Anxiety Class Presentation PDF

ANXIETY Dr Md Shamshir Alam, PhD College of Pharmacy National university of Science &Technology Bosher-Muscat Slide outline  Clinical descriptions of anxiety disorders.  Common risk factors of anxiety.  Etiology of anxiety.  Pathogenesis and signs and symptoms of anxiety.  Treatments of anxi...

ANXIETY Dr Md Shamshir Alam, PhD College of Pharmacy National university of Science &Technology Bosher-Muscat Slide outline  Clinical descriptions of anxiety disorders.  Common risk factors of anxiety.  Etiology of anxiety.  Pathogenesis and signs and symptoms of anxiety.  Treatments of anxiety. Learning Objectives  Explain the clinical descriptions of anxiety disorders.  Describe the common risk factors of anxiety.  Explain the etiology of anxiety.  Describe the pathogenesis and signs and symptoms of anxiety.  Select treatments of anxiety. Anxiety  Anxiety is an emotional state commonly caused by the perception of real or perceived danger that threatens the security of an individual.  Anxiety may involve feelings, behaviours and physiological responses.  It allows a person to prepare for or react to environmental changes. Everyone experiences a certain amount of nervousness and apprehension when faced with a stressful situation.  This is an adaptive response and is transient in nature.  Mild anxiety is adaptive and can provide motivation for survival.  In general, anxiety disorders are a group of heterogeneous illnesses that develop before age 30 years and are more common in females, individuals with social issues, and those with a family history of anxiety and depression.  Epidemiology of anxiety Anxiety disorders are the most common of all psychiatric illnesses.  Approximately 34% of the population are affected by an anxiety disorder during their lifetime.  More common in women than men.  Minority children and children from low socioeconomic environments is at risk.  A familial predisposition probably exists.  Types of Anxiety disorders Social Phobia  Panic disorder (panic attack)  Generalized anxiety disorder  Obsessive-compulsive Disorder  Phobic disorders  Agoraphobia  Social Phobia Most common anxiety disorder.  Is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviours.  Lead to other problems: alcohol (18.8%, drug abuse (13%), agoraphobia (44.9%).  Paralyzed by fears that he will humiliate or embarrass himself in front of others- drop out from school, unemployed, no friends.  Panic disorder (panic attack) Happen unexpected or situationally.  Spontaneous attacks of intense fear and discomfort; may last from minutes to an hour.  Symptoms of anxiety can last for hours.  S & S include – ↑ heart rate – Chest pain – Chills or hot flushes – Dizziness – SOB – Fear of losing control – Depersonalization  Generalized anxiety disorder Persistent, excessive and unrealistic worry that lasts for 6 months and more.  Worry for everything, irrational concerns.  S/S: – Restlessness – Difficulty concentrating or sleeping – Irritability – Fatigue – Muscle tension  Obsessive-compulsive Disorder  Anxiety ccharacterized by obsessions (which cause marked anxiety or distress) and/or by compulsions (which serve to neutralize anxiety). Phobic disorders Intense, irrational fear responses to an external object, activity, or situation; it causes severe distress & impair functioning.  Interventions: – Non-critical attitude – Provide activities – Physical care and comfort needs – Behavior is a method of coping  Posttraumatic Stress  Characterized by the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma. Agoraphobia  Anxiety about, or avoidance of, places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms. E.g. person in top of the building roof. Fight or Flight The body releases high levels of adrenaline and hormones, such as cortisol.  May cause your heart to beat faster, blood pressure to rise, and breathing to be faster or more shallow.  Purpose is to prepare the body to either fight the threat or flee.  Useful when confronting a real, physical threat (i.e. burning building), but not appropriate for nonphysical threats (i.e. public speaking).  Causes of Anxiety Genetics. Anxiety disorders can run in families.  Brain chemistry. Some research suggests anxiety disorders may be linked to faulty circuits in the brain that control fear and emotions.  Environmental stress. This refers to stressful events you have seen or lived through.  Life events often linked to anxiety disorders include childhood abuse and neglect, a death of a loved one, or being attacked or seeing violence.  Drug withdrawal or misuse. Benzodiazepines, alcohol and substance use.  Medical conditions. Some heart, lung, and thyroid conditions can cause symptoms similar to anxiety disorders or make anxiety symptoms worse. Eg. Heart disease, Diabetes mellitus, Hyperthyroidism  Risk factors of Anxiety History of mental health disorder. Having another mental health disorder, like depression, raises your risk for anxiety disorder. • Childhood sexual abuse. Emotional, physical, and sexual abuse or neglect during childhood is linked to anxiety disorders later in life. • Trauma. Living through a traumatic event increases the risk of posttraumatic stress disorder (PTSD), which can cause panic attacks. • Negative life events. Stressful or negative life events, like losing a parent in early childhood, increase your risk for anxiety disorder.  Severe illness or chronic health condition. Constant worry about your health or the health of a loved one, or caring for someone who is sick, can cause you to feel overwhelmed and anxious.  Substance abuse. The use of alcohol and illegal drugs makes you more likely to get an anxiety disorder. • Being shy as a child. Shyness and withdrawal from unfamiliar people and places during childhood is linked to social anxiety in teens and adults. • Low self-esteem. Negative perceptions about yourself may lead to social anxiety disorder.  Pathophysiology of Anxiety The following systems/theories are involved in the pathophysiology of anxiety  GABA system:  The role of GABA- benzodiazepine receptor complex in anxiety disorders has not been fully characterized.  However a potential role has been implicating in panic disorders, GAD and PTSD.  In GAD reduced temporal lobe benzodiazepine receptor are observed.  In PTSD, cortical benzodiazepine receptor are reduced. GABA system:  In PANIC decreased GABAA binding is noted.  Angiogenic agents– having the property of altering the binding of benzodiazepines to the gamma amino butyric acid receptor ↓ leads to Nerve cell excitability ↓ Anxiety  Serotonin system:  5-HT is involved in the pathophysiology of anxiety disorders.  As abnormal regulations of serotonin release and reuptake or abnormal responsiveness to 5- HT signals.  Amygdala  Its role includes detecting, coordinating and maintaining fearful emotions.  The amygdala integrates information from multiple sensory areas to assess for threats with consideration of input regarding the context of presenting stimulus.  Once a threat has been detected by the amygdala a rapid response is coordinated.  Amygdala  Its role includes detecting, coordinating and maintaining fearful emotions.  The amygdala integrates information from multiple sensory areas to assess for threats with consideration of input regarding the context of presenting stimulus.  Once a threat has been detected by the amygdala a rapid response is coordinated.  Non adrenergic system Locus coeruleus which is located in the brainstem ↓ Locus coeruleus is neither primary nor epinephrine containing area of the brain ↓ According to the noradrenergic theory of anxiety, in the presence of perceived threat, the locus coeruleus serves as an alarm center release nor epinephrine ↓ Leads to anxiety.  α2 adrenergic antagonist yohimbine, carbon dioxide inhalation, caffeine, isoproterenol each of these stimuli activates a pathway leads to anxiety.  Symptoms of anxiety  The • • • • • • • main symptom of anxiety disorders is excessive fear or worry and common symptoms of anxiety are: Panic, fear, and uneasiness. Feelings of panic, doom, or danger. Sleep problems. Cold, sweaty, numb, or tingling hands or feet. Shortness of breath. Breathing faster and more quickly than normal (hyperventilation) Heart palpitations Dry mouth Nausea Tense muscles Dizziness Thinking about a problem over and over again and unable to stop (rumination). • Inability to concentrate. • Intensely or obsessively avoiding feared objects or places. • • • • • Assessment of anxiety  Health history: physical examination  Medications anticholinergics, OTC drugs,  Screening: – Mini International Neuropsychiatric Interview (MINI) – Liebowitz Social Anxiety Scale – Brief Social Phobia Scale – Michigan Alcoholism Screening Test history: amphetamines, antihypertensive, epinephrine, Treatment of anxiety  The