Anxiety disorder and psychological management.ppt

Anxiety under psychology category

1. ANXIETY DISORDERS
Dr Shehan Williams ( MBBS, MD, MRCPsych, MPhil)
Senior Lecturer / Consultant Psychiatrist
North Colombo Teaching Hospital

2. A “ Rat Race “

3. ANXIETY DISORDERS

4. Is anxiety good ?

5. Performance
Anxiety
Common
problem

6. Anxiety Disorders
Continuous Episodic
Generalised
Anxiety
Disorder
Phobic Anxiety
Disorder
• Simple phobia
• Social phobia
• Agoraphobia
Panic
Disorder
Panic
attacks only

7. Generalised Anxiety Disorder
Psychological symptoms
• Fearful anticipation
• Irritability
• Sensitivity to noise
• Restlessness
• Poor concentration
• Worrying thoughts

8. Sleep disturbance
• Insomnia
• Night terror

9. Physical symptoms
Gastrointestinal - dry mouth
difficulty in swallowing
epigastric discomfort
frequent / loose motions
Respiratory- difficulty inhaling
overbreathing
Cardiovascular - palpitations
chest discomfort

10. Physical symptoms (cont.)
Genitourinary- frequency of micturition,
failure of erection,
menstrual discomfort,
amenorrhoea
Neuromuscular- tremor,
prickling sensations,
tinnitus,
dizziness,
headache

11. Other Associations
• Panic attacks
• Depersonalization
• Obsessions
• Depression

12. Symptoms of a panic attack
• palpitations
• dyspnoea
• chest discomfort
• sweating
• trembling
• dizziness or fainting
• nausea
• depersonalization

13. Depersonalization
Experience of being unreal, detached, and
unable to feel emotion.
Derealization
• In relation to the environment
• people seem lifeless
• objects lose their emotive quality

14. Depersonalization occurs in
• Healthy people ( when
tired )
• Anxiety ( commonly )
• Depression
• Temporal lobe epilepsy
• Schizophrenia

15. Aetiology
Predisposing factors
• Genetic
• Child hood upbringing
• Personality
Precipitating factors
• stressful events
Maintaining factors
• ways of thinking

16. Management
A. Proper assessment
Possible medical conditions
1. Thyrotoxicosis
2. Phaeochromocytoma
3. Mitral valve prolapse
4. Hypoglycaemic attacks (eg: insulinoma,
anti-diabetic Rx )

17. Management
B. Behaviour therapy
• Anxiety management training
• Relaxation training
Alteration of breathing pattern,
graded muscle exercises

18. Management
C. Cognitive therapy

19. I will fail, I am useless
anxious,
tense
Avoid people,
Tachycardia, sweating

20. Drug treatment
• Selective serotonin reuptake inhibitors ( SSRI )
• Fluoxetine, Citalopram, Sertraline
• Tricyclic antidepressents
• Imipramine, amitryptaline
Benzodiazepines - “Only short term “

21. Summary
Generalised Anxiety Disorder
Psychological Physical
symptoms symptoms
+
Management
Panic attacks Depersonalisation

22. Thank you