Psiquiatría - Tema 8: Trastornos de Ansiedad

Psiquiatría - TEMA 8

• Trastornos de ansiedad relacionados con el miedo: More prevalent in women, often with a hereditary component (three times more likely if a parent has it). Important to recognize for proper treatment.

Ansiedad

• Normal Anxiety: A normal emotional response to threatening situations. Focuses attention on the threat. Physiological changes (increased heart rate, breathing, muscle tension) prepare the body for defense or flight.

• Pathological Anxiety: Includes disproportionate and prolonged responses, often focusing on the person's own response or the opinions of others.

Classifications

• Infancy: Anxiety related to separation and selective mutism.

• Adolescence/Adulthood: Simple/specific phobia, social phobia, panic disorder, agoraphobia, generalized anxiety disorder, anxiety due to medical conditions/substances.

Symptoms

• Presentation: Can be in crisis form (panic disorder) or continuous form (generalized anxiety disorder). Also important to observe accompanying symptoms.

• Anxiety symptoms can be related to: Avoidance behaviors (specific phobia), obsessions, and compulsions (OCD). Medical symptoms (feeling worried about getting sick). Dissociation/conversion issues.

Epidemiology

• Common: Anxiety disorders are the most frequent psychiatric conditions in the general population. Phobias are among the most common types.
• Frequency: Panic attacks are a major psychiatric emergency (especially in primary care and emergency rooms), frequently occurring in young women (20-30 years old).

Phobias

• Definition: Persistent, excessive fear of a specific object, activity, or situation (the phobia stimulus) that's perceived as unreasonable but remains outside conscious control. This leads to avoidance behavior.
• Subtypes: social phobia, agoraphobia, and various specific phobias (e.g., animal phobias, blood-injection-injury phobias, situational phobias.)

Epidemiology

• Common in general population: Phobias are a common diagnosis among the general population.
• More prevalent in women
• More frequent in Children: Agoraphobia is among prevalent in consultations in the medical setting.

Etiology & clinical features

• Family history: Risk is increased for people with a first-degree relative affected by it. 
• Brain circuits: Implicated in the fear response involves the amygdala, limbic system, insula, anterior cingulate cortex, and prefrontal cortex. Psychological experiences can play a role in the development.
• Neurological mechanisms: Hyperactive amygdala or other stress response circuits can increase the risk. 
• Different presentations: Some phobias have an obvious onset relating to trauma; others develop in adulthood

Panic Disorder

• Description: Recurrent, unexpected panic attacks followed by significant worry about more attacks, and changes in related behaviors.

• Causes/triggers: Can be due to genetic predisposition, environmental factors, or an imbalance in brain chemistry.

• Symptoms: Sudden onset of intense fear, sensations of doom, increased heart rate, shortness of breath, sweating, trembling.

Generalized Anxiety Disorder

• Description: Chronic, excessive worry about various aspects of life, persistent for at least 6 months, impacting daily functioning.

• Symptoms: Worry about everyday things, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, problems sleeping.

Phobia Social

• Definition: Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.

• Typical presentation: This is not limited to public speaking, but to other situations where the individual fears embarrassment.

Epidemiology and Etiology

• High prevalence: Social phobia is a highly prevalent disorder.
• Biological factors: Genetic predisposition and involvement of neurotransmitter systems such as serotonin and noradrenaline.
• Environmental factors: Early negative experiences, social isolation, and perceived interpersonal difficulties in social environments.

Separation Anxiety Disorder

• Definition: Excessive anxiety and fear concerning separation from attachment figures.
• Typical Presentation: Intense anxiety and worry about separation or the possibility of separation, or about harm to or injury of an attachment figure.
• Comorbidities: Associated with other psychiatric disorders, particularly anxiety and mood disorders.

Selective Mutism

• Definition: A childhood disorder characterized by a consistent failure to speak in specific social situations, despite speaking in other settings.
• Typical presentation: The child can speak freely to people they know well in familiar situations. School and other social situations are where they have difficulty communicating.

Differential diagnoses

• Exclude organic causes: Ensure that anxiety symptoms are not caused by a medical condition (such as hyperthyroidism, heart conditions, or other medical issue). Important to exclude medical causes in patients who present for psychiatric reasons.

En este cuestionario se abordan los trastornos de ansiedad, centrándose en el miedo y su prevalencia, especialmente entre mujeres. Se discuten las diferencias entre la ansiedad normal y patológica, así como las clasificaciones en diversas etapas de la vida y sus síntomas. Es crucial reconocer estos trastornos para asegurar un tratamiento adecuado.