anxietysphobia, depression, bipolar disorders

about anniety disorders

2. Definition
Anxiety disorders are abnormal states in
which the most striking features are mental
and physical symptoms of anxiety.
Classification
DSM IV-Generalized anxiety disorder
-Agoraphobia
-Social phobia
-Simple phobia
-Panic disorders
}
phobic anxiety disorder

3. Generalized anxiety disorders
GAD in which anxiety is unvarying and
persistent .
GAD are frequently seen in general
medical practice.
Epidemiology-one year prevalence is
2.5 -6.5 %

4. Symptoms
Physical
(1)Gastrointestinal-Dry mouth, difficult in
swallowing epigastric
discomfort, excessive
wind frequent or loose
motions
(2)Respiratory -constriction in the chest,
Difficulty inhaling,
overbreathing
(3)Cardiovascular-Palpitations, Discomfort in
chest, awareness of
missed beats, pain
over the heart,
throbbing in the neck
(4)Genitourinary -Frequent or urgent
micturition
--Failure of erection
-Menstrual discomfort,
amenorrhea

5. (5)Neuromuscular system -Tremor, Prickling
sensation, Tinnitus,
Dizziness,
Headache,
aching muscles
-Sleep disturbance -Insomnia
-Night terror
-Psychological -Irritability
-sensitivity to noise
-restlessness
-poor concentration
-other symptoms -Depression
-obsessions
-Depersonalization

6. Aetiology
Predisposing factors
-genetic-monozygotic twin > dizygotic
but uncertain
-childhood upbringing -Anxiety is common in
childhood
-personality -anxiety -prone personality
Precipitating factors
-stressful events-relationship problems,
physical illness
-losses
Perpetuating factors
-stressful events
-ways of thinking e.g. palpitations are
evidence of physical illness

7. Differential diagnosis
◦Depressive disorder
◦Schizophrenia
◦Presenile or senile dementia
◦Drugs or alcohol

8. Treatment
Initial treatment
-Exclude concomitant depressive disorder
-Explain nature and cause of symptoms,
reassure about specific concerns
-If anxiety severe, short-term
benzodiazepine treatment
-Give help in solving stressful problems

9. Further treatment
-Relaxation training: respiratory control if
hyperventilating
-Continue problem solving
-If anxiety still severe, consider anxiolytic
drugs, antidepressant drugs.
Consider specialist referral for anxiety
management training

10. Prognosis
-Symptoms > 6 months → Diagnosis
Recovery is often slow
Prognosis is worse when symptoms are
severe.

11. Anxiety is intermittent
Arises in particular circumstances
Avoidance of circumstances that provoke
anxiety
Anticipatory anxiety

12. 1.Simple phobia
-Inappropriately anxious
-Presence of a particular object or
situation
-Tends to avoid it
-Spider, heights (acrophobia)
-phobia of excretion
-phobia of vomiting
-phobia of flying
-phobia of dental treatment
-onset of simple phobia in childhood

13. Treatment
-Is the exposure form of behavior
therapy . Such treatment is straight
forward but time consuming.
(2) Social phobia
-Inappropriate anxiety is experienced
in situations in which the person is
observed and could be criticized
-Onset of social phobia in late teenage

14. Common theme -Being observed and
open to criticism
Example -committees,
seminars
-eating or drinking in
public
-social gatherings
-writing or performing
in front of others
-Alcohol may be taken
to relieve anxiety, and
alcohol abuse is more
common among social
phobic
Aetiology -unknown

15. Treatment
-Psychological treatment –congitive
behavioral therapy
-Drug treatment
-anxiolytic drugs can provide short
term relief

16. 3.Agoraphobia
Clinical features
-Agoraphobic patients are anxious when they are
away from home, in crowds, or in situations that
they cannot leave easily.
-Two groups of anxiety symptoms are particularly
frequent
(1) Panic attacks
(2) Anxious cognitions (thoughts) about
fainting and loss of control.
-Situations feared and avoid by agoraphobic
-Common themes –Distance from home
-Crowding
-Confinement
-open spaces

17. -Anticipatory anxiety is common
-Other symptoms include depressive
symptoms, obsessional thoughts and
depersonalization
-An association between agoraphobia and
prolapse of the mitral valves
-Onset of agorephobia is mid-thirties
6 months prevalence 3-6 %
♀: ♂
2 : 1

18. Treatment
-Psychological treatment
-Drug treatment
-Anxiolytic drugs
Prognosis -continuously for a year
-persist for at least 5 years

19. panic disorder in which anxiety is intermittent
and unrelated to particular circumstances.
Clinical features
-Anxiety builds up quickly
-The response is severe
-Fear of a catastrophic outcome
Symptoms of panic attack
-Palpitations, dyspnoea, chest discomfort,
sweating, trembling
-Dizziness or fainting, flushing, nausea,
fears of impending death
-Loss of control or madness,
depersonalization
Prevalence-0.6 -1 % ♀: ♂
2 : 1

20. Diagnosis
-GAD
-PAD (agoraphobic)
-Depressive disorder
-Alcohol withdrawal
Treatment
-Psychological –cognitive therapy
-Drug treatment
-Anxiolytic drugs, antidepressant
Prognosis
-Prolonged and fluctuating course.