Anxiety Disorders Overview Quiz

Adult Anxiety Disorders: Introduction

• Adult anxiety disorders are a common group of mental disorders involving excessive anxiety causing significant distress or impairment in functioning.
• Anxiety disorders often begin during adolescence or young adulthood.
• Anxiety disorders tend to have a chronic course, waxing and waning over decades.
• A significant portion of those with anxiety disorders will respond to treatment, but many do not achieve a complete cure.
• Approximately a third of those with anxiety disorders are asymptomatic, a third significantly improve, and a third maintain substantial symptoms.
• Approximately 10% of those with anxiety disorders have poor outcomes.

About Anxiety Disorder Lectures

• Topics covered in the lectures include: generalized anxiety disorder, management of generalized anxiety disorder, panic disorder, phobic disorders, other anxiety disorders, and stopping treatment.

In This Lecture

• Topics covered in this lecture include: classification of adult anxiety disorders, normal vs. abnormal anxiety, course of anxiety disorders, etiology, and case studies.

Classification: Adult Anxiety Disorders

• Specific phobia
• Social anxiety disorder (social phobia)
• Panic disorder
• Agoraphobia
• Generalized anxiety disorder
• Substance/Medication induced anxiety disorder
• Anxiety disorder due to a general medical condition
• Other specified anxiety disorder
• Unspecified anxiety disorder

Why Do We Teach The Anxiety Disorders?

• Anxiety disorders are very common, impacting 1-4% of the adult population.
• They are more common in women.
• They impair functioning in work, interpersonal relationships, and recreational activities.
• They often lead to feelings of demoralization, avoidance, and a sense of being misunderstood by others.
• Anxiety disorders frequently lead to complications such as other anxiety disorders, mood and depressive disorders, and substance use disorders.
• The suicide risk is increased in people with anxiety disorders, though not as high as those with major depressive disorder (MDD).
• These disorders have wide differential diagnosis, overlapping with other mental and medical conditions.
• They are very treatable especially when diagnosed early.

The Anxiety Disorders: What Are They About?

• Anxiety disorders are a group of mental disorders characterized by excessive anxiety causing clinically significant distress or impairment in general functioning.

Description: What is an Emotion?

• An emotion is a subjective feeling state accompanied by subjective experience, physiological change, and behavior.

Description: What is Anxiety?

• Anxiety is an unpleasant feeling state anticipated in anticipation of a future threat.

Description: What is Fear?

• Fear is when the threat or perceived threat is imminent.

Description: What is Stress?

• Stress is the sum of all physiological and psychological responses to an event or situation requiring adjustment.

Description: What is a Stressor?

• A stressor is an event or situation requiring adjustment.

Normal vs. Abnormal Anxiety / Fear

• Normal Anxiety/Fear: Constructive, no impact on functioning, proportional subjective distress, proportional duration, proportional physical phenomena.
• Abnormal Anxiety/Fear: Destructive, negative effect on functioning, excessive subjective distress, excessive duration, excessive physical phenomena.

Course of The Anxiety Disorders?

• Anxiety disorders tend to be chronic, often starting in adolescence or young adulthood.
• The course of the disorder can wax and wane over many decades.
• Most people respond to treatment, but complete cures are uncommon.
• Outcomes vary greatly; about one-third are asymptomatic, one-third significantly improve, one-third continue with significant symptoms, and 10% do poorly.

What about Etiology?

• There are many theories regarding the etiology of anxiety disorders.
• These include biological and psychological factors.
• The exact cause of idiopathic anxiety disorders is currently unknown.

Case: Slide 1 to 3

• Case studies of individual experiences with anxiety disorders, including a young South African law student named Carol, are presented.
• Information provided includes her personal traits, her experiences with anxiety, her responses to testing situations, and aspects of her daily life.
• The case studies illustrate daily life with both types of anxiety.

Generalized Anxiety Disorder

• Criteria A. Excessive anxiety and worry more days than not for at least six months, about a number of events or activities.
• Criteria B. The individual finds it difficult to control the worry.
• Criteria C. Associated with three or more of six symptoms (e.g., restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances) present for most days over six months.
• Criteria D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Criteria E. The disturbance is not attributable to the physiological effects of a substance or another medical condition.
• Criteria F. The disturbance is not better explained by another mental disorder.
• This is a persistent excessive anxiety and difficult-to-control worry for at least six months.
• It has psychological and physiological symptoms causing significant functioning impairment that is not explainable by another mental disorder or substance.

Generalized Anxiety Disorder- Core clinical features

• These features are essential. Without them, a GAD diagnosis is not possible.
• Examples include, but are not limited to restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances.

Generalized Anxiety Disorder- Characteristic clinical features

• Not absolutely required for a diagnosis, but essential for a comprehensive understanding of the person.

Phobic Disorders

• Phobic disorders involve excessive, persistent (at least 6 months) unreasonable fear or anxiety towards circumscribed stimuli (such as an object or situation).
• The phobic stimulus typically evokes fear or anxiety disproportionate to the actual threat.
• Avoidance of the phobic stimulus is common, and enduring the stimulus is often associated with significant distress and impairment.
• These disorders impair functionality or cause significant distress for the person, are not caused by substances or medical conditions, and must not be mistaken for any other mental disorder.

Social Anxiety Disorder

• Social anxiety disorder is characterized by fear and anxiety towards social situations where the person anticipates negative evaluation.
• Consequences can be avoidance of social situations, leading to restricted life activities or avoidance of social activities.

Agoraphobia

• Agoraphobia involves fear and avoidance of situations where the person anticipates difficulty escaping or receiving help if they experience panic-like symptoms, other incapacitating symptoms, or embarrassing symptoms.
• People with agoraphobia may experience problems leaving home, using public transportation or public spaces, or being in crowds. The fear and avoidance limit daily life and lead to impairment.

Specific Phobia

• Specific phobia is an anxiety disorder characterized by fear and anxiety directed towards a particular object or situation.
• Examples of specific phobia subtypes include animal type (fear of animals), natural environment type (fear of heights), blood-injection-injury type (fear of blood or injuries), situational type (fear of enclosed spaces, flying), and other type.

Phobic Disorders: Management

• Work-up: See previous generalized anxiety disorder work-up procedures.
• Psychosocial treatment: Includes cognitive behavior therapy (CBT) for all subtypes; exposure and response prevention, relaxation techniques and restructuring of thoughts.
• Biological treatment: SSRIs (Selective Serotonin Reuptake Inhibitors) and venlafaxine are sometimes used for social anxiety disorder.

Anxiety Disorders: Stopping Treatment

• Many anxiety disorders are chronic, with waxing and waning patterns.
• Relapse after stopping medication is relatively high, often over 90% in some cases.
• Long-term treatment is often necessary.
• Treatment discontinuation may be possible after one year of complete symptom remission, functional restoration, and a sense of well-being and patient's readiness.
• Treatment must be stopped slowly over several months and may need booster sessions every five years for patients who have received cognitive behavioral therapy.