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PHYSICIAN of the YEAR 2014-NY State Osteopathic Medical Society
Board Certified Psychiatrist
Distinguished Fellow of the American Psychiatric Association
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Lois Kroplick, DO, DFAPA
(845) 362-4215

     ANXIETY DISORDERS


FACTS
Affects 40 million Americans adults 18 years and older
Symptoms have been present at least 6 months
Symptoms are not attributed to medical conditions 
Can get worse if not treated
Commonly occur with alcohol/drug abuse
Effective therapies are available 

TYPES OF ANXIETY DISORDERS

Panic 
Social Phobia
Specific Phobias
Generalized Anxiety Disorder
Agoraphobia

PANIC DISORDER

FACTS
Is a real illness
Occurs at any time, even during sleep
Peaks in 10 minutes
More common in women
Can be hereditary
Usually begins late adolescence

SYMPTOMS
Abrupt surge of intense fear or intense discomfort
At least four of following symptoms are present:
Palpitations
Sweating
Shaking
Shortness of breathe
Feeling of choking
Chest pain
Dizzy
Chills or hot sensations
Tingling/Numbness
Nausea
Sense of unreality (derealization)
Fear of losing control or going crazy
Fear of dying

SOCIAL PHOBIA
Intense anxiety in social situations where one is exposed to 
scrutiny of others
Fear is out of proportion to the actual threat
Social situations will be avoided or endured with intense fear
Followed by excessive worry about panic in future or
maladaptive behavior

SPECIFIC PHOBIA
Extreme fear about a specific object or situation
Immediately fear is evoked in the situation or seeing 
the object
Object is avoided or endured with intense fear
The fear is out of promotion to the actual danger

GENERALIZED ANXIETY DISORDER
Excessive worry more days than not for 6 months
Difficult to control the worry
At least three of the following symptoms are present:
Restless
Easily tired
Difficulty concentrating 
Muscle tension
Difficulty falling or staying asleep
Worry causes impairment in functioning or distress

AGORAPHOBIA
Marked anxiety in two or more of following situations:
Using public transportation
Being in open spaces
Being in enclosed spaces
Being outside your home alone
These situations are avoided, endured with great fear or may 
require a companion 
Fear is out of proportion to reality
Lasts 6 months
Causes significant distress or impairment 

TREATMENT OF ANXIETY DISORDERS

A combination of therapy and medication is the most effective 
way to treat anxiety.
Untreated anxiety can be debilitating and lead to depression. 

Before treatment begins, always see your medical doctor to rule out 
any physical cause of the anxiety. Many people with anxiety disorders 
self medicate with drugs and alcohol. This can lead to a worsening of 
anxiety and depression. 

MEDICATIONS FOR ANXIETY DISORDERS

Antidepressants

SSRI's (Serotonin Reuptake Inhibitors)
Lexapro, Prozac, Paxil, Zoloft, Celexa

SNRI's (Serotonin Norepinephrine Reuptake Inhibitors)
Effexor, Cymbalta

TRICYCLICS-Tofranil, Anafranil

MAOs-Nardil, Parnate

BENZODIAZEPINES (Klonopin, Ativan)
These medications are used for short periods of time due 
to the fact that people get used to these medications and 
need higher doses to achieve the same effect. 
It is important NOT to stop taking the Benzodiazepines abruptly 
as withdrawal symptoms can develop such as insomnia, seizures 
and a worsening of anxiety symptoms. 

BUSPIRONE (Buspar)
Not a benzodiazepine
Not addictive
Can take at least two weeks to work

BETA BLOCKERS (Propranolol)
Can prevent physical symptoms that accompany anxiety disorders
Given to someone who has fear of public speaking before speaking

PSYCHOTHERAPY

Cognitive Behavioral Therapy (CBT)
CBT helps people change their thinking patterns which are 
often false and create fear and anxiety. 
By changing one's thoughts, often people change the way they 
react to a stressful situation. 
CBT can be done individually or in a group. 
Often homework is assigned in between sessions.  

EXPOSURE BASED BEHAVIORAL THERAPY
A patient along with their therapist encounters the object or 
situation that they fear. With repeated exposure there is desensitization 
and anxiety decreases. The exposure can occur initially by videos or 
visualization exercises. This is followed by exposure in real life situations. 

PROGNOSIS
Untreated anxiety can be debilitating and lead to depression. The good 
news is that Anxiety Disorders are treatable. You don't have to suffer 
anymore!

Important Tools to Decrease your Anxiety
Exercise regularly
Meditation
Yoga
Sleep regular hours
Eat 3 meals and healthy snacks
Avoid drugs and alcohol, limit caffeine
Push yourself to socialize with positive people
Structure your day