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Anxiety Disorders

Anxiety Disorders. What is Anxiety?. ANXIETY. It is a feeling characterized by a diffuse, unpleasant, vague, sense of apprehension, often accompanied by autonomic symptoms. Characteristics of Anxiety. Unknown threat Internal Indefinite Conflictual. Adaptive Functions of Anxiety.

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Anxiety Disorders

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  1. Anxiety Disorders

  2. What is Anxiety?

  3. ANXIETY It is a feeling characterized by a diffuse, unpleasant, vague, sense of apprehension, often accompanied by autonomic symptoms

  4. Characteristics of Anxiety • Unknown threat • Internal • Indefinite • Conflictual

  5. Adaptive Functions of Anxiety • It is an alerting signal, that warns of threats • of body damage, pain, helplessness, possible punishment, or frustration of social or body needs • Of separation from loved ones • Of menace to one’s success or status • Of threats to one’s unity or wholeness • It promotes the person to take the necessary steps to prevent the threat, or to lesson it’s consequences.

  6. Pathological Anxiety Anxiety is said to be pathological when • It stops or hinders adaptive functioning • It hinders a person to perform it’s functioning in • Home • Society • Occupation Or • It creates mental stress for a person, experiencing it

  7. Manifestations of Anxiety • Psychological • Attention and concentration • Appearance • Orientation • Memory • Mood • Thoughts • Perceptions

  8. Manifestations of Anxiety • Vegetative • Sleep • Appetite • Sex • ANS • CNS • CVS • Respiratory • GIT • GUT

  9. Impact of Anxiety • Personal life • Family life • Social life • Occupational / Educational life

  10. Differential Diagnosis of Anxiety • Fear • Known threat • External • Definite • Non-Conflictual • Depression/ sadness • Symptoms • Thoughts

  11. Organic Differentials of Anxiety • General medical disorders • CNS • Neoplasm • CVA • Encephalitis • Wilsons disease, etc. • Hypoxia • Endocrine Disorders • Hyperthyroidism • Pheochromocytoma, etc.

  12. Organic Differentials of Anxiety • Inflammatory diseases • SLE • RA, etc. • Metabolic disorders • Hypoglycemia • Porphyria • Uremia • CVS • Ischemic disorders • Mitral Valve Prolapse

  13. Organic Differentials of Anxiety • Drugs • Amphetamine • Penicillin • Sulfonamides • Cannabis • Toxins • Mercury • Arsenic • Organophosphorus compounds

  14. Clinical Syndromes of Anxiety Panic Disorder • Clinical picture • Diagnosis ICD (3 attack in 3 weeks) DSM (1 attack + 1 month) • Etiology Biological (NA, 5HT, GABA) • Epidemiology • 1.5-3%; Life time prevalence • more common in females • More common in young adults • Differential diagnosis • Medical Disorders • MI, Pheochromocytoma, MVP • Asthma, CVA, Hyperthyroidism

  15. Clinical Syndromes of Anxiety Panic Disorder • Differential diagnosis • Psychiatric Disorders • Malingering • Factitious Disorders • Conversion Disorders • G A D, etc. • Co-Morbidity: Agoraphobia • Management: Crisis Intervention Pharmaco therapy : BDZs, TCAs, MAO, Beta-Blockers, Cognitive Behavior Therapy Relaxation Techniques

  16. Clinical Syndromes of Anxiety Obsessive – Compulsive Disorders • Obsession: Recurrent and intrusive thought, image, idea, or impulse. • Compulsion: Conscious, standardized, recurrent motor acts, based on obsessions • CLINICAL FEATURES • Obsession • Idea • Image • Impulse & etc. • Compulsion • Checking • Counting • Cleaning • Orderliness • Collecting • Touching & etc.

  17. Clinical Syndromes of Anxiety Obsessive – Compulsive Disorders • Diagnostic Essentials • Excessive / irrational / un reasonable • Marked distress • No physical cause • Not better explained in another disorder • Epidemiology • 2-3% life time prevalence • Unusually before the age 25 • Single • Etiology • Biological. Neurotransmitters : 5-HT, ACH, DA • Psychological • Defense mechanisms • Undoing • Reaction formation • Anal phase • Learning

  18. Clinical Syndromes of Anxiety Obsessive – Compulsive Disorders • Differential diagnosis • Touretter’s syndrome • Management • SSRIs • Other drugs • Behavioral therapy

  19. Clinical Syndromes of Anxiety Acute stress disorders • Clinical Essentials • Severe anxiety • H/O acute stress • Etiology • Event • Vulnerability • Temperament • Early life Epidemiology • Young adults • Single • Economically handicapped • Socially withdrawn Etiology • Benzodiazepine receptor • Hypthalamic – Pituitary – adrenal axis Management • Pharmacotherapy • Catharsis • Psycho-therapy

  20. Clinical Syndromes of Anxiety Post Traumatic Stress Disorder • Clinical Features • Arousal on Cues • Flash Backs • Nightmares • Epidemiology • 1-3% life time prevalence • Young adults • Single, divorced • Etiology • Event • Learning Theory • Biological Factors • N.E., D.,A., Opiates

  21. Clinical Syndromes of Anxiety Post Traumatic Stress Disorder • Management • Support • Encouragement to expose & discuss • Education of coping strategies • Pharmacotherapy • TCAs • Imipramine • Amitriptyline • SSRI • SNRI • ANTIPSYCHOTICS • ANXIOLYTICS • Psychotherapy

  22. Clinical Syndromes of Anxiety Generalized Anxiety Disorder • Clinical Picture • Excessive & pervasive worry • Generalized experience • Continuous • Epidemiology • More in females • 20’s • Etiology • GABA & 5- HT • Learning • Existential • Management • Pharmacotherapy • Benzodiazepines • TCAS • SSRIS • SNRIS • Other drugs (Buspirone, -blocker) • Psychotherapy

  23. Phobic Disorders • Diagnostic points Cues are avoided Interference with normal life Not due to any medical condition Not due to drugs Not better accounted for by another mental illness • Biological Factors + NA, DA + Genetic • Psychological factors + Symbolization, Displacement + Learning theory • Management Insight – oriented psychotherapy Behavioral therapies Pharmaco-therapy

  24. Phobic Disorders ‘Phobia’ is an irrational fear resulting in a consistent avoidance of feared object, activity, or situations. Types (based on clinical features) • Agora phobia : Fear of being in public places • Social phobia : Fear of social situation or performance, in front of un familiar people or possible scrutiny by others • Specific phobia • Executive & un reasonable • Cued • Any object

  25. Phobic Disorders • Diagnostic points • Cues are avoided • Interference with normal life • Not due to any medical condition • Not due to drugs • Not better accounted for by another mental illness • Epidemiology • Biological Factors • + NA, DA • + Genetic • Psychological factors • + Symbolization, Displacement • + Learning theory • Management • Insight – oriented psychotherapy • Behavioral therapies • Pharmaco-therapy

  26. THANK YOU

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