Transcript IN THE NAME OF GOD

ANXIETY DISORDERS
Dr nasirian
Anxiety disorders are among the most prevalent mental
disorders in the general population.
Nearly 30 million persons are affected in the United
States, with women affected nearly twice as frequently as
men.
Anxiety disorders are associated with significant
morbidity and often are chronic and resistant to
treatment.
(1) panic disorder with or without agoraphobia (2)
agoraphobia with or without panic disorder (3) specific
phobia
(4) social phobia
(5) obsessive-compulsive disorder (OCD)
(6) posttraumatic stress disorder (PTSD)
(7) acute stress disorder
(8) generalized anxiety disorder
Fear versus Anxiety
Fear is a response to a known, external, definite, or
nonconflictual threat; anxiety is a response to a threat
that is unknown, internal, vague, or conflictual.
Symptoms of Anxiety
Obsessive-Compulsive Disorder
Epidemiology
Comorbidity:
(major depressive disorder , social phobia,alcohol use
disorders, generalized anxiety disorder, specific phobia,
panic disorder, eating disorders, and personality
disorders,Tourette's disorder,Tic)
Etiology
 Biological Factors
 Neurotransmitters
 Serotonergic System
 Noradrenergic System
 Neuroimmunology
 Brain-Imaging Studies
 Genetics
Nonpsychiatric Clinical Specialists Likely to See
Obsessive-Compulsive Disorder Patients:
Dermatologist
Family practitioner
Oncologist, infectious disease internist
Neurologist
Neurosurgeon
Obstetrician
Plastic surgeon
Dentist
DSM-IV-TR Diagnostic Criteria for
Obsessive-Compulsive Disorder
 Either obsessions or compulsions:
 Obsessions as defined by ;
 recurrent and persistent thoughts, impulses, or images
that are experienced, at some time during the
disturbance, as intrusive and inappropriate and that
cause marked anxiety or distress
 the person attempts to ignore or suppress such
thoughts, or to neutralize them with some other
thought or action
 the person recognizes that the obsessional thoughts,
impulses are a product of his or her own mind
Compulsions as defined by
 repetitive behaviors (e.g., hand washing, ordering,
checking) or mental acts (e.g., praying, counting,
repeating words silently) that the person feels driven
to perform in response to an obsession
 the behaviors or mental acts are aimed at preventing
or reducing distress or preventing some dreaded event
or situation.
At some point during the course of the disorder, the
person has recognized that the obsessions or
compulsions are excessive or unreasonable.
The obsessions or compulsions cause:
marked distress,
are time-consuming (take more than 1 hour a day),
or significantly interfere with the person's normal
functioning, or relationships
Differential Diagnosis
Medical Conditions
Tourette's Disorder
Other Psychiatric Conditions
Course and Prognosis
Treatment
Pharmacotherapy
Behavior Therapy
Psychotherapy
Other Therapies(psychosurgery,ECT)
Posttraumatic Stress Disorder
The person has been exposed to a traumatic event in
which both of the following were present:
the person experienced, was confronted with an event or
threatened death or serious injury, or a threat to the
physical integrity of self or others
the person's response involved intense fear, helplessness,
or horror.
reexperience:
recurrent and intrusive distressing recollections of the
event
recurrent distressing dreams of the event
acting or feeling as if the traumatic event were recurring
intense psychological distress at exposure to internal or
external cues
physiological reactivity on exposure to internal or
external cues
Persistent avoidance
 efforts to avoid thoughts, feelings, or conversations
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associated with the trauma
efforts to avoid activities, places, or people that arouse
recollections of the trauma
inability to recall an important aspect of the trauma
markedly diminished interest or participation in
significant activities
feeling of detachment or estrangement from others
restricted range of affect (e.g., unable to have loving
feelings)
Persistent symptoms of increased
arousal
difficulty falling or staying asleep
irritability or outbursts of anger
difficulty concentrating
hypervigilance
exaggerated startle response
 Duration of the disturbance is more than 1 month.
 Acute: if duration of symptoms is less than 3 months

Chronic: if duration of symptoms is 3 months or
more
 With delayed onset
 Epidemiology
 Etiology
 Stressor
 Risk Factors
 Psychodynamic Factors
 Cognitive-Behavioral Factors
 Biological Factors
 Treatment
 Pharmacotherapy
 Psychotherapy
Generalized Anxiety Disorder
Excessive anxiety and worry occurring more days than
not for at least 6 months, about a number of events or
activities (such as work or school performance).
The person finds it difficult to control the worry.
 The anxiety and worry are associated with three (or
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more) of the following six symptoms
restlessness
being easily fatigued
difficulty concentrating or mind going blank
irritability
muscle tension
sleep disturbance
 Epidemiology
 Comorbidity
 Etiology
 Treatment
Phobias
 The term “phobia” refers to an excessive fear of a
specific object, or situation.
 Phobias are classified based on the nature of the
feared object or situation, and DSM-IV-TR recognizes
three distinct classes of phobia: Agoraphobia ,specific
phobia, and social phobia.
Specific Phobia
 Approximately 10 percent of individuals in the United
States meet criteria for specific phobia.
 The condition is more commonly diagnosed in females
than males.
 specific phobia often co-occurs with other anxiety or
mood disorders.
 comorbid disorders tend to cause more impairment
than specific phobia and because individuals with
isolated specific phobia are rarely seen in the clinic.
 Impairment associated with specific phobia typically
manifests as restricted social or professional activities.
subtypes of specific phobias:
animal type,
natural environment type,
blood-injury type,
Situational type
other
 Specific phobia exhibits a bimodal age of onset, with a
childhood peak for animal phobia, natural
environment phobia, and blood-injury phobia and an
early adulthood peak for other phobias, such as
situational phobia.
 The severity of the condition is believed to remain
relatively constant.
Social phobia
 A marked and persistent fear of one or more social or
performance situations in which the person is exposed
to unfamiliar people or to possible scrutiny by others.
The individual fears that he or she will act in a way (or
show anxiety symptoms) that will be humiliating or
embarrassing.
 The person recognizes that the fear is excessive or
unreasonable.
 The feared social or performance situations are
avoided or else are endured with intense anxiety or
distress.
 The avoidance, anxious anticipation, or distress in the
feared social or performance situation(s) interferes
significantly with the person's normal routine,
occupational (academic) functioning, or social
activities or relationships.
 prevalence estimates of social phobia vary widely,
from 2 to approximately 15 percent. Like specific
phobia, social phobia exhibits a female
preponderance, although the sex ratio in the clinic
may be more equal.
Panic Attack
 A discrete period of intense fear or discomfort, in
which four (or more) of the following symptoms
developed abruptly and reached a peak within 10
minutes:
 palpitations, or accelerated heart rate
 sweating
 trembling or shaking
 sensations of shortness of breath
 feeling of choking
 chest pain or discomfort
 nausea or abdominal distress
 feeling dizzy, unsteady, lightheaded, or faint
 derealization (feelings of unreality) or
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depersonalization (being detached from oneself)
fear of losing control or going crazy
fear of dying
paresthesias (numbness or tingling sensations)
chills or hot flushes
Panic disorder
 recurrent unexpected panic attacks
 at least one of the attacks has been followed by 1
month (or more) of one (or more) of the following:
 persistent concern about having additional attacks
 worry about the implications of the attack or its
consequences (e.g., losing control, having a heart
attack, going crazy)
 a significant change in behavior related to the attacks
Differential Diagnosis
 endocrinological disorders, including both hypo- and
hyperthyroid states, hyperparathyroidism
Pheochromocytomas
Episodic hypoglycemia associated with
insulinomas
seizure disorders,
vestibular dysfunction,
neoplasms,
Substance
disorders of the cardiac and pulmonary systems,
including arrhythmias, chronic obstructive pulmonary
disease, and asthma
 Clues that a medical etiology underlies panic-like
symptoms include:
the presence of atypical features such as ataxia,
alterations in consciousness, or bladder dyscontrol;
the onset of panic disorder relatively late in life; or
physical signs or symptoms indicative of a medical
disorder.
 The lifetime prevalence of panic disorder is in the 1 to
4 percent range.
 Panic disorder typically has its onset in late
adolescence or early adulthood.
 exhibit a fluctuating course, with varying levels of
persistence over the lifespan.
Approach to Treatment
Medical Evaluation
Choosing a Treatment Modality
Medications for Anxiety in Predictable Situations
β-Adrenergic Receptor Antagonists,
Benzodiazepines
 Medications for Chronic Recurrent or Unpredictable
Anxiety
SSRIs
SNRIs
TCA
MAOIs
others
Thanks for your
Attention