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  1. 2. Generalized anxiety disorder is the most common anxiety disorder. Features a constant state of worry that lasts all for more than 6 months. Gastrointestinal problems are often associated. Patient may have a history of being unsure of themselves, perfectionists, or conforming. Symptoms include: Restlessness, fatigue, poor concentration, irritability, tension, sleep disturbance. This disorder occurs often with depression or substance abuse commonly.
  2. 3. Panic disorder is different in that it is not constant state of worry; it lasts about a half hour. It can occur with other disorders. The difference here in panic disorder is that there is no specific trigger. Symptom diagnosed you look for two unexpected attacks with fear after the period you are looking for something of short duration and may be high severity lasting for 15 minutes. During this time the patient might feel their and and and andheart beat rapidly, starts sweating, and feel like they’re choking, and feel like they are losing touch with reality, or that they are about to die, or that they are going insane. This can happen quite often.
  3. 4. Phobic disorders are irrational fears that are common and due to specific triggers. This is how you differentiate them from panic disorders. For example agoraphobia is due to situations that the patient feels cannot escape. Social phobia is due to a feeling of public scrutiny. Obsessive-compulsive disorder is another fear and. It has to do with some kind of danger that patient feels he needs to do something about. There is heightened sense of responsibility. There may or may not be ritualistic compulsive behavior (routines). And may look like behavior problems and children. May be associated with body dysmorphic disorder. It’s different than obsessive-compulsive personality (perfectionism, excessively conscientious, morally rigid). Posttraumatic stress disorder has a triggering event (murder,rape, natural disaster, combat, death of loved ones, very sick loved ones). Patients get flashbacks, emotional numbness, lost touch with identity, even specific memory loss, hypervigilance. If one gets these symptoms before 4 weeks this is called acute stress disorder and there is very high risk for PTSD and tend to get a worse case.
  4. 5. Acute stress response is similar to reaction to a bear or to exercise.the hypothalamic pituitary adrenal system is activated. This makes cortisol dopamine norepinephrine epinephrine. The cortisol affects heart lungs circulation metabolism immune system and skin. Catecholamines activate the amygdala which is the fear center. They also suppress the front brain activity (complex tasks). Essentially one becomes more animalistic to respond to the bare. So short-term memory is decreased but long-term memory is increased. Probably good to review cortisol physiology in order to understand acute stress. Heart rate and blood pressure increase. Breathing increases. More red and white blood cells. Blood flow increases. Basically the body tries to supply more oxygen to the muscles, heart brain (skin becomes clammy) The immune system has increased mobilization but some parts are turned down. Fluids are diverted from nonessential locations like the mouth. This may increased dryness throat muscle spasms. There may be less digestive activity. Remember that cortisol is highest in the morning and lowest at midnight. Its purpose is to mobilize the immune system to fight potassium losing diarrhea diseases. Mobilizes nutrients (fats, proteins, glucose). Prolonged secretion causes hyperglycemia. There is less protein and glycogen synthesis. Stimulate gastric acid secretion. Concerns potassium, causes serum alkalosis. Prevents proliferation of T cells. Natural killer cells are not affected. Lowers bone formation. Long-term damage to cells and hippocampus – impaired learning. Increased sensitivity of the vasculature to epinephrine and norepinephrine. Increases the effectiveness of catecholamines. Anti-inflammatory effects (reduce histamine secretion). Too much cortisol results and Cushing’s a
  5. 6. The causes of anxiety disorder include genetics, environment, psych logical profile, and a biological fall nor ability to stress. This may include a hypersensitive amygdala (links fear to heart rate, blood pressure, physical response). There may be an abnormal pathway of nerves as is seen in OCP, attention deficit, Tourette’s – the symptoms of these 3 disorders are very similar and the disorders can coexist. Another possible cause of anxiety disorder is a smaller a total campus particularly seen and posttraumatic stress disorder. This would affect he motion and memory storage. There may be imbalances and neurotransmitters like GABA, serotonin, dopamine, epinephrine. Corticotropin releasing factor may call us changes in serotonin levels. There may be genetic predisposition as well as learning over some fears and phobias. A Streptococcus infection may lead to take related disorders and children including OCD and Tourette’s. Some things may not directly call his but rather increased risk of anxiety disorder. Shotty kids and toes who cannot tolerate uncertainty tend to get generalized anxiety. Again this may be due to a hypersensitive amygdala. There may be more anxiety and people with less social connections and a sense of a more threatening environment – Mexican American’s who immigrated to the United States become more anxious the longer they live in the United States (Lou’s cultural effects and social ties). Increased age is a risk factor for generalized anxiety. Panic attacks happen commonly after metal pole is and is associated with stressful life events and poor health. Women who were just gave birth tend to be obsessive-compulsive. There are a few risk factors for PTSD: Emotional disorder, drug abuse, history of anxiety, spell sole/child abuse, lack of social support and poverty, sleep disorders. If you have depression you’re probably having anxiety disorder too. You are also at high risk for alcoholism, smoking, other addictions. If you have bipolar disorder your more likely to get panic disorder. Anxiety disorders preceded several physical disorders: High cholesterol, high blood pressure, dangerous heart rhythms, sudden death from cardiac events, irritable bowel syndrome, tension and migraine headaches, obstructive lung disease, obesity, allergies (hayfever, hives, food allergies, conjunctivitis). Anxiety disorders, specifically PT SV, will cause shrinkage in the hippocampus from long-term exposure to cortisol. This may compromise the function of the brains receptors for anti-anxiety medication. Besides affecting the hippocampus, there will be physical limitation, poor health, and lower quality of life. Abnormal heart rhythms and heart attacks are more common. Stomach aches are seen more in children. To diagnose, rule out medical problems and medications. Ask about caffeine use, recent life changes, stressful events, drinking, substance abuse. In tubes diagnosis can be difficult because of anxiety might look like disruptive behavior from attention deficit hyperactivity. Comment chief complaints are: Muscle tension, trembling, twitching, aching, soreness, cold clammy hands, dry mouth, sweating, nausea or diarrhea, urinary frequency. Anxiety may mimic heart attacks and angina. Often hard to rule out depression but these two often occur together. Rule out heart problems like mitral valve prolapse (palpitations, chest pain, difficulty breathing after exertion, fatigue, cough, shortness of breath while lying down), paroxysmal supraventricular tachycardia. An asthma attack and looked like a panic attack. Hyperthyroidism can look like generalized anxiety disorder. partial seizures may look like panic attacks. Often difficult to determine whether or alcoholism or anxiety is the primary disorder. Overuse of caffeine can cause symptoms resembling a panic attack. Screen using Beck anxiety inventory, Hamilton anxiety rating scale, anxiety disorders interview schedule. Treatments used to be benzodiazepines. Now use SSRIs because affective, nonaddictive, minor side effects. Paxil (paroxetine) can be good for generalized anxiety disorder but may cause heart related birth defects if taken during first trimester. SSRIs can cause agitation, nausea, low sex drive, weak again. Benzodiazepines include Xanax and Klonopin and Valium (generalized anxiety) BuSpar (buspirone) acts on serotonin receptors called 5-HT 1a and works as well as benzodiazepine for generalized anxiety disorder but has very low potential for abuse and not addictive even with long-term use. Also has less pronounced side effects and no withdrawal effects. Beta-blockers or good for performance anxiety. Clonidine is a vessel relaxer used to other therapies fail. Neurontin and delivery for our anticonvulsants used for seizures blood work for social phobia, generalized anxiety, PTSD. The goal of cognitive behavioral therapy is to understand the realities of an anxiety provoking situation