6. ANXIETY DISORDERS (1).pptx....#&÷###*×;;#;;#&

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1. ANXIETY DISORDERS by BB

2. Anxiety : is a universal human characteristics involving tension , apprehension , even terror w/c serves as adaptive mechanism to warn about external threat by activating sympathetic nervous system. Becomes pathological when: __ fear is greatly out of proportional to risk/severity of the threat. __ Response continues beyond existence of threat. __ social/ occupational functioning is impaired.

3. Categories of Anxiety disorders 1. GENERAL ANXIETY DISORDER (GAD) Excessive worry about daily events & activities nearly every for at least 06 months Associated symptoms (3+) Restlessness, fatigue, irritability Impaired concentration Muscle tension, sleep disturbance

4. Person may experience physical symptoms: Dyspnea Palpitations Chest pain Gastric distress - diarrhea Tremors Insomnia Restlessness Females 2:1 4-5% life time prevalence 50-90% have MDD, phobia, panic

5. TREATMENT Acute episode: benzodiazepines - Combination of psychotherapy and pharmacotherapy o Buspirone , benzodiazepines (taper immediately), SSRI o Venlafaxine

6. 6 2. PANIC DISORDER A discrete period of intense fear / discomfort in w/c 4/more of the ff symptoms develop abruptly . Palpitation, Excessive heart rate Trembling Sweating Shortness of breathing Unsteadiness Depersonalization Nausea /vomiting Tingling Fear of dying, losing control and going crazy. Chest pain, chills ,chocking.

7. 7 Spontaneous recurrent panic attacks with no obvious precipitant: ~ 25 min - Panic attack followed by 1+ month of: o Fear of panic attack, worry, change behavior sudden onset, with feelings of intense apprehension, and dread; May be severe, recurrent, or intermittent lasting 5 – 30 minutes ;

8. 2-5% prevalence 40-80% comorbid MDD 20-40% substance Treatment Rule out organic cause (MI) - Acute: benzodiazepines ( diazepam, clonazepam , bromazepam etc 1. Maintenance: SSRIs 8-12 mo. a. flouxetine ( PaxilTM ) b. Sertraline ( ProzacTM ) 2. CBT, Relaxation,

9. 3. OBSESSIVE-COMPULSIVE DISORDER Characterized by episodes of obsession (unwanted, repetitive thought) and compulsion ( unwanted, repetitive action) that influence a person’s life; Char by irrational, repetitive, ritualistic behaviors that the px uses in attempt to control the anxiety resulting from obsessions; Affects the ADL of the client;

10. Treatment: Behavioral psychotherapy Antidepressants – *** Clomipramine ( Anafranil ); SSRI’s. Anxiolytics

11. 4. PHOBIA An irrational fear of an object or situation that persists even though the px may recognize it as unreasonable; Associated with panic-level of anxiety if the object, situation, or activity cannot be avoided; Client will do anything just to avoid the phobic object regardless of the consequences ;

12. Types of Phobia: a. Agoraphobia fear of being alone in open or public places where escape might be difficult or impossible; Client may not leave home; -- includes the fear of eating in public places, public speaking, or performing in public places Social Phobia = fear of situations in which one might be embarrassed or criticized, and the fear of making fool of oneself

13. Specific Phobia irrational and persistent a fear of a single object, activity, or situation such as snakes, closed spaces, and flying; e.g Arachnophobia Aluerophobia Acrophobia hematophobia Claustrophobia

14. Treatment: a. Behavioral techniques systemic desensitization – therapy of choice. _ Flooding b. Benzodiazepine Therapy

15. 5. Posttraumatic Stress Disorder (PTSD) Grieving-like behaviors that result from a major and severe trauma like rape, assault, accident, fire, war, or natural disaster; Usually occurs AFTER a major traumatic events (usually after ONE month) Acute Stress Disorder – anxiety during or immediate after a traumatic event (within 4 weeks or 1 month)

16. May show physical manifestations: Flashbacks Insomnia and nightmares Eating problems Depression and isolation guilt about surviving the event;

17. Types of PTSD: Acute – less than 3 months after the event; Chronic – 3 months or more after the event; Delayed – at least 6 months after the event;

18. Treatments: a. Psychotherapy b. Pharmacotherapy 1. Benzodiazepines 2. Antidepressants – SSRI. THANK U!!