Anxiety Disorders Overview

Anxiety Disorders

• Anxiety is a universal human characteristic, serving as an adaptive mechanism to warn about external threats by activating the sympathetic nervous system, triggering the "fight or flight" response.
• Anxiety becomes pathological when:
  • Fear is disproportionate to the risk or severity of the threat.
  • The anxious response persists after the threat has ceased.
  • Attention is focused on the person's response to the threat, hindering normal functioning.
  • Social or occupational functioning is impaired.

Common Neurotic Disorders

• Anxiety/phobic disorders include:
  • Panic disorder
  • Generalized anxiety disorder (GAD)
  • Phobias
  • Hypochondriasis
• Stress-related disorders include:
  • Acute stress reactions
  • Adjustment disorder
  • Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Features of Anxiety

• Psychological:
  • Apprehension
  • Fear anticipation
  • Feeling of dread
  • Hypervigilance
  • Restlessness
  • Sensitivity to noise
  • Difficulty concentrating
  • Insomnia or disturbing dreams
• Physical:
  • Chest tightness
  • Cardiovascular issues
  • Neurological symptoms
  • Gastrointestinal problems
  • Genitourinary symptoms
  • Musculoskeletal symptoms
  • Skin issues

Panic Disorder

• Characterized by recurrent, sudden, and unexpected panic attacks.
• At least one attack is followed by a month of ongoing concern about additional attacks, worry about consequences, or significant changes in behavior related to the attacks.
• Not a result of substance misuse, medical condition, or another psychiatric disorder.

Panic Disorder Symptoms

• Palpitations, pounding heart
• Sweating
• Trembling or shaking
• Shortness of breath
• Feeling of choking or difficulty swallowing
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy or faint
• Derealization or depersonalization
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations
• Chills or hot flashes

Epidemiology of Panic Disorder

• Lifetime prevalence: 4.2% for panic disorder, 8% for panic attacks.
• Women are 2-3 times more likely to be affected than men.
• Highest peak incidence: 15-24 years old.
• Second peak incidence: 45-54 years old.
• Rare after age 65.

Etiology of Anxiety Disorders

• Genetics
• Neurotransmitter imbalances
• Poor regulation of the autonomic nervous system response to stressors
• Locus ceruleus plays a critical role in anxiety expression

Differential Diagnosis of Anxiety

• Medical: Myocardial infarction, angina, chronic obstructive pulmonary disease (COPD), congestive heart failure, pheochromocytoma, other cardiac, pulmonary, or endocrine disorders.
• Psychiatric: Depressive disorders, phobic disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD).
• Substance-related: Cocaine, nicotine, caffeine, alcohol, or opiate withdrawal.

Course and Prognosis of Anxiety

• Chronic and waxing/waning course.
• Some patients recover within weeks.
• Prognosis is excellent with therapy.
• Relapse rate: 30-90%.

Management of Anxiety

• Pharmacological:
  • Selective serotonin reuptake inhibitors (SSRIs): (e.g., paroxetine, fluoxetine, fluvoxamine, citalopram, sertraline) for 8–12 months.
  • Tricyclic antidepressants (TCAs): (e.g., imipramine or clomipramine).
  • Benzodiazepines (short-term use) 2-4 weeks.
  • Beta-blockers
  • Buspirone
• Psychological:
  • Behavioral methods for phobias, exposure therapy, relaxation techniques, controlling hyperventilation.
  • Cognitive methods educating about bodily responses, modifying irrational thoughts and beliefs,cognitive behavioral therapy (CBT).

Phobic Disorder

• Intense, irrational fear & avoidance, impairing functioning.
• Agoraphobia: Anxiety symptoms restricted to places or situations where escape is difficult.
• Common phobias: panic disorder (60%), social phobia (55%),
• prevalence dependant.

Specific Phobias (Simple Phobias)

• Recurring excessive & unreasonable psychological/autonomic anxiety.
• Specific feared object or situation, leading to avoidance (e.g., animals, environment, blood/injection/injury, situational).
• Equally common in both sexes.
• Good prognosis often with late onset.

Social Phobia

• Anxiety restricted to social situations, leading to avoidance.
• Avoidance significantly interfering with daily routine.
• Commonest in South Africa (SA).
• Prevalence 3-13%.

Generalized Anxiety Disorder (GAD)

• Excessive worry, persistent anxiety, and feelings of apprehension regarding everyday events.
• Symptoms include muscle and psychic tension that causes distress and functional impairment.
• Lifetime prevalence 5%.
• More common in women.
• Commonly presented in primary care.

Stress-Related Disorders

• Acute stress disorder: Severe psychological disturbance following traumatic event, characterized by re-experiencing of elements of the event, hyper-arousal, avoidance, and emotional numbing.
• Adjustment disorders: Emotional or behavioral symptoms in reaction to identifiable stressors.
• Post-traumatic stress disorder (PTSD): Extended psychological distress following exposure to or witnessing of traumatic event.

Obsessive-Compulsive Disorder (OCD)

• Common, chronic condition often associated with marked anxiety and depression.
• Characterized by obsessions (recurrent thoughts, impulses, or images) and compulsions (repetitive behaviors or mental acts).
• Obsessions/compulsions cause distress or interfere with functioning.
• Not due to GMC or substance use.
• 2-3% of population globally.

OCD Epidemiology

• Mean age: 20 years
• 70% onset before age 25 years, 15% after age 35
• Equal sex distribution.

OCD Comorbidity

• Depressive disorder (50-70%)
• Alcohol and drug-related disorders
• Social phobia
• Specific phobia.
• Panic disorder
• Eating disorder

OCD Management

• Psychological:
  • Supportive psychotherapy (including family members, group therapy).
  • Psychoanalytic psychotherapy
  • Behavioral therapy: Response prevention, thought stopping
• Pharmacological:
  • Antidepressants (SSRIs, higher doses and longer treatment needed).
  • Electroconvulsive therapy (ECT) in some cases
  • Psychosurgery(in extreme cases)

Case Studies

These provide detailed examples of anxiety cases. Specific diagnoses, and potential approaches are presented in each case.

This quiz covers the essential aspects of anxiety disorders, including their definitions, types, and features. It addresses both neurotic disorders and stress-related conditions, helping you understand how anxiety can impact functioning. Test your knowledge on the psychological characteristics and various classifications of anxiety disorders.