anxiety disorders

1
anxiety disorders

• the experience of anxiety
• generalized anxiety disorder
• panic disorder
• phobias
• obsessive-compulsive disorder
• posttraumatic stress disorder
• treating anxiety disorders

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the experience of anxiety

• anxiety involves worry, fear, apprehension,
  intrusive thoughts, physical symptoms, and
  feelings of tension.
• It often seems to have an automatic quality that
  comes more from within the individual than from
  situational factors.
• It is normal for people to experience anxiety
  when faced with stressful, threatening
  situations, but it is abnormal to feel strong,
  chronic anxiety in the absence of an obvious
  cause. (However normal may vary with level of
  consciousness.)

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common anxiety symptoms and self-descriptions
indicative of high anxietysymptoms

• Nervousness, jitteriness
• Tension
• Feeling tired
• Dizziness
• Frequency of urination
• Heart palpitations
• Feeling faint

• Breathlessness
• Sweating
• Trembling
• Sleeplessness
• Difficulty in concentrating
• hypervigilance

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pathological anxietyepidemiology

• Anxiety disorders make up one of the most common
  groups of psychiatric disorders.
• the national co morbidity study reported that one
  in four persons met the diagnostic criteria for
  at least one anxiety d/o
• Women (30.5 percent lifetime prevalence) are more
  likely to have an anxiety d/o than are men (19.2
  percent lifetime prevalence).
• Finally. The prevalence of anxiety d/o decreases
  with higher socioeconomic status.

• Prevalence of anxiety d/o
• Disorder percent(1yr-
• prevalence)
• Any anxiety d/o 13.3
• Generalized anxiety
• d/o 2.8
• Panic d/o 1.7
• Phobic d/o 8.0
• Obsessive-compulsive
• d/o 2.3
• Posttraumatic stress
• d/o 3.6
• Source National Institute of Mental Health

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self- descriptions

• I am often bothered by the thumping of my
  heart.
• little annoyances get on my nerves and irritate
  me.
• I often suddenly become scared for no good
  reason.
• I worry continuously, and that gets me down.
• I frequently get spells of complete exhaustion
  and fatigue
• it is always hard for me to make up my mind.
• I always seem to be dreading something.
• I feel nervous and high-strung all the time.
• I often feel I cant overcome my difficulties.
• I feel constantly under strain.

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Psychological sciences
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biological sciences

• A range of biologically based sensitivities may
  exist among persons with the symptoms of anxiety
  disorders.
• Autonomic nervous system(functional division of
  the nervous system concerned with visceral
  activities) stimulation of the ANS may cause
  peripheral manifestations of anxiety-
  cardiovascular and/or gastrointestinal.
• Neurotransmitters (chemical product of the NS
  that makes possible the movement of the nerve
  impulse across the synapse)norepinephrine,
  serotonin,and y-aminobutyric acid (GABA) are the
  three major neurotransmitters associated with
  anxiety.
• Brain- imaging studies CT, MRI, PET, SPECT, EEG.
• Genetic studies
• Neuroanatomical considerations limbic system,
  and cerebral cortex.

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generalized anxiety disorder300.02

• A person with GAD experiences vague but intense
  concerns and fearfulness that persist over a long
  period- at least 6-months.
• The symptoms include motor tension, autonomic
  reactivity, apprehension about the future, and
  hypervgilance.
• durations as long as 20 years.
• prolonged use of drugs can have significant side
  effects.
• The distinction between GAD and normal anxiety is
  emphasized by the use of the words excessive and
  difficult to control in the criteria and by the
  specification the symptoms cause significant
  impairment or distress.

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clinical features of GAD

• Excessive anxiety and worry occurring for at
  least 6 months and affecting many areas of a
  persons life.
• Inability to control worry
• The presence of 3 or more of the following
  symptoms( only one type of symptom is required
  for DSM-IV in the diagnosis of children)
• a. restlessness feeling on edge
• b. being easily fatigue
• c. difficulty concentrating mind goes blank
• d. irritability
• e. muscle tension
• f. sleep disturbance( difficulty falling or
  staying asleep unsatisfying sleep)
• 4. Considerable distress or impairment in social,
  occupational, or other important areas of life.

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treatment for GAD

• Psychotherapy
• Cognitive-behavioralcognitive address patients
  hypothesized cognitive distortions directly, and
  behavioral approaches address somatic symptoms
  directly. (relaxation and biofeedback).
• supportive offers patients reassurance and
  comfort, although its long-term efficacy is
  doubtful.
• Insight-oriented focuses on uncovering
  conflicts and identifying ego strengths.

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substance-induced anxiety disorder293.84

• The disorder is the direct result of a toxic
  substance. Including drugs of abuse, medication,
  poison, and alcohol, among others.
• The DSM-IV diagnostic criteria for
  substance-induce anxiety disorder require the
  presence of prominent anxiety, panic attacks,
  obsessions, or compulsions. The guidelines state
  that the symptoms should have develop during the
  use of of the substance or within a month of the
  cessation of substance use. The structure of the
  diagnosis includes specification of the substance
  (e.g. cocaine), specification of the appropriate
  state during the onset (e.g., intoxication), and
  mention of the specific symptom pattern (e.g.,
  panic attacks).

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Panic disorder

• Panic Disorder is an illness in which a person
  experiences sudden, sometimes unexpected rushes
  of intense fear or discomfort accompanied by a
  number of distressing physical sensations.
• The panic attack, the core feature of panic
  disorder, strikes suddenly, often in familiar
  places where there is seemingly nothing to be
  afraid of.
• But when the attack comes, it comes as if there
  were a real threat, and the body reacts
  accordingly.  Panic disorder is often accompanied
  by agoraphobia, the fear of being alone in public
  places (such as supermarkets), particularly
  places from which a rapid exit would be difficult
  in the course of a panic attack.
• In addition to agoraphobia, other phobias and
  obsessive-compulsive disorder can coexist with
  panic disorder.
• .

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Panic d/oPanic attacks

• The term panic attack denotes an abrupt surge of
  intense anxiety rising to a peak that either is
  cued by the presence, or thoughts, of particular
  stimuli or that occurs without obvious cues and
  is spontaneous and unpredictable. During these
  episodes, the person experiences the urge to
  flee, or the feeling that they need to escape.
  The symptoms may be misdiagnose as a serious
  medical condition (M.I.).

• It is known that the d/o typically begins when
  its victims are in their 20s. Often a serious
  event, will trigger the first attack. Women are
  two to three times more likely to be affected
  than men. 3 million Americans will experience
  panic disorders sometime in their lives.

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Criteria for panic attack

• A discrete period of intense fear or discomfort,
  in which four (or more) of the following symptoms
  developed abruptly and reached a peak within 10
  minutes is not codable disorder.
• Palpitations, pounding heart, or accelerated
  heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feeling of choking
• Cheat pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Derealization (feelings or unreality) or
  depersonalization (being detached from oneself)
• Fear of losing control or going crazy
• Fear of dying
• Paresthesias
• Chills or hot flashes

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treatment for panic disorder

• Can consist of taking a medication to adjust the
  chemicals in your body-just as you might take
  medicine to correct a thyroid imbalance or any
  other hormonal imbalance. two major categories of
  medication that have been shown to be safe and
  effective in the treatment of panic disorder are
  antidepressants and benzodiazepines. Another
  treatment is cognitive behavior therapy (CBT),
  which focuses on reducing the persons fears of
  panic symptoms and assisting the person to resume
  avoided activities. The combination of medication
  and psychotherapy appears to be more effective
  than either treatment alone.

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agoraphobia

• DSM-IV-TR includes diagnoses for panic disorder
  with and without agoraphobia and also for
  agoraphobia without history of panic disorder.
• patients with agoraphobia avoid situations in
  which it would be difficult to obtain help. They
  prefer to be accompanied by someone in crowded
  stores, closed-in spaces (tunnels, bridges, and
  elevators) and closed-in vehicles (subways,
  buses, and airplanes) severely affected patients
  may refuse to leave the house. Agoraphobic
  individuals are often clinging and dependent.

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Diagnostic criteria for

• Panic disorder with agoraphobia 300.21
• Both (1) and (2)
• The presence of agoraphobia

• Agoraphobia without history of panic disorder
  300.22
• The presence of agoraphobia related to fear of
  developing panic-like symptoms
• Criteria have never been met for panic disorder
• The disturbance is not due to the direct
  physiological effects of a substance or a general
  medical condition
• If an associated general medical condition is
  present, the fear described in criterion A is
  clearly in excess of that usually associated with
  the condition.

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phobias

• People who have phobias have fears related to
  specific objects, people, or situations.
• Phobias often develop gradually or begin with a
  generalized anxiety attack.
• Phobias are common disorders that affect women
  about twice as frequently as men. Phobias often
  begin before adulthood and are likely to become
  chronic.
• Phobias can be grouped into three main types
  specific phobias, social phobias, and agoraphobia.

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examples for five categories of phobias

• Separation fear social fears
• Crowds eating with strangers
• Traveling alone being watched while writing
• Being alone at home being watched while working
• Animal fears
• Mice
• Rats mutilation fears
• Insects open wounds
• Nature fears surgical operations
• Mountains blood
• The ocean
• Cliffs, heights

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Specific phobias300.29

• Most commonly occurring type of phobia. This
  group includes miscellaneous irrational fears
  such as intense fear of a certain type of animal
  or of being in an enclosed place. Specific
  phobias may arise from an earlier frightening or
  anxiety-producing situation that involved the
  type of person or situation that later became
  associated with the phobia. Procedures that use
  the classical conditioning approach of pairing
  the phobic stimulus with nonanxiety response are
  often used successfully to treat specify phobias.
• Criteria A (excessive fear) and B (stimulus
  exposure)
• In specific phobia the panic attack is
  situationally bound to the specific phobic
  stimulus. Specify type.
• Treatment exposure therapy(therapist desensitize
  pt. by using a series of gradual, self-paced
  exposures to the phobic stimuli, and they teach
  pt.s various techniques to deal with anxiety,
  including relaxation, breathing control, and
  cognitive approaches. Pharmacotherapy may also
  benefit.

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Social phobias(social anxiety disorder)300.23

• Intense and incapacitating fear and embarrassment
  when dealing with others characterize social
  phobias. Fear of blushing when in a social
  situation and fear of eating when others are
  present are two social phobias that are
  especially difficult to treat successfully.

• Treatment
• Psychotherapy for the generalized type of social
  phobia usually involves a combination of
  behavioral and cognitive methods, including
  retraining, desensitization, rehearsal during
  sessions, and a range of homework assignments.

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Obsessive-compulsive disorder300.3

• People affected by an obsessive-compulsive d/o
  are unable to control their preoccupation with
  specific ideas or are unable to prevent
  themselves from repeatedly carrying out a
  particular act or series of acts that affect
  their ability to carry out normal activities.
• Obsessive behavior is the inability to stop
  thinking about a particular idea or topic. The
  topic of these thoughts is often felt by the
  person involved to be unpleasant and shameful.
• Compulsive behavior is the need to perform
  certain behaviors over and over. Many compulsions
  deal with counting, ordering, checking, touching
  and washing.

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OCDDSM-IV-TR CRITERIA

• Criteria for obsessive-compulsive disorder
  include having recurrent and persistent thoughts,
  impulses, or images that are not simply general
  worries and real-life problems.
• Patients recognize that the unwanted thoughts and
  rituals are the products of their minds, but
  distress persist and personal routines are
  seriously disrupted.

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OCDsymptoms patterns

• The presentation of obsessions and compulsions is
  heterogeneous in adults and in children and
  adolescents. The symptoms of an individual
  patient may overlap with time, but OCD has four
  major symptoms patterns.
• 1. Contamination- the fear object is often hard
  to avoid (e.g. feces, urine, dust, or
  germs)accompanied by compulsive avoidance.
  patients usually believe that the contamination
  is spread from object to object or person to
  person.
• 2. pathological doubt-often implies some danger
  of violence (e.g. forgetting to turn off the
  stove or not locking the door)followed by a
  compulsion of checking. The pt.s always feel
  guilty about having forgotten or committed
  something.
• 3. Intrusive thoughts- repetitious thoughts of a
  sexual or aggressive act that is reprehensible to
  the pt. without compulsions.

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OCD-symptoms patterns

• 4. Symmetry- the fourth most common patterns is
  the need for symmetry or precision, which can
  lead to a compulsion of slowness.
• 5. Other symptom patterns- religious obsessions
  and compulsive hoarding are common in patients
  with OCD. Trichotilomania (compulsive hair
  pulling) and nail niting may be compulsions
  related to OCD.
• Cognitive therapist seek to help patients become
  aware of their excessive sense of responsibility
  as a step toward overcoming obsessions and
  compulsions.

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Posttraumatic stress disorder309.81 (PTSD)

• PTSD may occur after an extreme stress such as a
  natural disaster, a serious accident, or
  participation in a battle or other war-related
  situations.
• PTSD symptoms vary widely but may include
  recurrent dreams, flashbacks, impaired
  concentration, and emotional numbing. T
• hose experience PTSD after a stressful experience
  are likely to have had previous histories of
  psychological disorder.

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• The emotional disorder that often arises after a
  trauma such as war, assault, natural disaster, or
  death of a loved one is posttraumatic stress
  disorder(PTSD). According to the DSM-IV-TR, a
  person with
• PTSD must have been exposed to some event during
  which he/she feels fear, helplessness, or horror.
  
• Then, the person continues to reexperience the
  event through memories, reenactments, nightmares,
  or flashbacks. Cues that remind the person of
  the event are avoided and emotional
  responsiveness is numbed.
• Often such individuals are chronically
  overaroused, easily startled, and quick to anger.
  With PTSD, the alarm response is a true alarm,
  meaning that it occurs in response to real threat
  or danger.