Anxiety disorders

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  • The inverted U diagram depicting performance vs anxiety demonstrates that there is a an optimum amount of anxiety for optimum performance. The complete removal of anxiety does not improve performance. This seems logical but as we develop more and more sophistication we can sometimes impede ourselves. Example of this is the recent psychiatry board examination. This is an oral examination. As such candidates with excessive levels of anxiety may perform poorly due to the difficulty with concentration which accompanies their excess anxiety. Others may fear being too anxious and take beta blockers to block anxiety and subsequently have a deterioration in performance. The question of when and whether someone should take beta blockers to treat performance anxiety is a complicated one. Clearly there should be some discomfort in performing many important roles. The anxiety heightens our awareness and concentration. A good rule of thumb is that you should take tests under the conditions that you perform on a daily basis.
  • In the HPA axis, the hypothalamus produces and releases CRH, which in turn controls the release of ACTH from the pituitary. ACTH stimulates glucocorticoid secretion from the adrenal cortex. This pathway is very useful as a a means of increasing metabolism and preparing an organism for quick action in the face of acute stress. The downside, though, is that chronic stress is neurotoxic
  • What does the pharm. Of these drugs, which effectively treat GAD, tell us about the cause of the disorder?…
  • Anxiety disorders

    1. 1. Anxiety DisordersAnxiety Disorders ((General FeaturesGeneral Features)) 07/27/1307/27/13 11 ASHRAF TANTAWY Professor of Psychiatry. Suez Canal University, Egypt.
    2. 2. Everybody must be aware of AnxietyEverybody must be aware of Anxiety Disorders.Disorders. WHY?WHY? Anxiety disorders are very commonAnxiety disorders are very common ~30%~30% ofof any population.any population. They are the mostThey are the most common mental illnesscommon mental illness.. Anxiety disorders have symptoms that mimicAnxiety disorders have symptoms that mimic physical diseasesphysical diseases.. Anxiety disorders can lead to many problemsAnxiety disorders can lead to many problems ranging fromranging from losing jobslosing jobs (due to many missed(due to many missed days of work) todays of work) to disabilitydisability as in PTSD.as in PTSD. Anxiety disorders areAnxiety disorders are treatabletreatable.. All medical personnelAll medical personnel must have knowledgemust have knowledge and skills to deal with anxious patientsand skills to deal with anxious patients regardless of their specialties.regardless of their specialties.07/27/1307/27/13 22
    3. 3. STRESSSTRESS 07/27/1307/27/13 33 • Definition: Experiencing events that are perceived as endangering one’s physical, social or psychological well-being. • Response to stressors is influenced by Controllability, predictability & challenge to our limits. • Psychological Responses To Stress: - Anxiety. - Anger & Aggression. - Apathy & Depression. - Cognitive Impairment.
    4. 4. FEARFEARA normal response.A normal response. A realistic response to an identifiable stimulus.A realistic response to an identifiable stimulus. Imagine that you are facing a wild animal,Imagine that you are facing a wild animal, What is your normal response?What is your normal response? Fear is normal.Fear is normal. •07/27/1307/27/13 •44
    5. 5. FEAR?FEAR? PHOBIA?PHOBIA? WORRY?WORRY?Fear:Fear: RealisticRealistic response toresponse to an identifiablean identifiable stimulus.stimulus. Phobia:Phobia: UnrealisticUnrealistic response toresponse to an identifiablean identifiable stimulus.stimulus. Worry:Worry: UnrealisticUnrealistic (Pervasive)(Pervasive) fear tofear to indefinableindefinable stimulusstimulus (Future Oriented)(Future Oriented).. 07/27/1307/27/13 55
    6. 6. Justifiable Fears vs.Justifiable Fears vs. Anxiety DisorderAnxiety Disorder What make fears pathological?What make fears pathological? If fears are:If fears are:  Excessive.Excessive.  Out of proportion with the actualOut of proportion with the actual threat.threat.  Difficult to be controlled.Difficult to be controlled.  Interfering with daily activities.Interfering with daily activities. 07/27/1307/27/13 66
    7. 7. Primary vs. SecondaryPrimary vs. Secondary AnxietyAnxiety Anxiety may be due toAnxiety may be due to A primary psychiatric disorder.A primary psychiatric disorder. A secondary psychiatric disorder:A secondary psychiatric disorder: - Substance abuse.- Substance abuse. - Substance-Induced Anxiety Disorder.- Substance-Induced Anxiety Disorder. - A medical condition.- A medical condition. - Another psychiatric condition.- Another psychiatric condition. - Psychosocial Stressors.- Psychosocial Stressors. - Adjustment Disorder with Anxiety.- Adjustment Disorder with Anxiety.07/27/1307/27/13 77
    8. 8. General Features ofGeneral Features of Anxiety DisordersAnxiety Disorders Anxiety disorders are psychiatric disordersAnxiety disorders are psychiatric disorders characterized by:characterized by: 1- Fears.1- Fears. 2- Tension.2- Tension. 3- Autonomic Over-Activity.3- Autonomic Over-Activity. 4- Apprehension.4- Apprehension. 5- Continuous vigilance for danger.5- Continuous vigilance for danger.07/27/1307/27/13 88
    9. 9. Shared Features of AnxietyShared Features of Anxiety DisordersDisorders Substantial proportion of etiology isSubstantial proportion of etiology is stress related.stress related. Reality testing is intact.Reality testing is intact. Symptoms are ego dystonic (distressing).Symptoms are ego dystonic (distressing). Disorders are enduring or recurrent.Disorders are enduring or recurrent. Demonstrable organic factors are absent.Demonstrable organic factors are absent. 07/27/1307/27/13 99
    10. 10. Symptoms of Anxiety DisordersSymptoms of Anxiety Disorders Cognitive symptoms.Cognitive symptoms. Emotional & Behavioral symptoms.Emotional & Behavioral symptoms. Somatic symptoms.Somatic symptoms. Impairment of social orImpairment of social or occupational function.occupational function.07/27/1307/27/13 1010
    11. 11. Cognitive SymptomsCognitive Symptoms Difficulty Concentrating.Difficulty Concentrating. Marked Distress.Marked Distress. Obsessions (Time-Consuming).Obsessions (Time-Consuming). Helplessness.Helplessness. Intrusive Thoughts and Images.Intrusive Thoughts and Images. Distressing Dreams.Distressing Dreams. Flashbacks.Flashbacks. Feared Stimulus (Phobia).Feared Stimulus (Phobia).07/27/1307/27/13 1111
    12. 12. Emotional & BehavioralEmotional & Behavioral SymptomsSymptoms Excessive Worry.Excessive Worry. Difficulty Controlling The Worry.Difficulty Controlling The Worry. Restlessness and Irritability.Restlessness and Irritability. De-Realization.De-Realization. Fear of Losing Control or Dying.Fear of Losing Control or Dying. Avoidance Behavior.Avoidance Behavior. Compulsive Acts.Compulsive Acts.07/27/1307/27/13 1212
    13. 13. Somatic SymptomsSomatic Symptoms Muscle Tension.Muscle Tension. Sleep Disturbances.Sleep Disturbances. Fatigue.Fatigue. Accelerated Heart Rate.Accelerated Heart Rate. Sweating.Sweating. Feeling of Choking or Chest Pain.Feeling of Choking or Chest Pain. Nausea.Nausea. Feeling Dizzy.Feeling Dizzy. Chills or Hot Flashes.Chills or Hot Flashes. Numbness or Tingling Sensations.Numbness or Tingling Sensations.07/27/1307/27/13 1313
    14. 14. Performance-AnxietyPerformance-Anxiety CurveCurve 07/27/1307/27/13 1414 Impairment of Social orImpairment of Social or Occupational FunctionOccupational Function
    15. 15. Anxiety Disorders SubtypesAnxiety Disorders Subtypes • Generalized Anxiety disorder (GAD). • Panic disorder (PD). • Obsessive-Compulsive disorder (OCD). • Post-traumatic Stress disorder (PTSD). • Social Anxiety Disorder (SAD). • Specific Phobias (SPh). • Acute Stress Reaction (ASR). • Adjustment Disorder with Anxious Mood. 07/27/1307/27/13 1515
    16. 16. Prevalence of ADsPrevalence of ADs Psychiatric Disorders:Psychiatric Disorders: (30 - 50%).(30 - 50%). Anxiety Disorders:Anxiety Disorders: (15% - 30%).(15% - 30%). SAD and SPh:SAD and SPh: (10%).(10%). PTSD:PTSD: (7.5%).(7.5%). GAD:GAD: (5%).(5%). PD:PD: (1-2%); lifetime prevalence (3.5%).(1-2%); lifetime prevalence (3.5%). OCD:OCD: (2.5%).(2.5%). 07/27/1307/27/13 1616
    17. 17. Gender & Anxiety DisordersGender & Anxiety Disorders FemaleFemale is at higher risk than Male for all anxietyis at higher risk than Male for all anxiety disorders.disorders. GAD, PD , PTSD and SPh:GAD, PD , PTSD and SPh: F:M ratio (2:1).F:M ratio (2:1). OCD:OCD: F:M ratio (3:2).F:M ratio (3:2). PTSD:PTSD: -- 60% M60% M && 50% F50% F report exposure to at least one life-report exposure to at least one life- threatening situation during their life.threatening situation during their life. -- ~ 10% F~ 10% F && 5% M5% M will develop PTSD at some time inwill develop PTSD at some time in their life.their life. -- 10% F10% F && 8% M8% M of the exposed persons.of the exposed persons.  These data emphasizeThese data emphasize the role of female reproductivethe role of female reproductive hormones and activitieshormones and activities in producing Anxietyin producing Anxiety disorders.disorders. 07/27/1307/27/13 1717
    18. 18. Generalized Anxiety DisorderGeneralized Anxiety Disorder (GAD)(GAD) 07/27/1307/27/13 1818 • A very important disorder as it mimics many chronic medical conditions. • Most of the patient are referred from GP, Family Physician or Internist.
    19. 19. Excessive constant uncontrollable worryExcessive constant uncontrollable worry aboutabout many everyday events and issues.many everyday events and issues. The focus of GAD worryThe focus of GAD worry can shift, usuallycan shift, usually focusing on issues like job, finances, health offocusing on issues like job, finances, health of self and family; but it can also include moreself and family; but it can also include more mundane issues such as, chores, car repairsmundane issues such as, chores, car repairs and being late for appointments.and being late for appointments. GADGAD can occur with other anxiety disorders,can occur with other anxiety disorders, depressive disorders, or substance abuse.depressive disorders, or substance abuse. 07/27/1307/27/13 1919
    20. 20. Over concern regarding the future. The worry seriously interferes withThe worry seriously interferes with functioningfunctioning.. The intensity, duration and frequency of the worry are disproportionate to the issue. The disturbance occurs most of the days for at least 6 months. PrevalencePrevalence ~3-6%~3-6% of population.of population. 07/27/1307/27/13 2020
    21. 21. Panic Disorder (PD)Panic Disorder (PD) 07/27/1307/27/13 2121 • A very important disorder as it mimics acute cardiac conditions. • Most of the patients are referred by Emergency or cardiology departments.
    22. 22. Recurrent, unexpected, rapid onsetRecurrent, unexpected, rapid onset attacks ofattacks of intense and severe autonomicintense and severe autonomic manifestations: accelerated heart rate,manifestations: accelerated heart rate, sweating, trembling, feeling of choking orsweating, trembling, feeling of choking or chest pain, nausea, dizziness, chills or hotchest pain, nausea, dizziness, chills or hot flashes, numbness or tingling sensations.flashes, numbness or tingling sensations. In-between:In-between: Persistent concern of havingPersistent concern of having an attack and avoidance of situations.an attack and avoidance of situations. Must be differentiated from:Must be differentiated from: substancesubstance abuse: caffeine and amphetamines.abuse: caffeine and amphetamines. Classify:Classify: with or without agoraphobia.with or without agoraphobia. 07/27/1307/27/13 2222
    23. 23. Three types of Panic Attacks:Three types of Panic Attacks: 1. Unexpected:1. Unexpected: the attack comes withoutthe attack comes without warning and for no discernable reason.warning and for no discernable reason. 2. Situational:2. Situational: situations in which ansituations in which an individual always has an attack, forindividual always has an attack, for example (Always, he has attack uponexample (Always, he has attack upon entering a tunnel).entering a tunnel). 3. Situational Predisposed:3. Situational Predisposed: situations insituations in which an individual is likely to have awhich an individual is likely to have a Panic Attack but does not always havePanic Attack but does not always have one.one.07/27/1307/27/13 2323
    24. 24. AgoraphobiaAgoraphobia Fear ofFear of open placesopen places.. Fear of being in places orFear of being in places or situations where somethingsituations where something terrible could happen andterrible could happen and escape might be difficultescape might be difficult.. AvoidanceAvoidance of theof the situations with markedsituations with marked distress.distress. Usually associated withUsually associated with panic disorderpanic disorder..07/27/1307/27/13 2424
    25. 25. Obsessive-Compulsive DisorderObsessive-Compulsive Disorder (OCD)(OCD) 07/27/1307/27/13 2525 • A disorder of superego. • It can be complicated by skin lesions. • Most patients are referred by a dermatologist.
    26. 26.  Obsessive Subtype:Obsessive Subtype: Intrusive and inappropriate thoughts, images or urges,Intrusive and inappropriate thoughts, images or urges, causing anxiety or distress such as: Contamination,causing anxiety or distress such as: Contamination, pathological doubt, need for symmetry, somatic, sexualpathological doubt, need for symmetry, somatic, sexual and aggressive.and aggressive.  Compulsive Subtype:Compulsive Subtype: Repetitive behaviors/ mental acts performed inRepetitive behaviors/ mental acts performed in response to obsession to reduce anxiety & distress.response to obsession to reduce anxiety & distress.  Obsessive Compulsive Subtype.Obsessive Compulsive Subtype.  Hoarding Subtype: (DSM-V & ICD-11)Hoarding Subtype: (DSM-V & ICD-11) Unable to throw away useless items, such as oldUnable to throw away useless items, such as old newspapers, junk mail & even broken appliances.newspapers, junk mail & even broken appliances. 07/27/1307/27/13 2626
    27. 27.  Marked distress/ time-consuming/Marked distress/ time-consuming/ interferes with ability to function.interferes with ability to function.  OC spectrum Disorders:OC spectrum Disorders: Impulse control disorders- Tourette’sImpulse control disorders- Tourette’s Syndrome (Tics)- Body dysmorphicSyndrome (Tics)- Body dysmorphic disorder- Self injury- OC personality.disorder- Self injury- OC personality.  OCD:OCD: Recurrent absurd ideas. TheRecurrent absurd ideas. The patient knows that they are absurd. Hepatient knows that they are absurd. He tries to resist them but he fails. So, he getstries to resist them but he fails. So, he gets anxiety. Then compulsive acts start toanxiety. Then compulsive acts start to relief anxiety.relief anxiety.07/27/1307/27/13 2727
    28. 28. Posttraumatic Stress DisorderPosttraumatic Stress Disorder (PTSD)(PTSD) 07/27/1307/27/13 2828 Disasters Sep 11th , 2001 • A very important disorder as it leads to disability. • It needs unusual stress (extraordinary) to happen.
    29. 29. Exposure to an unusual stress (Exposure to an unusual stress (Extra- ordinary TraumasTraumas) such as a serious) such as a serious accident, a natural disaster, or criminalaccident, a natural disaster, or criminal assault.assault. A response to an event involvingA response to an event involving panicpanic like attackslike attacks with persistent avoidance ofwith persistent avoidance of associated stimuli.associated stimuli. Re-experienceRe-experience of the event, such as:of the event, such as: intrusive thoughts and images, distressingintrusive thoughts and images, distressing dreams and flashbacks.dreams and flashbacks. Acute onsetAcute onset (within 3 months).(within 3 months). Chronic onsetChronic onset (from 3 to 6 months).(from 3 to 6 months).07/27/1307/27/13 2929
    30. 30. Social Anxiety DisorderSocial Anxiety Disorder (SAD)(SAD) 07/27/1307/27/13 3030 Box Man Self TTT It was called Social Phobia but it is better to call it Social Anxiety Disorder. (Why?)
    31. 31. It isIt is inappropriate public behaviorinappropriate public behavior duedue to exposure to unfamiliar people.to exposure to unfamiliar people. Subtypes:Subtypes: 1-1- Generalized Social AnxietyGeneralized Social Anxiety ((GSPGSP):): Multiple fears, some of which are non-Multiple fears, some of which are non- speaking fears.speaking fears. (95%)(95%) (You Must Treat).(You Must Treat). 2-2- Specific Social AnxietySpecific Social Anxiety ((SSPSSP):): Fears to specific situation, similar toFears to specific situation, similar to specific phobias.specific phobias. (5%)(5%) (You May Not Treat).(You May Not Treat). 07/27/1307/27/13 3131
    32. 32. Common Anxiety Provoking SituationsCommon Anxiety Provoking Situations Public speaking.Public speaking. Talking with people in authority.Talking with people in authority. Developing close relationships.Developing close relationships. Making or answering a phone call.Making or answering a phone call. Interviewing.Interviewing. Attending and participating in class.Attending and participating in class. Speaking with strangers.Speaking with strangers. Meeting new people.Meeting new people. Eating, drinking or writing in public.Eating, drinking or writing in public. Using public bathrooms.Using public bathrooms. Driving.Driving. Shopping.Shopping. 07/27/1307/27/13 3232
    33. 33. Specific Phobias (SPh)Specific Phobias (SPh) Intense, irrational fear that is out ofIntense, irrational fear that is out of proportion to the threat.proportion to the threat. Avoidance of the feared stimulus.Avoidance of the feared stimulus. Immediate anxiety upon encountering theImmediate anxiety upon encountering the stimulus.stimulus. It is called by the stimulus name e.g.,It is called by the stimulus name e.g., Animals and Insects.Animals and Insects. Natural Environment (e.g., Water).Natural Environment (e.g., Water). Blood, Injection, Injury.Blood, Injection, Injury. Situational (Planes & Elevators).Situational (Planes & Elevators).07/27/1307/27/13 3333
    34. 34. Co-Morbidity of Anxiety DisordersCo-Morbidity of Anxiety Disorders 1- Other Psychiatric Disorders:1- Other Psychiatric Disorders: Major Depressive Disorders:Major Depressive Disorders: GADGAD 60%, PD 50% & OCD 25%.60%, PD 50% & OCD 25%. OCD:OCD: with SAD (40%).with SAD (40%). Substance Abuse:Substance Abuse: most probably as amost probably as a self medication to relief anxiety andself medication to relief anxiety and tension.tension.07/27/1307/27/13 3434
    35. 35. 2- Medical Diseases:2- Medical Diseases: –Endocrine and Metabolic Diseases:Endocrine and Metabolic Diseases: Thyroid Dysfunction, Hyper Adrenalism, VitaminThyroid Dysfunction, Hyper Adrenalism, Vitamin B12 Deficiency, Acidosis & Hyperthermia.B12 Deficiency, Acidosis & Hyperthermia. –Drug Intoxication:Drug Intoxication: Caffeine, Amph., & Cocaine.Caffeine, Amph., & Cocaine. –Drug Withdrawal:Drug Withdrawal: Alcohol & Narcotics.Alcohol & Narcotics. –Neurological Diseases:Neurological Diseases: Delirium, Fits & Temporal Lobe Epilepsy.Delirium, Fits & Temporal Lobe Epilepsy. –Cardio-Vascular Diseases:Cardio-Vascular Diseases: Angina, Arrhythmias, CHF & Hypotension.Angina, Arrhythmias, CHF & Hypotension. –Respiratory Diseases:Respiratory Diseases: COPD, Asthma & Pulmonary Embolism.COPD, Asthma & Pulmonary Embolism. –Blood Diseases:Blood Diseases: Anemia.Anemia.07/27/1307/27/13 3535
    36. 36. SOME DISEASES THAT MAY BE CAUSEDSOME DISEASES THAT MAY BE CAUSED BY OR MADE WORSE BY ANXIETYBY OR MADE WORSE BY ANXIETY ((PsychosomaticsPsychosomatics)) Chest:Chest: BRONCHIALASTHMA.BRONCHIALASTHMA. Cardiac:Cardiac: ANGINA & HEART CONDITIONS.ANGINA & HEART CONDITIONS. GIT:GIT: STOMACH OR DUODENAL ULCERS,STOMACH OR DUODENAL ULCERS, ULCERATIVE COLITIS; IBS.ULCERATIVE COLITIS; IBS. Skin:Skin: ECZEMA, PSORIASIS & HAIR LOSS.ECZEMA, PSORIASIS & HAIR LOSS. Gyne:Gyne: MENSTRUAL DISTURBANCES.MENSTRUAL DISTURBANCES. Dental:Dental: MOUTH ULCERS.MOUTH ULCERS. Developmental:Developmental: STUTTERING.STUTTERING. 07/27/1307/27/13 3636
    37. 37. General Causal FactorsGeneral Causal Factors 07/27/1307/27/13 3737 Biological Psychological Genetic NTs & H Brain Circuits Learning: Conditioning Preparedness Cognitive Social Stressors
    38. 38. Genetic FactorsGenetic Factors Genetic Tendency:Genetic Tendency: – Higher concordance in MZ than DZHigher concordance in MZ than DZ twins (All anxiety disorders).twins (All anxiety disorders). – Adoption studies (GAD).Adoption studies (GAD). – Family studies (PD).Family studies (PD). Gene Studies:Gene Studies: (OCD).(OCD). Gene-Environment Interaction:Gene-Environment Interaction: (PTSD).(PTSD). 07/27/1307/27/13 3838
    39. 39. Anatomical FactorsAnatomical Factors 07/27/1307/27/13 3939 Limbic System and Hypothalamus [GAD, PD, ASR, PTSD] Amygdala [PD] Autonomic N S [GAD, PD, SAD, SPh] Basal Ganglia: [OCD and its spectrum]
    40. 40. NeurotransmittersNeurotransmitters GABAa:GABAa: GAD, PD.GAD, PD. Norepinephrine:Norepinephrine: PD.PD. Dopamine:Dopamine: OCD.OCD. MAOI:MAOI: SAD.SAD. CO2:CO2: GAD, PD.GAD, PD. Serotonin (5-HT):Serotonin (5-HT): GAD, PD, OCD, SAD, ASR, PTSD.GAD, PD, OCD, SAD, ASR, PTSD.07/27/1307/27/13 4040
    41. 41. Hormones: The HPAAxisHormones: The HPAAxis 07/27/1307/27/13 4141
    42. 42. Adrenal cortex CRH ACTH - - PTSD, Acute stress, chronic stress and GAD Glucocorticoi d Receptors are responsive 07/27/1307/27/13 4242
    43. 43. A Biological Model for Panic and Social Anxiety Disorders hypothalamus thalamus amygdala Sensory cortex serotonin - - SSRI07/27/1307/27/13 4343
    44. 44. Psychological FactorsPsychological Factors Psychoanalytical Theory:Psychoanalytical Theory: -- GAD:GAD: Conflict betweenConflict between Id & Ego.Id & Ego. -- OCD:OCD: Personality arrest atPersonality arrest at Anal Stage.Anal Stage. -- Phobia:Phobia: Anxiety due to repressedAnxiety due to repressed Id Impulses.Id Impulses. Psychological Vulnerability:Psychological Vulnerability: -- Tendency to believe that unexpected bodilyTendency to believe that unexpected bodily sensations are dangerous.sensations are dangerous. -- Worry about a panic attack makes the futureWorry about a panic attack makes the future attack more likely (attack more likely (Vicious circleVicious circle) () (PDPD).). 07/27/1307/27/13 4444
    45. 45. The Cognitive Theory: PanicThe Cognitive Theory: Panic 07/27/1307/27/13 4545
    46. 46. Cognitive Behavioral Theory:Cognitive Behavioral Theory: -- Phobia:Phobia: Conditioning of anxietyConditioning of anxiety to externalto external stimuli.stimuli. Behavioral Theory:Behavioral Theory: -- OCD:OCD: Learned behavior reinforced by fear reduction.Learned behavior reinforced by fear reduction. The Fear of Fear Hypothesis:The Fear of Fear Hypothesis: -- Some people have an overly aroused NS.Some people have an overly aroused NS. - A tendency to be upset by the sensation generated by- A tendency to be upset by the sensation generated by their NS.their NS. Intensity of Trauma:Intensity of Trauma: ((PTSDPTSD).). Psychological Factors:Psychological Factors: ((PTSDPTSD);); – Family instability.Family instability. – Less influence at high levels of trauma.Less influence at high levels of trauma. – Social support.Social support. 07/27/1307/27/13 4646
    47. 47. 07/27/1307/27/13 4747 Conditioning Theory: (SPh)Conditioning Theory: (SPh)
    48. 48. Management ofManagement of Anxiety DisordersAnxiety Disorders Psychoanalytical Theory:Psychoanalytical Theory: - Reveal Source of The Conflict (- Reveal Source of The Conflict (GAD & ASRGAD & ASR).). - Free Association (- Free Association (SAD & SPhSAD & SPh).).  Cognitive Behavioral Theory (CBT):Cognitive Behavioral Theory (CBT): - Relaxation.- Relaxation. - Cognitive Training.- Cognitive Training. - Graded Exposure.- Graded Exposure. - Systematic Desensitization.- Systematic Desensitization. - Flooding.- Flooding. - Altering Irrational Beliefs.- Altering Irrational Beliefs. -- Cognitive & Coping Strategies.Cognitive & Coping Strategies.  Biological Theory:Biological Theory: Pharmacotherapy.Pharmacotherapy.07/27/1307/27/13 4848
    49. 49. PharmacotherapyPharmacotherapy 1. Benzodiazepines. 2. Antidepressants: SSRIs, MAOIs & Tricyclics. 3. Buspirone. 4. Antipsychotics. 5. Mood Stabilizers. 6. β-blockers. 07/27/1307/27/13 4949
    50. 50. ConclusionsConclusions Anxiety disorders are commonAnxiety disorders are common (~ 30%)(~ 30%).. Although there are many psychosocialAlthough there are many psychosocial factors that induce anxiety disorders,factors that induce anxiety disorders, biological causesbiological causes are more evident.are more evident. There are co-morbidity particularly withThere are co-morbidity particularly with manymany physical diseasesphysical diseases which necessitatewhich necessitate the psychiatric care for these physicalthe psychiatric care for these physical diseases.diseases. 07/27/1307/27/13 5050
    51. 51. ConclusionsConclusions Anxiety disorders have cognitive,Anxiety disorders have cognitive, behavioral & somatic symptoms & canbehavioral & somatic symptoms & can lead to disability.lead to disability. So,So, differential diagnosisdifferential diagnosis is veryis very important.important. So, we have to deal with them asSo, we have to deal with them as A Bio-Psycho-SocialA Bio-Psycho-Social approach.approach. 07/27/1307/27/13 5151
    52. 52.  There are different effective & safeThere are different effective & safe medications and effective psychotherapy aremedications and effective psychotherapy are available now.available now.  So, anxiety disorders are more treatable thanSo, anxiety disorders are more treatable than before.before.  Anxiety disorders can lead to many seriousAnxiety disorders can lead to many serious condition. So, we have to fight anxietycondition. So, we have to fight anxiety disorders.disorders. Conclusions 07/27/1307/27/13 5252
    53. 53. 07/27/1307/27/13 5353

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