Anxiety Disorders PDF

Anxiety Disorders _______________________________________________________ Definitions - Fear is the emotional response to real or perceived imminent threat. - Anxiety is anticipation of future threat. - Fear more often associated with autonomic arousal necessary for fight or flight, thoughts of imme...

Anxiety Disorders _______________________________________________________ Definitions - Fear is the emotional response to real or perceived imminent threat. - Anxiety is anticipation of future threat. - Fear more often associated with autonomic arousal necessary for fight or flight, thoughts of immediate danger, & escape behaviors. - Anxiety more often associated with muscle tension & vigilance in preparation for future danger & cautious or avoidant behavior. Features of anxiety Psychological Physical Apprehension+ hypervigilance CVS & Chest Excessive worries+ anticipation GI Difficulty concentrating GUT & RS Feeling of restlessness SKIN Sleep disturbance MSS Normal Anxiety VS Abnormal Anxiety ⭐ Normal Abnormal Apprehension Proportional to the trigger Out of proportion Attention External triggers > body reponses Body responses < Features Few, not severe Many, severe Time Not prolonged Prolonged Severity Minimal effect on life Interfere with life Generelized Anxiety Disorders - 6 months duration – most of the time Excessive worries about many events Multiple physical & psychological features (3 out of 6) Difficult to control Significant impairment in function Not due to GMC, medications Substance abuse or other axis I psychiatric disorder - " > # Prevalence - Prevelance 3 – 5%. - Age of onset vary , range 20 – 55Y - Comorbidity 50-90% other mental disorders. _______________________________________________________ !1 _______________________________________________________ Panic attack VS Panic disorder Panic Attck Panic disorder - A symptom not a disorder - " > # Prevalence - Episodic sudden intense fear (dying, going mad, or - Age at onset 20-35Y loosingself-control) Can be part of many disorders: panic disorder, GAD, phobias, sub. Abuse, acute & PTSD. Disorder with specific criteria: 1- Unexpected recurrent panic attacks 2 types of Panic attcks 1- Unexpected 2- Situationally bound 2- 1 month period (or more) of persistent concern about having another attack or worry about implications of attack, or change in behavior related to the attacks. Symptoms of panic attack - Palpitation, Sweating, Trembling, Shortness of breath, Feeling of choking, Chest pain, Feeling dizzy, Fear of dying, Paresthesias 3- Not due to other disorders _______________________________________________________ Phobias - Is an irrational exaggerated fear & avoidance of a specific object or situation. - Pt. recognize that it’s irrational & feel anxious when facing or imagining the object or situation. - ± panic attack on exposure. Types of Phobias Type Features Specific phobia - Marked fear or anxiety about a specific objects or situations. - " > # Prevalence “except in blood type”? - Common in childhood Risk factors: 1- Genetic susceptibility. 2- Environmental: (overprotection, neglect, modeling, truma. 3- Temperamental: -ive affectivity or behavioral inhibition. Example - Blood ex Dental clinic Hospital Airplane(height) Animals Insects Thunder or Storms Darkness Clowns Social phobia - Embarrassement when observed performing. - Sweating, tremor, palpatation, SOB , functional impair. - Speaking in public - Leading prayers - Serving gusets Agoraphobia - Fears of being in places or sitations from which escape might - Mousques - Public transport - Functional impair be difficult or embarrassing. - Or in sitations where help may not be available in the event of having panic or panic like attack. - Marked fear or anxiety about 2 or more of the following: 1. 2. 3. 4. 5. Using public transportation (, buses, trains, ships, planes) Being in open spaces (parking lots, marketplaces, bridges) Being in enclosed places (shops, theaters, cinemas) Standing in line or being in a crowd Being outside of the home alone _______________________________________________________ !2 _______________________________________________________ Social anxiety disorder - Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. - Examples: Social interactions (Having a conversation, meeting unfamiliar people), being observed (eating or drinking), & performing in front of others (giving a speech). OCD & related disorders Type Obsessivecompulsive disorder (OCD) Features - " = # Lifetime Prevalence - Lifetime Prevalence 2-3 % - Mean age of onset 20Y - 25% of cases start by age 14 years 1- Obsessions - Recurrent persistent intrusive unwanted thoughts impulses or images from his own mind, that cause marked distress & anxiety pt tries to suppress them with some other thoughts or actions. 2- Compulsions - Repetitive behaviors or mental acts that pt feels driven to do in response to an obsession or according to rules that must be applied rigidly. 3- Excessive or unreasonable 4- Cause marked distress or time consuming or interfere with function. —————————————————————————————————————————————— Examples: - Contamination & washing - Pathological doubt - Checking & counting - Intrusive thoughts: images of aggression, self- harm, sexual act - Symmetry & slowness - Religious obsessions Body dysmorphic disorder - Is preoccupation with 1 or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others. Repetitive behaviors (mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (comparing one's appearance with that of other people). - The appearance preoccupations are not better explained by concerns with body fat or weight in an individual with an eating disorder. Hoarding disorder - Characterized by persistent difficulty discarding orparting with possessions, regardless of their actual value, as a result of a strong perceived need to save the items & to distress associated with discarding them. - It differs from normal collecting in that it consists of excessive collecting, buying, or stealing of items that are not needed or for which there is no available space. Trichotillomania (hairpulling disorder) Pulling one's hair resulting in hair loss, & repeated attempts to decrease or stop hair pulling. - Not triggered by obsessions or preoccupations. - May be preceded or accompanied by various emotional states as anxiety or boredom. - Preceded by an increasing sense of tension or may lead to gratification, pleasure, or a sense of relief when the hair is pulled. - Varying degrees of conscious awareness Excoriation (skin-picking) disorder - Characterized by recurrent picking of one's skin resulting in skin lesions & repeated attempts to decrease or stop skin picking. - Not triggered by obsessions or preoccupations. - May be preceded or accompanied by various emotional states as anxiety or boredom. - Preceded by an increasing sense of tension or may lead to gratification, pleasure, or a sense of relief when the skin is picked. - Varying degrees of conscious awareness Others - Substance/medication-induced OCD - Obsessive-compulsive & related disorder due to another medical condition _______________________________________________________ Done by Maha Albarrak Good Luck !3