ANXIETY DISORDERS

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ANXIETY DISORDERS

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ANXIETY DISORDERS

  1. 1. ANXIETY DISORDERS
  2. 2. DEFINITION: Anxiety disorders include a constellation of disorders in which anxiety and associated symptoms are experienced at level of severity that impairs functioning. Types of Anxiety Disorder  1.Generalised Anxiety Disorder.  2.Social Anxiety Disorder.  3.Post Trauma Stress Disorder
  3. 3. PATHOPHYSIOLOGY: Noradrenergic model :  The locus ceruleus may have a role in regulating anxiety, as it activates norepinephrine (NE) release and stimulates the sympathetic and parasympathetic nervous systems.  Chronic noradrenergic overactivity downregulates α2 adrenoreceptors in patients with generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD).  Patients with social anxiety disorder (SAD) appear to have a hyperresponsive adrenocortical response to psychological stress. γ- aminobutyric acid (GABA) receptor model:  Anxiety symptoms may be linked to underactivity of GABA systems or downregulated central BZ receptors.  Abnormalities of GABA inhibition may lead to increased response to stress in PTSD patients.
  4. 4. Serotonin (5-HT) model:  The 5-HT and 5-HT2 antagonist meta-chlorophenylpiperazine (m-CPP) causes increased anxiety in PTSD patients.  Dysregulation of the hypothalamic-pituitary-adrenal axis may be a risk factor for eventual development of PTSD.
  5. 5. Symptoms: Generalized Anxiety disorders: Psychological and congnitive :  Excessive anxiety, Poor concentration or mind going blank. Physical symptoms  Restlessness, Fatigue, Sleep disturbance, Irritability Social Anxiety Disorder Some feared situations  Eating or writing in front of others, Interacting with authority figures, Speaking in public, Physical symptoms  Diarrhea, Sweating, Tachycardia Posttraumatic stress disorder:  Decreased concentration  Insomnia
  6. 6. DIAGNOSIS:  Physical and mental status examination.  Patients with GAD have irritable bowel syndrome.  Anxiety symptoms may associated with medical illness Cardiovascular Respiratory system  Anxiety symptoms may psychiatric illnesses mood disorders Schizophrenia
  7. 7. Non drug Treatment:  Short –term counseling  Stress management  exercise
  8. 8. Drug management: Benzodiazepines - Diazepam - 2-40 mg/day Oxazepam - 30-120mg/day Lorazepam - 0.5-10 mg/day Azapirones - Buspirone - 15-60 mg/day Gepirone Antihistamines - Hydroxyzine 200-400mg/day β blocker - propranolol
  9. 9. MECANISM OF ACTION
  10. 10. Pharmacological Treatment for Generalized Anxiety Disorder
  11. 11. Pharmacological Treatment for Social Anxiety Disorder
  12. 12. Pharmacological Treatment of Post Trauma Stress Disorder
  13. 13. Adverse effect: Benzodiazepines: sedation, vertigo , increased appetite weight gain. Azapirone: dizziness,nausea,headache. Antihistamines: confusion,nausea, constipation. β- blockers - bradycardia,wheezing Drug intractions: BZs : The combination of BZs with alcohol or other CNS depressants may be fatal. Antacids - decreased rate of benzodiazepine absorption β blocker :combination with cimitidine increase metabolism of propranolol.
  14. 14. THANK YOU

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