Anxiety Disorders Fkg

7/27/2019 Anxiety Disorders Fkg

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ANXIETY DISORDERs

Department of Psychiatry

Medical Faculty

Padjadjaran UniversityHasan Sadikin Hospital


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Epidemiology

The most prevalent mental disorder s in the

general population

Nearly 30 million person are affected in the US

Women nearly twice as frequently as men


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Anxiety disorder are frequently co morbid

with many other condition (beside MDD and

other anxiety disorder)substance abuse,

ADHD, bipolar, pain disorder, sleep disorder


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Anxiety normal or disorder

Anxiety is a normal emotion under

circumstances of threat and is thought to be

part of the evolutionary fight or flight

reaction of survival.

Every experiences anxietya diffuse,

unpleasant, vague sense of apprehension,

often accompanied by autonomic symptoms.


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Fear vs Anxiety

Anxiety

is an alerting signal

It warns of impending danger and enables a

person to take measures to deal with a threat

Is unknown, internal, vague, or conflictual

Fear

Is similar alerting signal

A known, definite, or non conflictual threat


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General sign and symptoms of anxiety

Core symptom of anxietyexcessive fear and

worry, feeling dizzy, unsteady, faint, light-headed

Autonomic symptoms : headache, perspiration,

sweating, trembling, shaking, dry mouth,

palpitation, pounding heart, tightness in the

chest, chest pain or discomfort, mild stomach

discomfort, nausea, restlessness (inability to sit orstand still for long, etc), difficulty of breathing ,

feeling choking,


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Pathophysiology of Anxiety

I. Psychological factors

Psychoanalytic theories (Freud theory)anxietyas a signal of the presence of danger in the

unconsciouspsychic conflict unconscioussexual or aggressive wishes and superego orexternal reality

Behavioral theoriesa conditioned response

to a specific environmental stimulus.

Existential theoriespersons experience feelingof living in a purposeless universe.


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2. Biological Factors

Autonomic Nervous system

Neurotransmitter (serotonin, norepinephrine) Hypothalamic-Pituary-Adrenal (HPA) axis

Corticotrophin-releasing hormone (CRH)

GABA


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Anxiety and fearsymptoms are regulated by anamygdala-centered circuit.

Worryby a cortico-striatal-thalamo-cortical(CSTC) loop

AMYGDALAplays a central role in theexperience of anxiety and fear, has reciprocalconnections with a wide range of other brainregionAmygdalaanterior cingulated

cortex, hypothalamus, thalamus, hippocampus,orbital prefrontal cortex, brainstem sites (e.g.,PAG, raphe


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Affect of fearover activation of circuit ofamygdale with anterior cingulate cortex (ACC)and Amygdala with orbitofrontal cortex

Avoidanceamygdale and periaqueductalgray (PAG).

Avoidance is a motor response ~ freezing

under threat, fight or flight Endocrine output of fearamygdale

activation of HPA axisincreases in cortisol.


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A quick boost of cortisol may enhance survival when aperson is encountering a real but short term threat.Prolonged HPA activation and cortisol releasesignificant health implicationCAD, Type 2 DM, and

stroke.

Respirationinappropriate or excessive activation ofthe parabrachial nucleus (PBN) via the

amygdaleincrease in the rate of respiration,

shortness of breath, exacerbation of asthma, or a sense

of being smothered/chockingespecially in panicattacks


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Traumatic memories stored in the

hippocampus activate the amygdale

activate other brain regions and generate a

fear response


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Classification

Panic disorder with or without agoraphobia

Agoraphobia with or without Panic disorder

Specific Phobia

Social Phobia

PTSD (Post Traumatic Stress Disorder)

Acute Stress disorder

Generalized Anxiety Disorder

Obsessive Compulsive Disorder


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AGORAPHOBIA

Fear or avoidance of at least two :

Crowds places

Public places Travelling alone

Travelling away from home


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Social Phobia

Marked fear of being the focus of attention, or

behaving in a way that will be embarrassing or

humiliating

avoidance social situationseating or

speaking in public, parties, meeting,

classroom)


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Specific Phobia

Marked fear of a specific object or situation

not included in agoraphobia or social phobia

Marked avoidance of an object or situation

specific (animal, birds, insects, heights

thunder, flying, injection, blood, etc)


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Obsessive Compulsive Disorder (OCD)

Either obsession or compulsion (or both) arepresent on most days for a period of at least 2weeks

Obsessions (thoughts, ideas, or images) andcompulsions (acts).

Repetitive, unpleasant, acknowledged as

excessive or unreasonable Patient tries to resist them, but unsuccessfully

Cause distress


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Panic attack/disorder

Recurrent unexpected panic attack , characterized by 4 or more:

- palpitation

- sweating

- trembling or shaking

- shortness of breath

- feeling of chocking

- chest pain or discomfort

- nausea or abdominal distress

- feeling dizzy, lightheaded or faint

- derealization or depersonalization

- fear of losing control or going crazy

- fear of dying- Numbness or tingling

- chills or hot flushes

Significant change in behavior related to the attack


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Acute stress disorder

Has been exposed to the traumatic events (experienced, witnessed, or was confronted)

The persons response involved intense fear, helplessness, or horror

3 or more of symptoms:

- a subjective sense of numbing, detachment, or absence of emotional

- a reduction in awareness of his or his surroundings

- derealization

- depersonalization

- dissociative insomnia

Persistently re experienced in at least one of the following ways: recurrent images, thoughts,dreams, illusions, flashback episodes, or sense of reliving the experience

Marked avoidance of the stimuli that arouse recollections of the trauma (e.g,: thought, feelings,conversation, activities, places, people)

Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poorconcentration, hyper vigilance, exaggerated startle response, motor restlessness.

Clinically distress or impairment in social , occupational , or other important areas of functioning


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Generalized Anxiety Disorder

Excessive anxiety or worry about a number of events or activities(future oriented), occurring more days than not for at least 6months

Worry is difficult to control

Worry is associated with at least three of the following symptoms:

- restlessness or feeling keyed up on edge- easily fatigued

- difficulty concentrating

- irritability

- muscle tension

- sleep disturbance

Anxiety and worry cause significant distress and impairment insocial, occupational, or other daily functioning


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Therapy

Pharmacotherapy (benzodiazepines,

AntidepressantSSRI)

Psychotherapy (CBT, Insight oriented)

Behavior therapy (flooding, desensitization)

Documents

Anxiety Disorders Fkg