Transcript Anxiety disorder..

Anxiety disorders
Dr. Eman Abahussain
psychiatry consultant,kkuh,kauh.
Normal vs. Abnormal anxiety
Anxiety Disorders:
1- GAD
2-Panic disorder
3- Agoraphobia
4- Social phobia
5- Specific phobia 6- Acute & PTSD
7- OCD
fear:
is a response to a known external definite threat
Anxiety:
is a response to a threat that is unknown internal
vague or conflictual.
NORMAL ANXIETY ABNORMAL
ANXIETY
-Apprehension
Proportional to the
trigger
( time & severity).
- Attention
Out of proportion
body responses <
External trigger > body
responses.
- Features
few - not severe - not
prolonged & minimal
effect on life .
Many – severe –
prolonged
& interfere with life.
features of anxiety:
Psychological
Physical
Apprehension+ hypervigilance
CVS & CHEST:
Excessive worries+ anticipation
GI:
Difficulty concentrating
GUT & RS:
Feeling of restlessness
SKIN:
Sensitivity to noise
MSS: CNS:
Sleep disturbance
Generalized Anxiety Disorder
Criteria:
6 months duration – most of the time
Excessive worries about many events
Multiple physical & psychological features
Difficult to control
Significant impairment in function
Not due to GMC , substance abuse or other
axis I psychiatric disorder
:
COMORBIDITY:
50-90% other mental disorders.
Epidemiology:
women > men Prevalence : 3 – 5 %.
Age of onset vary , range : 20 – 55 years.
Pt. usually consults medical
(non-psychiatric) specialties,
and / or faith-healers first.
MSE :
Tense posture, excessive movement
e.g. hands (tremor) & head, excessive blinking
Sweating
Difficulty in inhalation.
D Dx :
Normal reaction to stress.
Anxiety due to physical problems:
anemia –hyperhyroidism - BA - Rx – sub. A.
Panic disorder.
Adjustment disorder with anxious mood.
Somatization disorder.
Hypochondriasis.
Mixed anxiety & depressive disorder.
Depressive disorders.
Psychotic disorders.
Course & Prognosis
chronic, fluctuating & worsens with stress.
it may cause Secondary depression .
Poor Prognostic Factors:
 Very severe symptoms
 Personality problems
 Uncooperative patient.
Management of GAD
 Rule out common physical causes.
 Explain the nature of the illness & symptoms.
 Reassure that symptoms are not due to a
physical disease.
 Draw attention to psychological factors.
 Cognitive-Behavioral Treatment (CBT).
 Short course(2/52) BDZ e.g. lorazepam.
 Long term Rx: SSRI-SNRI-TCA - 6 months after
initial response to treatment,(NICE
guidelines),few studies examine relapse
prevention .
Panic Disorder
Panic attack :
 a symptom not a disorder.
 Can be part of many disorders: panic disorder,
GAD, phobias, sub. Abuse
acute & PTSD
 It is adiscreate period of intense fear or
discomfort,in which 4 of the anxiety
symptoms developed abruptly and reached
apeak within 10 min .
Symptoms of panic attack:
Palpitation 
Sweating 
Trembling 
Shortness of breath 
Feeling of choking 
Chest pain 
Feeling dizzy 
Fear of dying 
paresthesias 
Panic Disorder:
Disorder with specific criteria:
1- unexpected recurrent panic attacks
(+/- situationally bound).
2- one month period (or more) of persistent
concern about having another attack or
worry about the implications of the attack, or
change in behavior related to the attacks.
3- Not due to other disorders
Epidemiology
Etiology
Genetic predisposition
Women > men
Prevalence : 1– 3 %
Age at onset :
20 --- 35 years
Disturbance of
neurotransmitters
NE & 5 HT
in the locus ceruleus
( alarm system
in the brain )
Behavioral conditioning
Prognosis:
30-40% became symptoms free 
50%have mild symptoms 
10-20%continue to have significant symptoms 
Management
Rule out physical causes.
Support & reassurance
CBT:
cognitive therapy( instructions about a patient false
beliefs and information about panic attack)
behavioral therapy (relaxation, breathing
training, in vivo exposure)
Medications:
BNZ , SSRIs, TCAs
Treatment should continue for 12 months or more.
Phobic Disorders
Specific
Social
Agoraphobia
Objects or situations
e.g. blood ex.
dental clinic
hospital
airplane (height)
animals
insects
thunder
storms
lifts
darkness
•Embarrassment
when observed
performing
e.g. speaking in
public,
leading prayer
serving guests
Sweating / tremor
palpitation / SOB
Functional impair.
Fear of being in
places or
situations from
which escape
might be difficult
or embarrassing
or help may not
be available in the
event of having
panic or panic
like attack.
• e.g. mosques
public transport
Functional impair.
Specific
Epidemiology:
M=F
common in children
Etiology :
? Modeling
cont. of childhood fears
Treatment :
behavior therapy: exp.
+ / - BNZ
Social
Agoraphobia
Epidemiology:
Epidemiology:
M : F = ? Cultural F.
F:M=2:1
prevalence : 3 - 13 %.
Prevalence : 2 – 10%.
only 10 % come .
Onset : 2o – 35 y.
Etiology: genetic
Etiology:
predis. ( shyness )
Personality predis.
psychosocial (shame – Psychosocial trigger.
criticism ).
Treatment:
Treatment :
CBT, Assertiveness
CBT with graded exp.
training.
Medications :
Medications :
Either; SSRIs, TCAs, or
PRN : B-blockers, BNZ
MAOIs +/- BNZ
SSRIs , MAOIs , or
TCA
OCD
 1-obsessions:
 Recurrent persistent intrusive thoughts impulses or
images from his own mind, that cause marked distress
and anxiety, pt tries to suppress them with some other
thoughts or actions.
 2-compulsions:
 Repetitive behaviors or mental acts that pt feels driven
to do .
 3- they are excessive or unreasonable
 4- cause marked distress or time consuming or
interfer with function.
-Contamination & washing
- pathological doubt, Checking & counting
Ablution, prayers…
-intrusive thoughts: Images of aggression ,
Self- harm ,Sexual act.
-symmetry, and slowness
-other symptoms: religious obsessions
Males
= Females
Lifetime prevalence = 2-3 %
Mean age of onset = 20 – 25 yeas
the course is usually long but variable
,some have fluctuating course and
others constant one.
20-30%have significant improvement
40-50% moderate improvement.
20-40%remain ill or even worse.
DD
1.
Anxiety, panic and phobia.
2.
Depressive disorders.
3.
Hypochondriasis
4.
Schizophrenia.
5.
Organic mental disorders.
6.
OCPD: perfectionism, orderliness…
Treatment
Pharmacobehavioral :
1- Pharmacological:
SSRIs : fluoxetine - paroxetineclomipramine
Duration of treatment 12 months and more.
2- Behavioral : exposure & response prevention
others
Good p. Factors
Bad p. Factors
 Non – severe

 No OCPD

 Depressed / anxious
mood

 Compliance with T

 Family support

very – severe
OCPD
No Depressed /
anxious mood
Non- Compliance
with treatment.
No Family support
Thanks