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ANXIETY DISORDERS

Anxiety is a state of tension &apprehension with hyperactivity of

the autonomic nervous system as a

natural response to perceived

threat. Anxiety disorders have three

components.Cognitive component.

Physiological responses.

Behavioral Response.

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BEHAVIORAL RESPONSES

Avoidance of certain situation.Impaired task performance

COGNITIVE COMPONENTSubjective feelings of apprehension.

A sense of impending danger.

A feeling of inability to cope.

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PHYSIOLOGICAL RESPONSES

Increased heart rate. Raised blood pressure.

Muscle tension.

Rapid breathing.

Nausea.

Dry month.Diarrhoea.

Frequent urination.

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Anxiety disorders may be classified

as follows

Generalized anxiety disorder (GAD).Panic disorder.

Phobic disorders agoraphobia,

specific phobias and social phobias.

Obsessive compulsive disorder

(O.C.D)Post traumatic stress disorder (PTSD)

Secondary disorders due to general

medical condition and substances.

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GENERALISED ANXIETY DISORDER

Persistent generalized & excessive

feelings of anxiety not attached to any

particular specific situations but rathercaused by a general tendency to worry

excessively. It may last for months.

There is a sense of impending disorder,

through not specific

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Typical worries include excessive

worries about work or social

performance, exaggerated

concern about finances & thepossibility of becoming ill or

having an accident.

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Common symptoms of GAD

Nervousness, restlessness, trembling.

shortness of breath

SweatingMuscle tension

Feeling jittery, tense and constantly

on edge

Trouble falling or staying asleep

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Poor concentrationIrritable mood, depressed mood

Palpitations

frequent urination

Easily fatigued , light headedness

Difficulty making decisions

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PANIC DISORDER

PANIC ATTACK

A panic attack is a discrete period of

intense fear or discomfort, in which

four or more of the following

symptoms develop abruptly & reached

a peak within ten minutes.Palpitations

Sweating

Trembling and shaking

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Symptoms of panic attacks can be

terrifying & distressing. They may last a

few minutes or longer. In MOST cases,

panic attacks occur in the absence of any

identifiable stimulus.Attacks may be followed by persistent

concerns a bout having another panic

attack. They are mysterious and terrifying

due to their unpredictable quality.

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Many people with panic attacks

develop agoraphobia (a fear of

public places) for fear of having an

attack in public.

Panic disorder can be classified asbeing with or without agoraphobia;

panic disorders tend to appear in

late adolescence or early adulthood

(mid 20s). They are more frequent in

females.

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The situations include

Being outside the home aloneBeing in a crowd or standing on a line

Being on a bridge, elevators.

Travelling in a bus ,train or car

They feel relieved when accompanied

by someone else.It usually develops after the individual

has experienced of panic like

symptoms.

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PHOBIC DISORDERS

Phobias are strong and irrational fears ofcertain object or situations. The word is

derived fromphobos, a Greek god of fear.

People with phobias relies that theirfears are out of proportion to the danger

involved. However, they feel helpless to

deal with fears. Instead, they makestrenuous effort to avoid the phobic

situation or object.

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AGORAPHOBIA.

Its anxiety about being in places or

situations from which escape mightbe difficult (or embarrassing) or in

which help may not be available in

the event of having an unexpected

or situationally predisposed panic

attack or panic like symptoms.

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SOCIAL PHOBIA.

Social phobia is common as panic andagoraphobia disorders. It is experienced byboth men and women. It is chronic disorder

that fluctuates over time and may causemarked impairment in social and occupationalfunctioning if untreated.

The key feature of social phobia is excessivefear of situations in which the person might bescrutinized, evaluated and judged negatively.

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Individuals doing something embarrassing or

acting in a way that may be humiliating. Fear

of specific social situation results in avoidance.

A more generalized social phobia may lead to

almost complete social isolation. Social

phobia is often under-recognized by medical

workers, because they either confuse it with

shyness or judge the secondary depression orsubstance dependence to be the primary

disorder. If a person says, people make me

anxious or nervous, consider social phobia.

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Common situations feared include speaking in

public, writing in the presence of others eating

or drinking in public or using public toilets.

Common (embarrassing) symptoms include

blushing, nausea, shaking and the urge to go

the toilet.

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SPECIFIC PHOBIA

Specific phobias may include fear of dogs,spiders, snakes, elevators, heights andenclosed spaces, airplanes, still water,

injections, illness, or death. Commonsymptoms consists of trembling, acceleratedheart rate, difficulty breathing, light-headedness and sweating. Phobias can

develop at any point in life. Many of themdevelop during childhood, adolescence andearly adulthood.

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Once phobias develop, they seldom go away

on their own. Phobias may broaden and

intensify over time and are twice as common

among women than men. Phobias that begin

during childhood usually disappear without

treatment. However, phobias disappear

without treatment. However, phobias thatdevelop later in life are usually more chronic.

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OBSESSIVE COMPULSIVE DISORDER

(OCD)

Men =women

Usually the OCD has two components: Cognitive (thoughtsof being infected by germs) and behavioral (washing andcleaning rituals). Either occur alone.

Obsessions are persistent, repetitive, intrusive andunwelcome thoughts, images and impulses that invade theindividuals consciousness. They are often abhorrent to theperson, but very difficult to dismiss or control. Thoughtsare recognized as being generated within individual s ownmind versus thought insertion found in schizophrenia.Obsessional thoughts focus on contamination, disasters,violence, harm to self or others, blasphemy, sex or otherdistressing things.

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Compulsions are persistent, repetitive anduncontrollable behavioral urges to perform certainbehaviours, such as washing or cleaning rituals,resisted only with two great difficulty.

Responses to obsessive thoughts and function toreduce anxiety associated with thoughts.

Compulsive rituals result in temporary relief.

Behavioural compulsions are extremely difficult tocontrol.

Rituals include washing, checking things repeatedly,cleaning, counting, or doing tasks in a specific and rigidorder.

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Failure to perform leads to anxiety (perhaps even

a panic attack). Like phobic avoidance responses,

compulsions appear to reduce anxiety.

OCD may lead to avoidance of certain objects or

situations (e.g. dirt, and not leaving the house to

avoid locking doors); life disruption; frustration;irritation to individual, family, friends and

workmates; depression and anxiety.

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POST TRAUMATIC STRESS DISORDER

(PTSD)

Is a syndrome that develops after a person sees,is involved ion, or hears of an extreme traumaticstressor.

stressor can be war, torture, natural disasters,assault, rape, serious accidents MVA)

Reacts with fear and helplessness, reliving theevent and trying to avoid being reminded of the

event. The symptoms must last for more than a month

after the event.

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Epidemiology

Lifetime prevalence 8% in gen pop

10-12 % for women and 5-65 FOR MEN

5-15% will experience subclinical PTSD

Those who have experienced traumatic eventslifetime prevalence is 5-75%

Age: any but mainly young adults coz predisposedto precipitating situations

Marital status: single, divorced, widowed, sociallywithdrawn

SES: Low SES

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Risk factors

Severity of trauma

Duration of trauma

Proximity of a persons exposure to the actual trauma

Hx of depression in 1st degree relatives

Presence of childhood trauma

Inadequate family or peer support system

Being female

Genetic vulnerability to psychiatric illness

Recent excessive alcohol intake

Personality disorder- borderline, dependent, antisocial

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Aetiology

STRESSOR: Subjective meaning to a person

Preexisting biological factors-neurotransmitter

theories- noradrenergic system, endogenous opiate

system Increased activity and responsiveness of the

autonomic nervous system

Psychosocial factors

Previous and after traumatic events

genetic vulnerability

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Clinical features

Painful re-experiencing of the event

Pattern of avoidance and emotional numbing

Constant hyperarousal

MSE reveals: feelings of guilt, rejection, and

humiliation

Dissociative states, panic attacks, hallucinations,

aggression. Violence, poor impulse control,depression, substance related disorders

Cognition- impaired memory, and attention

MANAGEMENT PRINCIPLES OF

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MANAGEMENT PRINCIPLES OF

ANXIETY DISORDERS

Rule out organic or physiological pathology.

Rule out mood and substance abuse problems.

Educate the patient on disorder.Provide training in strategies to control anxiety

symptoms.

Appropriate referrals.

Avoid unnecessary medication especially

sedatives

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BIOLOGICAL MANAGEMENT

Benzodiazepines may be used forsymptoms relief.

AntidepressantsSSRIs + TCAs ( co-

morbid features of mood disorder are

not uncommon)

Beta blockersAntihistamines hydroxyzine in GAD

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PSYCHOLOGICAL MANAGEMENT

Cognitive behavioral therapy is the

most effective approach.

SOCIAL MANAGEMENT

It includes education & support

involving family & relevant

support structures