GAD & Panic Disorder.pdf

GENERALIZED ANXIETY and PANIC DISORDER Lely Setyawati Kurniawan lelysetyawatidr  ANXIETY DISORDER Feeling excessive worry or fear Feeling restless or unable to sit still Easy cold sweats, palpitations, shaking, other physical complaints such as dizziness, nausea....

GENERALIZED ANXIETY and PANIC DISORDER Lely Setyawati Kurniawan lelysetyawatidr  ANXIETY DISORDER Feeling excessive worry or fear Feeling restless or unable to sit still Easy cold sweats, palpitations, shaking, other physical complaints such as dizziness, nausea. 2 FEAR  AMIGDALA & NEUROTRANSMITTER 3 WORRY CSTC LOOPS&NEUROTRANSMITTER 4  FEAR and ANXIETY Fear is a response to external threat Fear or fear-like behavior are seen in most mammals and often used as animal models of anxiety. Anxiety is a common human emotion, is an affect, internal state, focused very much on anticipation of danger. Anxiety & fear both are alerting signals and act as a warning of an internal and external threat. 5  FEAR and ANXIETY This distinction between fear and anxiety arose accidentally. When Freud's early translator mistranslated angst, the German word for fear, as anxiety, Freud himself generally ignored the distinction that associates anxiety with a repressed, unconscious object and fear with a known, external object. 6  FEAR and ANXIETY The distinction may be difficult to make because fear can also be caused by an unconscious, repressed, internal object displaced to another object in the external world. For example, a boy may fear barking dogs because he actually fears his father and unconsciously associates his father with barking dogs. 7 Peripheral Manifestations of Anxiety 1. Diarrhea 9. Syncope 2. Dizziness, light- 10.Tachycardia headedness 11.Tingling in the 3. Hyperhidrosis extremities 4. Hyperreflexia 12.Tremors 5. Hypertension 13.Upset stomach 6. Palpitations 14.Urinary frequency, 7. Pupillary mydriasis hesitancy, urgency 8. Restlessness (e.g., pacing) 8  Brain Circuit & Symptoms Khawatir Korteks frontal/singulat (kognisi khawatir) Keterjagaan Talamus (keterjagaan) Insula lobus temporalis (aktivasi simpatis) Perubahan Ketegangan otonom motorik Ganglia basalis (ketegangan motorik) 27 9  Type of Anxiety Disorders 1. Generalized anxiety disorder 2. Social anxiety disorder 3. Agoraphobia 4. Panic disorder 5. Separation anxiety disorder 6. Specific phobias 10  Generalized anxiety disorder (GAD) Generalized anxiety disorder is characterized by excessive, often irrational worry about many things, persisting for at least six months and affecting everyday functioning. It’s also marked by restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and difficulty sleeping. Generalized anxiety disorder is distinguished from other anxiety disorders by the widespread nature of worries. 11  Epidemiology of GAD Childhood anxiety occurs in about 1 in 4 children at some time between the ages of 13 and 18 years. The median age at onset is 11 years. However, the lifetime prevalence of a severe anxiety disorder in children ages 13 to 18 is approximately 6%. The general prevalence in children under 18 years is between 5.7% and 12.8%. The prevalence is approximately twice as high among women as among men. 12  Etiology of GAD Twin studies: GAD influence by genetic factors Personality traits Neuroticism Highly co-morbidity between GAD and MDD Failure of anterior with the amigdala during implicit regulation of emotional processing 13 SYMPTOM OF GAD 14 Diagnostic criteria of GAD in DSM-5 Excessive anxiety and worry for at least 6 months Difficulty controlling the worrying The anxiety is associated with 3 or more of the below symptoms for at least 6 months: Restlessness, feeling keyed up or on edge Being easily fatigued Difficulty in concentrating or mind going blank, irritability Muscle tension Sleep disturbance Irritability The anxiety results in significant distress or impairment in social and occupational areas The anxiety is not attributable to any physical cause 15 GAD PHARMACY 16  Panic disorder In panic disorders, people have recurring, sudden episodes of intense fear or discomfort. These panic attacks may be triggered by stress, a specific or general fear, or even exercise but sometimes they have no discernible cause. They typically come on suddenly, peaking within 10 minutes, but may last up to several hours. During a panic attack, an individual may have a feeling of impending doom and the urge to run away. 17 SYMPTOM OF PANIC DISORDER 18  PANIC DISORDER Recurrent unexpected Panic Attacks 1. Palpitation 2. Sweating 3. Trembling or shaking 4. Shortness of breath ICD-10 (PPDGJ): F41.0 5. Feeling of choking DSM-5: 300.01 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, lightheaded, or faint 9. Chills or hot flashes 19  PANIC DISORDER Recurrent unexpected Panic Attacks 10. Numbness or tingling 11.Derealization or depersonalization 12.Fear of losing control or ‘going crazy’ 13.Fear of dying 14.Persistent concern of future attack 15.Worry about the meaning of or consequences of the attacks (e.g., heart attack or stroke) 16.Significant change in behavior related to the attacks (e.g., avoiding places at which panic attacks have occurred) 17.Presence of agoraphobia 20 PANIC PHARMACY 21  Overcoming Panic Attacks 1. Help yourself 2. Stay where you are until the panic attack passes. 3. Concentrate on overcoming your anxiety not on the physical complaints 4. Practice slow, relaxed breathing. 5. In a state of panic or anxiety, breathing will be faster. Learning to control our breathing by breathing slowly will help us feel calmer and more relaxed 22  AGORAPHOBIA (300.22 / F40.0) Agoraphobia (Greek) = Fear of the marketplace. Persons avoid the large shopping venues. Marked fear or anxiety about 2 or more situations: 1. Using public transportation 2. Being in open spaces 3. Being in encloses places 4. Standing in line or being in a crowd 5. Being outside of the home alone. 23  SOCIAL PHOBIA (300.23 / F40.10) Social Anxiety Disorder (SAD) Marked fear or anxiety about 1 or more situations in which the individual is exposed to possible scrutiny by others. Ex. : public speaking, writing, eating, or drinking in public, initiating or maintaining conversations, Fears humiliation or embarrassment Manifesting anxiety symptoms (blushing or sweating) Feared social or performance situations are avoided or endured with intense anxiety or distress. 24  SPECIFIC PHOBIA Marked and persistent fear that is excessive, unreasonable, cued by the presence or anticipation of a specific object or situation For example: flying, enclosed spaces, heights, storms, animals (e.g., snakes or spiders), receiving an injection, blood. Recognition that the fear is excessive or unreasonable Avoidance, anticipatory anxiety, or distress is significantly impairing. 25 26  OBSESSIVE-COMPULSIVE DISORDER Has obsessions or compulsions Obsessions are defined as recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate, for example: Contamination Repeated doubts Order Impulses Sexual images 27  OBSESSIVE-COMPULSIVE DISORDER Compulsions are defined as repetitive behaviors or mental acts whose goal is to prevent or to reduce anxiety or distress, for example: Hand washing, Ordering, Checking, Praying, Counting, Repeating words. Recognition that the fear is excessive or unreasonable Obsessions cause marked distress, are time- consuming (more than 1 hour per day), or cause significant impairment in social, occupational or other daily functioning 28 29  Treatment Psychological treatment: CBT, relaxation training, breathing management. Pharmacological treatment: Anti-anxiety, SSRI, SNRI, TCA, MAOI, Anti-psychotic. Combining CBT and pharmacotherapy. Treatment the co-morbidity ec. Substance abuse , mood disorder, etc. 30 31 Relaksasi 32 https://youtu.be/SH2PjUWqKNY Progressive Muscle Relaxation 33  PATIENTS WHO REQUIRE ATTENTION TO SCREENING No physical abnormalities were found Patients who come repeatedly Patients with alternating complaints Patients with various complaints Emotional patient Patients who clearly show mental or behavioral disorders 34  WHEN TO REFER PATIENTS WITH ANXIETY? Symptoms persist, there is no improvement after social intervention for a long time Panic symptoms increase and become more severe Behavior becomes difficult to control, an anxious personality or other chronic illness Self harm or others Ask for expert opinion or treatment limitations 35  CONCLUSION Generalized Anxiety Disorder and Panic Disorder are highly prevalent, frequently disabling conditions that often begin in childhood and persist into adulthood. They are generally very responsive to pharmacological and or cognitive behavioral treatments. 36 37