Anxiety disorders-SEC. A


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Anxiety disorders-SEC. A

  2. 4. FEAR vs. ANXIETY <ul><li>Known in origin </li></ul><ul><li>Definite </li></ul><ul><li>External source </li></ul><ul><li>Alerting signal </li></ul><ul><li>Non-conflictual </li></ul><ul><li>Unknown or vague </li></ul><ul><li>Indefinite </li></ul><ul><li>Internal in Origin </li></ul><ul><li>Alarming signal </li></ul><ul><li>Conflictual </li></ul>
  3. 5. Peripheral Manifestations of Anxiety <ul><li>Diarrhea </li></ul><ul><li>Dizziness, lightheadedness </li></ul><ul><li>Hyperhydrosis </li></ul><ul><li>Hyperreflexia </li></ul><ul><li>Hypertension </li></ul><ul><li>Palpitations </li></ul><ul><li>Pupillary mydriasis </li></ul><ul><li>Restlessness </li></ul><ul><li>Syncope </li></ul><ul><li>Tachycardia </li></ul><ul><li>Tingling sensations in the extremities </li></ul><ul><li>Tremors </li></ul><ul><li>Upset stomach </li></ul><ul><li>Urinary frequency, hesitancy, urgency </li></ul>
  4. 6. Anxiety Disorders <ul><li>Panic disorder </li></ul><ul><li>Specific and social phobia </li></ul><ul><li>Obsessive and Compulsive disorders </li></ul><ul><li>Posttraumatic Stress Disorder </li></ul><ul><li>Acute Stress Disorder </li></ul><ul><li>Generalized Anxiety Disorder </li></ul><ul><li>Anxiety due to GMC </li></ul><ul><li>Substance induced disorder </li></ul><ul><li>Anxiety disorder NOS </li></ul>
  5. 9. Panic Attacks <ul><li>Palpitations, pounding heart, tachycardia </li></ul><ul><li>Sweating </li></ul><ul><li>Tremble or shaking </li></ul><ul><li>Shortness of breath or smothering </li></ul><ul><li>Choking sensation </li></ul><ul><li>Chest pain or discomfort </li></ul><ul><li>Sense of abdominal distress </li></ul><ul><li>Feeling of dizziness, unsteady,lightheadedness </li></ul><ul><li>Fainting sensation </li></ul><ul><li>Derealization </li></ul><ul><li>Depersonalization </li></ul><ul><li>Fear of losing control, dying, of being crazy </li></ul><ul><li>Paresthesias </li></ul><ul><li>Chills or hot flushes </li></ul>
  6. 10. Panic Attack <ul><li>Is not a codable diagnosis </li></ul><ul><li>It occurs also in some anxiety disorder </li></ul><ul><li>It is a discreet period of intense fear or discomfort which developed suddenly peaked within 10 minutes with four or more symptoms of panic attack </li></ul>
  7. 11. Panic Disorder <ul><li>Occurrence of 2 or more panic attacks in a month </li></ul><ul><li>Presence of one panic attack but preoccupied of having another panic attack within a month’s duration </li></ul><ul><li>May occur with agoraphobia or without agoraphobia </li></ul>
  8. 12. Specific Phobias <ul><li>Ablutophobia – fear of washing or bathing </li></ul><ul><li>Achluophobia – fear of darkness </li></ul><ul><li>Aeroacrophobia – fear of heights </li></ul><ul><li>Agliophobia – fear of pain </li></ul><ul><li>Agoraphobia – fear of crowded places </li></ul><ul><li>Aichmophobia – fear of needles </li></ul><ul><li>Alliumphobia – fear of garlic </li></ul><ul><li>Altophobia – fear of heights </li></ul>
  9. 13. <ul><li>Haemophobia – fear of blood </li></ul><ul><li>Gynephobia – Fear of women </li></ul><ul><li>Cacophobia – fear of ugly people </li></ul><ul><li>Homophobia – fear of being homosexual </li></ul><ul><li>Iatrophobia - fear of doctors </li></ul><ul><li>Ithyphallophobia – fear of having an erect penis </li></ul><ul><li>Pelladophobia – fear of bald people </li></ul><ul><li>Penteraphobia – fear of mother-in-law </li></ul>Specific Phobias
  10. 14. <ul><li>Claustrophobia – fear of being locked </li></ul><ul><li>Triskaidekaphobia – fear of number 13 </li></ul><ul><li>Somniphobia – fear of going to sleep </li></ul><ul><li>Paraskavedekatriaphobia - Fear of Friday the 13th </li></ul><ul><li>Coprophobia – fear of feces </li></ul><ul><li>Photophobia - Fear of light. </li></ul><ul><li>Oneirophobia - Fear of dreams. </li></ul>Specific Phobias
  11. 15. <ul><li>Is described as recurring obsessions or compulsions “severe enough to be time consuming… or caused mark distress or significant impairment.” People with this disorder recognize that their actions are irrational or disproportionate. </li></ul>Obsessive – Compulsive Disorder
  12. 16. Obsessions - Compulsions <ul><li>Contamination </li></ul><ul><li>Pathological doubt </li></ul><ul><li>Somatic </li></ul><ul><li>Need for symmetry </li></ul><ul><li>Aggressive </li></ul><ul><li>Sexual </li></ul><ul><li>Multiple Obsessions </li></ul><ul><li>Checking </li></ul><ul><li>Washing </li></ul><ul><li>Counting </li></ul><ul><li>Need to ask or confess </li></ul><ul><li>Symmetry and precision </li></ul><ul><li>Hoarding </li></ul><ul><li>Multiple comparisons </li></ul>
  13. 17. Obsession vs Compulsions <ul><li>Recurrent and intrusive thought, feeling, idea, or sensation. </li></ul><ul><li>Increases anxiety </li></ul><ul><li>Is a conscious standardized, recurrent pattern of behavior, such as counting, checking, or avoidance. </li></ul><ul><li>Compulsions decrease anxiety. </li></ul>
  14. 18. Major Presenting Symptom of Obsessions <ul><li>Concern or disgust with bodily wastes or secretions (urine, stool, saliva), dirt, germs, environmental toxins. Fear concerns </li></ul><ul><li>Fear something terrible may happen (fire, death or illness of loved one, self, or others) </li></ul><ul><li>Concern or need for symmetry, order, or exactness. </li></ul><ul><li>Scrupulosity (excessive praying or religious concerns out of keeping with patient’s background) </li></ul><ul><li>Lucky and unlucky numbers </li></ul><ul><li>Forbidden or perverse sexual thoughts, images, or impulses </li></ul><ul><li>Intrusive nonsense sounds, words, or music </li></ul>
  15. 20. Major Presenting Symptoms of Compulsion <ul><li>Excessive or ritualized hand washing, showering, bathing, tooth brushing, or grooming </li></ul><ul><li>Repeating rituals (going in and out of door, up and down from chair) </li></ul><ul><li>Checking doors, locks, stove, appliances, car brakes </li></ul><ul><li>Cleaning and other rituals to remove contact with contaminants </li></ul><ul><li>Touching </li></ul><ul><li>Ordering and arranging </li></ul><ul><li>Measures to prevent harm to self or others (e.g., hanging clothes a certain way) </li></ul><ul><li>Counting </li></ul><ul><li>Hoarding and collecting </li></ul><ul><li>Miscellaneous rituals (e.g., licking, spitting, special dress pattern) </li></ul>
  16. 21. Posttraumatic Stress Disorder <ul><li>A set of typical symptoms that develop after a person sees, is involved in, or hears of an “extreme traumatic stressor.” </li></ul><ul><li>The symptoms must last for more than a month and impairs important matters of life such as family and work. </li></ul><ul><li>The stress is overwhelming enough to affect almost everyone. </li></ul><ul><li>It can arise from experiences in war, torture, natural catastrophes, assault, rape, and serious accidents in cars and burning buildings. </li></ul><ul><li>Re-experiencing of the traumatic event in their dreams and their daily thoughts, they are determined to evade anything that would bring the event to mind causing hyper arousal. </li></ul>
  17. 22. Clinical Features of PTSD <ul><li>Painful experiencing of the event </li></ul><ul><li>A pattern of avoidance and emotional numbing, and fairly constant hyper arousal </li></ul><ul><li>The disorder may not develop until months or even years after the event </li></ul><ul><li>The MSE often reveals feelings of guilt, rejection, humiliation. </li></ul><ul><li>Patients may also describe the dissociative states and panic attacks, and illusions and hallucinations may be present. </li></ul><ul><li>Cognitive testing may reveal that patients have impairments of memory and attention. </li></ul><ul><li>Associative symptoms include aggression, violence, poor impulse control, and substance-related disorders. </li></ul>
  18. 24. Clinical Features of PTSD <ul><li>Persistent symptoms of increased arousal not present before the trauma as indicated by two or more of the ff; Difficulty falling or staying asleep Irritability or outburst of anger Difficulty concentrating Hyper vigilance Exaggerated startled response Duration of the symptoms is more than one month </li></ul>
  19. 25. Acute Stress Disorder <ul><li>The person has been exposed to a traumatic event </li></ul><ul><li>Experiencing the distressing event which has three or more ff dissociative symptoms </li></ul><ul><li>A traumatic event is persistently re=experienced in one of the ff way: recurrent images, illusions, thoughts, dreams, flashback episodes </li></ul><ul><li>Marked avoidance of stimuli that arouse recollections of the trauma </li></ul><ul><li>Marked symptoms of anxiety or increased arousal </li></ul><ul><li>The disturbance last for a minimum of two days or maximum of 4 weeks and occurs within 4 weeks of the traumatic events. </li></ul>
  20. 26. Generalized Anxiety Disorder <ul><li>Is defined as excessive anxiety and worry about several events or activities for a majority of days during at least a six-month period. </li></ul><ul><li>The worry is difficult to control and is associated with its somatic symptoms such as muscle tension, irritability, difficulty of sleeping, and dresslessness. </li></ul>
  21. 27. Criteria for GAD <ul><li>Excessive anxiety and worry (Apprehensive expectation) occurring more days than not for six month </li></ul><ul><li>The person find it difficult to control the worry </li></ul><ul><li>The anxiety and worry are associated with the ff six symptoms </li></ul><ul><ul><li>Restlessness </li></ul></ul><ul><ul><li>Easy fatigueability </li></ul></ul><ul><ul><li>Difficulty concentrating </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Muscle tension </li></ul></ul><ul><ul><li>Sleep disturbance </li></ul></ul>
  22. 28. Anxiety due to GMC <ul><li>Hyperthyroidism </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Hepatorenal disease </li></ul><ul><li>Parkinson’s disease </li></ul><ul><li>Atrophy in psychosis </li></ul><ul><li>Multiple sclerosis </li></ul><ul><li>Respiratory failure </li></ul><ul><li>Bronchitis </li></ul><ul><li>Asthmatic attack </li></ul><ul><li>Addison’s disease </li></ul><ul><li>Etc. </li></ul>
  23. 29. Substance-Induced Anxiety Disorder <ul><li>Methamphetamine intoxication </li></ul><ul><li>Cocaine intoxication </li></ul><ul><li>Cannabis intoxication </li></ul><ul><li>Methylenedioxymethamphetamine intoxication </li></ul>
  24. 30. The End