Anxiety disorders for undergraduates


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Anxiety disorders for undergraduates

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Anxiety disorders for undergraduates

  1. 1. ANXIETY DISORDERSDr. Mohamed AbdelghaniM.B.B.Ch., M.Sc., M.D. Psych.
  2. 2. Definition Anxiety is a pathological state characterized by afeeling of dread accompanied by somatic signs thatindicate a hyperactive autonomic nervous system. It is differentiated from fear, which is a response to aknown and reasonable cause.
  3. 3. Aetiology
  4. 4. A- Biological Excessive autonomic reaction with increasedsympathetic tone, results in increased release ofcatecholamines. Increased norepinephrine metabolites (3-methoxy 4-hydroxyphenyl glycol). Hyperactivity in locus ceruleus (centre of adrenergicneurones). Decreased GABA causes CNS hyperactivity.
  5. 5. B- Learning theory Anxiety is produced by frustration or stress. Onceexperienced, anxiety becomes a conditionedresponse to other, less severe, frustrating orstressful situation----- “Classical conditioning”. Social learning theory: may be learned throughidentification and imitation of anxiety patterns inparents.
  6. 6. Clinical subtypes1) Panic disorder2) Generalized anxiety disorder.3) Specific phobia.4) Social phobia.5) Obsessive compulsive disorder.6) Post-trauamtic stress disorder.7) Substance-induced anxiety disorder.8) Anxiety disorder due to general medical condition.
  7. 7. Obsessive-compulsive disorder (OCD) Obsessions: Repetitive thoughts, impulses, images or ruminations. Resistence to this repetition, which is associated withincreased anxiety. Realization that these thoughts, impulses or images areunreasonable, unpleasant and unwanted. Recognition that they are the product of one’s own mind(not imposed from without as in thought insertion).
  8. 8.  Compulsions: Repetitive behaviours or mental acts are performed inresponse to an obsessions. The behaviours or mental acts aim at preventing orreducing distress. They are significantly interfere with the patient’sfunctioning. Not substance-induced or not due to general medicalconditions.
  9. 9. Specific phobiaA. Excessive, unreasonable and persistent fear cued bythe presence of a specific object, e.g., Animal type. Natural environment type (e.g., heights, storms, water). Blood-injection-injury type. Situational type (e.g., airplanes, elevators, closed or openedplaces).B. The person recognizes that the fear is excessive orunreasonable.C. The person avoids the feared situation.
  10. 10. Social phobia Excessive, unreasonable and persistent fear of socialsituations. Exposure to the feared social situations provokesanxiety. The person recognizes that his fear is excessive andunreasonable. The person avoids the feared situations.
  11. 11. Panic disorder Definition:Recurrent unexpected panic attacks, followedby one month or more of persistent concernabout having additional attacks, and significantchange in behaviour.
  12. 12. Panic attack Intense fear or discomfort, in which four or more of thefollowing symptoms developed abruptly and reached apeak within 10 minutes. Palpitaion, sweating, trembling, tachypnea, feeling ofchoking, chest pain, nausea, dizziness, derealization(feelings of unreality), depersonalization (being detachedfrom oneself), fear of going crazy, fear of dying,numbness and hot flushes. Not substance-induced or not due to general medicalcondition.
  13. 13. Generalized anxiety disorder (GAD) Excessive anxiety and worry for 6 months or more aboutactivities of daily living. The anxiety and worry are associated with three or more ofthe following: Restlessness, easily fatigued, difficulty concentratingirritability, muscle tension and sleep disturbance. Significant impairement in social , occupational functions. Not substance-induced or not due to general medicalcondition.
  14. 14. Posttraumatic stress disorder (PTSD) The person exposed to or witnessed a traumatic event thatinvolved actual or threatened death or serious injury to self orothers. Re-experiencing of the traumatic event in dreams, images orthoughts. Avoidance of thoughts, places, and persons associated with thetrauma. Increased arousal; ittitability, difficulty falling asleep, andhypervigilance. Duration of the disturbance is more than one month. D.D if the duration less than one month, it is called acutestress disorder.
  15. 15. Treatment
  16. 16. Pharmacological-ABenzodiazepines:Indications: good short-term treatment for GAD, PTSD,panic disorder and agoraphobia.Adverse effects: drowsiness, cognitive impairment anddependence.BuspironeIndication: GAD.Adverse effects: headache and dizziness.
  17. 17. Serotonin specific reuptake inhibitors (SSRI) : Indications: all types of anxiety, and depressioncomorbid with anxiety. Adverse effects: nausea, decreased appetite, sleepdisturbances.
  18. 18. B- Psychological1) Insight-oriented psychotherapy.2) Cognitive Behavioural therapy ( CBT ).
  19. 19. at:Thank u