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Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
Anxiety
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Anxiety
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Anxiety

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  • 1. Dr. Aftab Asif Associate Professor Department of Psychiatry Anxiety Disorders
  • 2. NORMAL ANXIETY & PATHOLOGICAL TYPES OF ANXIETY    
    • Behavior
    • Ability to function
    •   Assessment by patient, friend & clinician
    • Neuropsychiatric Evaluation
  • 3. ANXIETY DISORDER
    •   Panic disorder (with or
    • with out agoraphobia)
    • Specific phobia
    • Special phobia
    • Generalized anxiety disorder
    • Obsessive-compulsive disorder
    • Acute stress disorder
    • Posttraumatic stress disorder
    •   Anxiety disorder due to medical condition
    • Substance-induced anxiety disorder
  • 4.      PSYCHOANALYTIC THEORIES:
    •    “ Anxiety around ego to take defensive action against the pressure from within”
  • 5. MAJOR CATEGORIES:
    • Depending on the nature of the feared consequences
    • Id or impulse anxiety
    • Separation anxiety
    • Castration anxiety
    • Superego anxiety
  • 6.    BEHAVIOURAL THEORIES:
    • Conditioned response to a specific environmental stimuli.
    • Regular food Contaminated food Allergy Desensitization
  • 7. BIOLOGICAL THEORIES:
    • Biological events precede the psychological conflict
    •  Autonomic nervous system Stimulation of ANS- like
    • Cardiovascular – tachycardia
    • Muscular – headache
    • Gastrointestinal – diarrhoea
    • Respiratory – tachypnea
  • 8. NEUROTRANSMITTER:
    • Norepinephrine
    • Serotonin
    • GABA
  • 9. Norepinephrine: Locus Ceruleus Pons     Limbic system Cerebral cortex Brainstem Spinal cord   Stimulation Fear
  • 10.
    •  - Adrenergic agonist
    • (Isoproternol)
    •  
    •  2 - Adrenergic antagonist (yohimbine)
    • = Increased pain attacks
    •  
    • Clonidine (catapres) = Reduced pain attacks
  • 11. SEROTONIN:
    • Raphe nuclei in rostral brainstem
    • Cerebral cortex
    • Limbic system
    • Amygdala
    • Hippocampus
    • Hypothalamus
    • Some drug involved with serotonin reduce the anxiety level.
  • 12. GABA
    • Benzodiazepine inhance
    • The level of GABA reduced anxiety
    • Benzodiazepine severe panic attacks
    • antogonist (flumazenil)
  • 13. BRAIN – IMAGING STUDY:
    • CT/MRI --- some
    • increase in the size
    • of cerebral ventricles.
    • MRI – specific defect
    • in the tight temporal lobe.
    • PET/SPECT/EEG –
    • Abnormalities in frontal cortex.
  • 14. GENETIC STUDIES:
    • 50% relatives
    • have panic
    • attacks
  • 15. NEUROANATOMICAL CONSIDERATIONS:
    • Limbic system
    • Increased concentration
    • of GABA
    • Cerebral cortex
    • Frontal cerebral cortex
    • Connected with Parahippocampal cingulated gyrus hypothalamus
    • Production of anxiety
  • 16. DIFFERENT DISORDER VARIES
    • Wide range of medical conditioning:
    • Hyperthyroidism
    • Hypothyroidism
    • Hypoparathyroidism
    • Vit B12 deficiency
    • Cardiac arrythmias
    • Hypoglycemia
    • 83 % of cardiomyopathy patient awaiting cardiac transplantation have panic disorder.
    • 25 % Parkinson’s disease hare panic attacks
    • 25 % of chronic obstructive pulmonary disease (COPD) have panic attacks
  • 17.
      • Amphetamine
      • Cocaine
      • Caffeine
    Substance Induced Anxiety Disorder
  • 18. Mixed anxiety/depression disorder
    • A
    D D A A D A D
  • 19. PANIC DISORDER
    • Epidemiology:
    • Life time prevalence
    • 1.5 to 3 % - panic disorder
    •   4 % - panic attacks
    •   Women Men
    • 2-3 1
    • Mitral valve prolapse
    •       Mid systolic dick on cardiac auscultation
    •      Prolapse of one of the mitral valve leaflets
    •      Heterogenous
  • 20. DRUGS USED FOR THE TREATMENT OF PANIC DIAORDER. Nausea, diarrhea, anxiety/nervousness, sexual dysfunction somnolence 60 mg 20-40 mg 10 mg Paroxetine Nausea, diarrhea, anxiety/nervousness, sexual dysfunction 60 mg 20-40 mg 10 mg Fluoxetine Dry mouth, drowsiness, nausea, anxiety/nervousness, othostatic hypotension, myoclonus, hypotension, myoclonus, hypertensive 90 mg 30-90 mg 15 mg twice daily Pheneizine Dry mouth, blurred vision, constipation, urinary hesitancy, othostasis, somnolence, anxiety, sexual dysfunction 150 mg 50-100 mg 25 mg at bedtime Imipramine CommonS. Effect Max. Dosage Daily Dosing Range Starting Dosage Drug
  • 21. Somnolence, ataxia, memory problems, physical dependence, withdrawal reactions 6 mg/day 1.5-4.0 mg 0.25-0.5 mg twice daily Clonazepam Nausea, diarrhea, anxiety/nervousness, sexual dysfunction 6 mg/day 1.5-4.0 mg 0.25-0.5 mg 3times daily Alprazolam Nausea, diarrhea, anxiety/nervousness, sexual dysfunction 60 mg 25-150 mg 25 mg Sertraline
  • 22. PHOBIC DISORDERS
    • “ A marked and persistent
    • fear that is excessive at
    • unreasonable, cued by
    • the presence or anticipation
    • of a specific object or
    • situation.”
  • 23. SPECIFIC TYPES:
    • Animal type
    • if the fear is cued by :
    • Animals or insects
    • Natural environment type:
    • Storms, heights or water
    • Blood-injection - injury type:
    • Situational type :
    • Public transportation, tunnels, bridges, elevatos, flying, driving, peak in childhood or in mid 20s
  • 24. SOCIAL PHOBIA:
    • Exposed to unfamiliar people
    • or to possible scrutiny by others.
    • EPIDIMIOLOGY:
    • Phobic disorder – 5-10 % in
    • general population
    • Social phobia – 3 %
  • 25. TREATMENT:
    • Pharmacological Treatment:
    • Benzodiazepine
    •  -blockers
    • Antidepressants.
    • Psychotherapy:
    • Behavior or Cognitive behavior therapy
  • 26. GENERALIZED ANXIETY DISORDER (GAD)
    • Excessive anxiety and
    • worry for at least 6months.
    • SYMPTOMS:
    • Restlessness or feeling
    • keyed up, on edge
    • Difficulty concentration or mind going blank
    •   Irritability
    • Muscle tension
    •   Sleep disturbance
  • 27. EPIDIMIOLOGY:
    •   Early adult life.
    •   Commonly in women
    •   More frequently in general
    • Medical practice than in Psychiatry
    •   High rate of comorbidity
    •   Symptoms of hyperarousal
    •   Do not recognize themselves as having psychiatric illness
  • 28. DIFFERENTIAL DIAGNOSIS:
    • Major depression
    • OCD
    • Panic disorder
    • Somatoform disorder
    • Paranoid
    • Eating disorder
    • Hyper thyroidism
    • Hypothyroidism
    • Diabetes
    • Drugs
    • Mitral valve prolapse
    •      
  • 29. TREATMENT:
    • Pharmacological treatment:
    • Benzodiazepine
    • Buspirone(serotonin 1 A receptor partial agonist)
    • TCA
    • SSRI
    • Psychotherapy:
          • Cognitive – behavior therapy .
    •  

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