<strong>for</strong>mation about panic disorders, see<br />
chapter Panic Disorder.)<br />
S: Subjective<br />
The patient <strong>com</strong>plains <strong>of</strong> <strong>the</strong> following:<br />
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Difficulty concentrating<br />
Dizziness or ligh<strong>the</strong>adedness<br />
Dry mouth<br />
Easy fatigability<br />
Exaggerated startle response<br />
Feeling anxious or on edge<br />
Flushes or chills<br />
Frequent urination<br />
Irritability<br />
Muscle tension, aches, or soreness<br />
Nausea, diarrhea, or o<strong>the</strong>r abdominal distress<br />
Palpitations or accelerated heart rate<br />
Restlessness<br />
Shortness <strong>of</strong> breath or smo<strong>the</strong>ring sensations<br />
Skin rashes<br />
Sweating or cold, clammy hands<br />
Trembling, twitching, or feeling shaky<br />
Trouble falling or staying asleep<br />
Trouble swallowing or "lump in <strong>the</strong> throat"<br />
History<br />
Section 8—Neuropsychiatric Disorders | 8–1<br />
Obtain <strong>the</strong> following in<strong>for</strong>mation during <strong>the</strong> history:<br />
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Anxiety patterns (eg, constant or intermittent;<br />
timing)<br />
Caffeine intake<br />
Con<strong>com</strong>itant illnesses<br />
Family history <strong>of</strong> similar problems<br />
Medications, supplements, and herbal preparations<br />
New or recurrence <strong>of</strong> previous episodes<br />
Onset: sudden or gradual<br />
Recent stressors<br />
Recreational drugs or alcohol use (current or recent)<br />
Sleep disturbances<br />
O<strong>the</strong>r physical symptoms<br />
O: Objective<br />
Per<strong>for</strong>m a physical examination, including mental status<br />
and neurologic examination. Note heart rate, respiratory<br />
rate (shortness <strong>of</strong> breath, hyperventilation), tremor,<br />
rashes.<br />
A: Assessment<br />
A partial differential diagnosis includes <strong>the</strong> following:<br />
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Allergic reactions<br />
Anemia<br />
Central nervous system (CNS) or opportunistic<br />
infections or malignancies<br />
Electrolyte imbalances<br />
Excessive caffeine intake<br />
Heart disease, arrhythmias<br />
Hyperthyroidism<br />
Hypoglycemia<br />
Immune disorders<br />
Medications such as efavirenz, isoniazid, steroids,<br />
<strong>the</strong>ophylline<br />
Respiratory disease<br />
Sleep disturbances or sleep deprivation<br />
Substance use (eg, amphetamines, cocaine)<br />
Substance withdrawal (eg, alcohol, benzodiazepines)<br />
Systemic or o<strong>the</strong>r infections<br />
Vitamin B12 deficiency
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