ANXIETY DISORDERS

Dr David Schaefer

History

Normal anxiety: - evolutionary - alerting signal - interpersonal

Pathological: - most common

- selective attention - Yerkes Dobson

Classification

Generalised anxiety disorder Panic disorder Agorophobia Specific phobia Social phobia OCD PTSD Substance induced anxiety disorder

Panic Attack Discrete period of intense fear/discomfort Starts suddenly, peaks at 10 mins Palpitations Sweating Trembling/shaking SOB/choaking Chest pain Nausea Dizzy/fainting Derealization/detached Fear losing control ,dying Paraesthsia, chills

Panic Disorder

Recurrent unexpected panic attacks Worry about additional panic attacks Worry about consequences Behavioural change

Treatment Panic Disorder

Emergency- Benzos First line- SSRI (delayed effect) 2nd line- MAOI

- Mirtazepine

- TCA- imipramine, clomip

- Venlafaxine

- Epilim

Panic Disorder-Therapy

Psychoeducation Cognitive- ‘false alarm’ Relaxation- muscular, imagery Breathing

Obsessive Compulsive Disorder

Obsessions- recurrent intrusive thoughts, impulses, images. Recognise thoughts are their own

Compulsions- repetitive behaviours/mental acts in response to obsession or rule. Include:

- handwashing, ordering, checking,praying, repeating words, counting

Compulsion aimed at reducing stress/preventing event

Treatment OCD

SSRI or Clomipramine Add Neuroleptic Citalopram and Clomipramine Mirtazepine and SSRI

Therapy OCD

Exposure CBT

Obsessive Compulsive Related Disorders OCD Body Dysmorphic Disorder Hoarding Disorder (new to DSM V) Trichotillomania Excoriation (skin picking) Substance induced Obsessional jealousy

PTSD

Exposure to traumatic event Reexperienced: Recurrent recollections Dreams FlashbacksAvoidanceEmotional numbing/detachmentHyperarousal- sleep, irritability,startle reflex

Treament PTSD

SSRI Add neuroleptic Mirtazepine Venlafaxine ? CMZ, clonidine, lamictin, Epilim ? Benzos

Therapy PTSD

Cognitive- world unsafe Exposure therapy- conditioned fear response

Eye Movement Desensitisation and Reprocessing

Behavioural- breathing, progressive muscular relaxation

Specific Phobia

Marked fear specific object/situation Exposure provokes anxietyb response Avoidance Realises fear unreasonable

Treatment- exposure therapy

- ?B-blockers

Social Anxiety Disorder Fear of social/performance situations Fears humiliation/embarrassment Exposure causes anxiety Avoidance Anxious anticipation Blushing

Treatment- emergency- Benzos -1st line- SSRI - B-blocker- performance - Buspirone - Venlafaxine - Epilim

Therapy SAD

CBT- mind reading Exposure therapy

Generalised Anxiety Disorder

Excessive anxiety and worry Unable to control worry Symptoms- restlesness - fatigue - poor concentration - irritability - muscular tension - insomnia- Common- prevalence 5-8%- women>men- Many seek help other specialities

Treatment GAD

Benzos?- sort-term 2-4 weeks Stessum SSRI- start low dose Mirtazepine Venlafaxine B-blockers ?neuroleptics

Therapy GAD

Psycho-education CBT Exercise Relaxation

Summary

Common Disorders Often Missed High comorbidity Often missed Treatment medication and therapy