anxiety disorder, steps to recover from critical anxiety

Anxiety disorder

1. Anxiety Disorders


Saraswati Dhungana, MD
Lecturer
Department of Psychiatry and Mental Health
Maharajgunj Medical Campus
May 20, 2019

F40-F48 Neurotic, stress-related and somatoform disorders

2. Contents
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Definition
Epidemiology
Types
Etiology
Diagnosis
Management

3. Anxiety: Definition
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A feeling of apprehension about a future threat
Vs Fear: Response to an immediate threat
Anxiety disorders- group of psychiatric conditions that involve
excessive anxiety

4. Normal Versus Pathologic Anxiety
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Normal anxiety- adaptive
An inborn response to threat or to the absence of people or
objects that signify safety can result in cognitive (worry) and
somatic (racing heart, sweating, shaking, freezing, etc.) symptoms
Pathologic anxiety-
excessive
impairs function

5. General Considerations
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Often have an early onset- teens or early twenties
2:1 female predominance
Waxing and waning course over lifetime
Similar to major depression and chronic diseases
Functional impairment
Quality of life

6. Epidemiology
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Sixth leading cause of disability, in terms of YLDs, in both high-income (HI)
and low- and middle-income (LMI) countries.

Women are twice as likely as men to have anxiety disorder
Possible explanations
Women may be more likely to report symptoms
Men more likely to be encouraged to face fears
Women more likely to experience childhood sexual abuse
Women show more biological stress reactivity

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Cultural factors
Culturally specific syndromes
Taijin kyofusho
Japanese fear of offending or embarrassing others
Ratio of somatic to psychological symptoms appears similar across
cultures

8. Types of anxiety disorders
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Panic Disorder
Phobias
Generalized Anxiety Disorder
Specific anxiety disorders

9. Panic Disorder
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The abrupt onset of an episode of intense fear or discomfort
Peaks in approximately 10 minutes
Includes at least four of the following symptoms:

10. Signs and symptoms
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A feeling of imminent danger or
doom
The need to escape
Palpitations
Sweating
Trembling
Shortness of breath or
suffocation feeling
A feeling of choking
Chest pain or discomfort

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Nausea or abdominal
discomfort
Dizziness or lightheadedness
A sense of things being unreal,
depersonalization
A fear of losing control o
r "going crazy"
A fear of dying
Tingling sensations
Chills or hot flushes

11. Panic Disorder- Types
There are three types of Panic Attacks:

1. Unexpected - the attack "comes out of the blue" without warning
and for no discernable reason.

2. Situational - situations in which an individual always has an attack,
for example, upon entering a tunnel.

3. Situationally Predisposed - situations in which an individual is
likely to have a Panic Attack, but does not always have one, eg, an
individual who sometimes has attacks while driving.

12. Generalized Anxiety Disorder
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Excessive uncontrollable worry about everyday things.
Affects daily functioning and can cause physical symptoms.
Can occur with other anxiety disorders, depressive disorders, or
substance abuse.

13. Generalized Anxiety Disorder Contd..
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The focus of GAD worry can shift, usually focusing on issues like
job, finances, health of both self and family

The intensity, duration and frequency of the worry are
disproportionate to the issue

14. Social anxiety disorder
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An intense fear of social situations.

Arises when the individual believes that they may be judged,
scrutinized or humiliated by others.

Acutely aware of the physical signs of their anxiety and fear that
others will notice, judge them, and think poorly of them.

In extreme cases this intense uneasiness can progress into a full
blown panic attack.

15. Common anxiety provoking situations:
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public speaking
talking with people in authority
dating and developing close relationships
making a phone call or answering the phone
interviewing
attending and participating in class
speaking with strangers
meeting new people
eating, drinking, or writing in public
using public bathrooms
driving
shopping

16. Specific anxiety disorders
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Disproportionate fear of a particular object or situation

Common examples: fear of flying, snakes, heights, etc.
Fear out of proportion to actual threat
Awareness that fear is excessive
Most specific phobias cluster around a few feared objects and
situations
High comorbidity of specific phobias

17. Specific Anxiety Disorders- Types:

18. Etiology
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Biopsychosocial Model
Biological
Genetics
Neurotransmitters
Overactive flight or fright response
2. Psychological
Personality
Coping
3. Social
Learning
Adverse social conditions

19. Differential Diagnoses

20. General treatment approaches:
Biopsychosocial model
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Pharmacotherapy
Antidepresssants
Anxiolytics

Psychotherapy
Cognitive Behavior Therapy
Systemic desensitization
Relaxation

21. Dhat Syndrome

22. Nosology and concepts
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Term first used by Wig in 1960
Culture bound sexual neurosis
Preoccupied with loss of semen by nocturnal emissions or in urine
with no objective evidence
Guilt and undue concern with the debilitating effects of loss of
semen on physical and psychological health

23. Presentation
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Young men, lower socio-economic class
Vague multiple somatic and psychological symptoms
Lack of physical strength, fatigue, lethargy, poor concentration,
forgetfulness, etc.
Anxiety and depressive symptoms
With or without sexual dysfunction

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Extended to include Indian women presenting with somatic
symptoms a/w leucorrhoea
Explained as due to loss of vital fluid

25. Management
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Considered equivalent to anxiety disorder
Psychological explanation
Pharmacological management with Antidepressants

26. Conversion Disorders
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Presence of symptoms or deficits affecting motor or sensory
function, suggesting a medical or neurological disorder
Sudden onset
Significant psychosocial stressor
Clear temporal relationship between stressor and symptoms

27. Contd…
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Symptoms usually not intentionally produced or feigned
Usually a secondary gain
Detailed physical examination and medical investigations do not
reveal any disorder or substance use disorder

28. THANK YOU