Anxiety disorders

Anxiety disorders

Dr. Eman Abahussain psychiatry consultant,kkuh,kauh.

Normal vs. Abnormal anxiety

Anxiety Disorders: 1 -GAD 2-Panic disorder 3 -Agoraphobia 4- Social phobia 5 -Specific phobia 6- Acute & PTSD

7 -OCD

fear: is a response to a known external definite

threatAnxiety:

is a response to a threat that is unknown internal vague or conflictual.

NORMAL ANXIETYABNORMAL ANXIETY

-Apprehension

-Attention

-Features

Proportional to the trigger

( time & severity.)

External trigger > body responses.

few - not severe - not prolonged & minimal effect on life.

Out of proportion

body responses>

Many – severe – prolonged

& interfere with life.

: features of anxiety

Psychological Physical

Apprehension+ hypervigilance

Excessive worries+ anticipation

Difficulty concentrating

Feeling of restlessness

Sensitivity to noise

Sleep disturbance

CVS & CHEST:

GI:

GUT & RS:

SKIN:

CNS: MSS:

Generalized Anxiety DisorderCriteria:

6 months duration – most of the time Excessive worries about many events

Multiple physical & psychological features Difficult to control

Significant impairment in function Not due to GMC , substance abuse or other

axis I psychiatric disorder

:

COMORBIDITY:50-90% other mental disorders.

Epidemiology: women > men Prevalence : 3 – 5.%

Age of onset vary , range : 20 – 55 years.Pt. usually consults medical

( non-psychiatric )specialties, and / or faith-healers first.

MSE: Tense posture, excessive movement

e.g. hands (tremor) & head, excessive blinking Sweating

Difficulty in inhalation.

D Dx: Normal reaction to stress.

Anxiety due to physical problems: anemia –hyperhyroidism - BA - Rx – sub. A.

Panic disorder. Adjustment disorder with anxious mood.

Somatization disorder. Hypochondriasis.

Mixed anxiety & depressive disorder. Depressive disorders.

Psychotic disorders.

Course & Prognosis

chronic, fluctuating & worsens with stress.

it may cause Secondary depression.

Poor Prognostic Factors: Very severe symptoms Personality problems Uncooperative patient.

Management of GAD Rule out common physical causes.Explain the nature of the illness &

symptoms.Reassure that symptoms are not due to a physical disease.Draw attention to psychological factors.Cognitive-Behavioral Treatment (CBT).Short course(2/52) BDZ e.g. lorazepam.Long term Rx: SSRI-SNRI-TCA - 6

months after initial response to treatment,(NICE guidelines),few studies examine relapse prevention .

Panic attack :

a symptom not a disorder.Can be part of many disorders: panic disorder, GAD,

phobias, sub. Abuse acute & PTSD It is adiscreate period of intense fear or discomfort,in

which 4 of the anxiety symptoms developed abruptly and reached apeak within 10 min .

Symptoms of panic attack:Palpitation

SweatingTrembling

Shortness of breathFeeling of choking

Chest painFeeling dizzyFear of dying

paresthesias

Panic Disorder: Disorder with specific criteria:

1- unexpected recurrent panic attacks (+/- situationally bound).

2- one month period (or more) of persistent concern about having another attack or worry about the implications of the attack, or change in behavior related to the attacks.

3- Not due to other disorders

Epidemiology

Women > men

Prevalence : 1– 3 %

Age at onset:

20 --- 35 years

EtiologyGenetic

predisposition

Disturbance of neurotransmitters

NE & 5 HT in the locus ceruleus

( alarm system in the brain)

Behavioral conditioning

Prognosis:30-40% became symptoms free

50%have mild symptoms10-20%continue to have significant symptoms

Management

Rule out physical causes.

Support & reassurance CBT: cognitive therapy( instructions about a patient

false beliefs and information about panic attack)

behavioral therapy (relaxation, breathing training, in vivo exposure)

Medications: BNZ , SSRIs, TCAsTreatment should continue for 12 months or

more.

Phobic Disorders Specific SocialAgoraphobia

Objects or situations

e.g. blood ex.

dental clinic

hospital

airplane )height(

animals

insects

thunder

storms

lifts

darkness

•Embarrassment

when observed performing

e.g. speaking in

public ,

leading prayer

serving guests

Sweating / tremor

palpitation / SOB

Functional impair.

Fear of being in places or situations from which escape might be difficult or embarrassing or help may not be available in the event of having panic or panic like attack.

• e.g. mosques

public transport

Functional impair.

Specific Social Agoraphobia

Epidemiology:

M = F common in children

Etiology:

? Modeling

cont. of childhood fears

Treatment:

behavior therapy: exp.

- / + BNZ

Epidemiology:

M : F = ? Cultural F.

prevalence : 3 - 13.%

only 10 % come.

Etiology: genetic predis. ) shyness (

psychosocial )shame – criticism (.

Treatment:

CBT, Assertiveness training .

Medications:

PRN : B-blockers, BNZ

SSRIs , MAOIs , or TCA

Epidemiology:

F : M = 2 : 1

Prevalence : 2 – 10%.

Onset : 2o – 35 y.

Etiology:

Personality predis.

Psychosocial trigger.

Treatment:

CBT with graded exp.

Medications:

Either; SSRIs, TCAs, or

MAOIs +/- BNZ

OCD1-obsessions:Recurrent persistent intrusive thoughts impulses

or images from his own mind, that cause marked distress and anxiety, pt tries to suppress them with some other thoughts or actions.

2-compulsions:Repetitive behaviors or mental acts that pt feels

driven to do .3- they are excessive or unreasonable4- cause marked distress or time consuming or

interfer with function.

-Contamination & washing - pathological doubt, Checking &

countingAblution, prayers…-intrusive thoughts: Images of

aggression , Self- harm ,Sexual act.-symmetry, and slowness -other symptoms: religious obsessions

Males = Females

Lifetime prevalence = 2-3 %

Mean age of onset = 20 – 25 yeas

the course is usually long but variable ,some have fluctuating course and others constant one.

20-30%have significant improvement

40-50% moderate improvement.20-40%remain ill or even worse.

D D1. Anxiety, panic and phobia.

2. Depressive disorders.

3. Hypochondriasis

4. Schizophrenia.

5. Organic mental disorders.

6. OCPD: perfectionism, orderliness…

TreatmentPharmacobehavioral :

1 -Pharmacological:

- SSRIs : fluoxetine - paroxetine clomipramine

Duration of treatment 12 months and more.

2 -Behavioral : exposure & response prevention

others

Non – severeNo OCPDDepressed /

anxious mood

Compliance with T

Family support

Good p. Factors

Bad p. Factors

very – severe OCPD No Depressed /

anxious mood

Non- Compliance with treatment.

No Family support

Thanks