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1. ANXIETY DISORDERS
GROUP 4

2. GROUP MEMBERS
1. STANELY SAKALA
2. OLIVER MWEPYA
3. NAOMI MBEWE
4. VERNANCIOUS MOMBA
5. SYDNEY NSOOKA
6. SERA MAKO
7. TYSON SAKALA

3. INTRODUCTION
• Feelings of anxiety are so common in our
society that they are almost considered
universal.
• Anxiety arises from the chaos and confusion
that exists in the world today.
• Fears of the unknown and conditions of
ambiguity offer a perfect breeding ground for
anxiety to take root and grow.

4. • Low levels of anxiety are adaptive and can
provide the motivation required for survival
(Townsend M.C, 2011).
• Normal anxiety becomes pathological when it
causes significant subjective distress and/or
impairment in functioning of an individual
(Ahuja N.).

5. GENERAL OBJECTIVE
• By the end of this presentation students
should be able to demonstrate understanding
of anxiety disorders.

6. SPECIFIC OBJECTIVE
By the end of this presentation students should
be able to:
1. Define the sub types of anxiety disorders.
2. State the aetiology of anxiety disorders.
3. List signs and symptoms of anxiety disorders.
4. Explain diagnostic criteria for anxiety
disorders.

7. DEFINITIONS
Anxiety
• A diffuse apprehension that is vague in nature
and is associated with feelings of uncertainty
and helplessness (Townsend m.c, 2011).
• Anxiety is a ‘normal’ phenomenon, which is
characterized by a state of apprehension or
unease arising out of anticipation of danger
(Ahuja N.).

8. Anxiety disorders
• Disorders in which the characteristic features
are symptoms of anxiety and avoidance
behavior (e.g. phobias, obsessive-compulsive
disorder, panic disorder, generalized anxiety
disorder, post-traumatic stress disorder)
(Townsend, 2011).

9. • A persistent fear of one or more social or
performance situations in which the person is
exposed to unfamiliar people or to possible
scrutiny by others.
• The individual fears that he or she will act in a
way (or show anxiety symptoms) that will be
embarrassing and humiliating (Current DSM-5).

10. AETIOLOGY OF ANXIETY
• The cause of anxiety disorders is not clearly
known. There are however several theories, of
which more than one may be applicable in a
particular patient.

11. 1. Psychodynamic theory
• According to this theory, anxiety is a signal
that something is disturbing the internal
psychological equilibrium.
• This is called a signal anxiety.
• This anxiety arouses the ego to take defensive
action which is usually in the form of
repression, a primary defense mechanism.

12. Psychodynamic theory cont.…
• Ordinarily when repression fails, other
secondary defense mechanism (like
conversion isolation) are called into action.
• In anxiety, repression fails to function
adequately but the secondary defense
mechanisms are not activated.
• Hence, anxiety comes to the fore front
unopposed.

13. 2. Behavioral theory
• According to this theory, anxiety is viewed as
an unconditioned inherent response of the
organism to the painful or dangerous stimuli.
• In anxiety and phobias, this becomes attached
to relatively neutral stimuli by conditioning.

14. 3. Cognitive Behavioral Theory
• According to cognitive behaviour theory, in
anxiety disorders, there is evidence of
selective information processing (with more
attention paid to threat related information),
cognitive distortions, negative automatic
thoughts and perception of decreased control
over both internal and external stimuli.

15. 4. Biological theory
(i) Genetic evidence
• About 15-20% of first degree relatives of the
patients with anxiety disorder exhibit anxiety
disorders themselves.
• The concordance rate in the monozygotic
twins of patients with panic disorders is as
high as 80 %( 4 times more than in dizygotic
twins).

16. 4. Biological theory cont.….
(ii) Chemically induced anxiety states
• Infusion of chemical (like sodium lactate,
isoproterenol and caffeine),inhalation of 5%
CO2 can produce panic episodes in
predisposed individuals.

17. 4. Biological theory cont….
(iii)GABA-benzodiazepine receptors
• Benzodiazepine receptors are distributed
widely in the central nervous system.
• GABA is the most prevalent inhibitory
neurotransmitter in the CNS.
• It has been suggested that alteration in GABA
levels may lead to production of clinical
anxiety.

18. 4. Biological theory cont….
• The fact that the benzodiazepines (which
facilitate GABA transmission, thereby causing
a generalized inhibition effect on the CNS)
relieve anxiety and that benzodiazepine-
anatagonists (e.g.flumazenil) and adverse
agonists (e.g. (β-carbolines) cause anxiety,
lends heavy support to this hypothesis.

19. 4. Biological theory
(iv) Other neurotransmitters
• Norepinephrine, 5-HT, dopamine, opioid
receptors and neuroendocrine dysfunction
have also been implicated in the causation of
anxiety disorders.
• Neuroanatomical basis - Locus ceruleus,
limbic system and prefrontal cortex are some
of the areas implicated in anxiety disorders.
Regional cerebral blood flow is increased in
anxiety, though vasoconstriction occurs in
severe anxiety.

20. 4. Biological theory
Note: Organic anxiety disorder – is a disorder
characterized by the presence of anxiety which
is secondary to the various medical disorders
(e.g.hyperthyroidism, phheochromocytoma,
coronary artery disease).
• If anxiety symptoms can occur secondary to
medical disorders, it seems possible then that
anxiety has a biological basis.

21. CLASSIFICATION OF ANXIETY
DISORDERS
1. PHOBIC ANXIETY DISORDERS
• Phobia is defined as an irrational fear of a
specific object, situation or activity, often
leading to persistent avoidance of the feared
object, situation activity (Ahuja N.).
• The common types of phobias are:
i. Agoraphobia
ii. Social phobia
iii. Specific phobias

22. (i) Agoraphobia
• It is characterized by an irrational fear of being
in places away from the familiar setting of
home.
• The patient is afraid of all the places or
situations from which escape might be
difficult (or embarrassing) or in which help
may not be available in the event of having a
Panic Attack or panic-like symptoms.

23. (ii) Social Phobia
• This is characterized by an irrational fear of
performing activities in the presence of other
people or interacting with others.
• The patient is afraid of his own actions being
viewed by others critically, resulting in
embarrassment or humiliation.
• There is marked distress and disturbance in
routine daily function.
• Examples include fear of: writing in public, public
speaking, eating in public, public performance,
speaking to strangers, dating, speaking to
authority figures etc, often leading to avoidance
behavior.

24. (iii) Specific (simple) phobias
• In contrast to agoraphobia and social phobia
where the stimuli are generalized, in specific
phobia the stimuli is usually well
circumscribed to highly specific situations
such as proximity to particular animals,
heights ,thunder ,darkness, flying , close
spaces, urinating or defecating in public
toilets, eating certain foods, dentistry, or the
site of blood or injury.

25. (iii) Specific (simple) phobias
• This is an example of irrational fear of objects
or situations.

26. 2. OTHER ANXIETY DISORDERS
• These are anxiety disorders in which
manifestation of anxiety is a major symptom
and is not restricted to any particular
environmental situations. Depressive and
obsessional symptoms and even some
element of phobic anxiety may also be
present provided that they are clearly
secondary or less severe.

27. Panic anxiety disorder (episodic paroxysmal
anxiety)-the essential feature is recurrent
attacks of severe anxiety which are not
restricted to any particular situation.
• Or set of circumstances are therefore
unpredictable.
• As with other anxiety disorders the dominant
symptoms include sudden onset of
palpitations, chest pains, choking sensation,
dizziness and feelings of unreality
(depersonalization or direalisation).

28. • There is also secondary fear of dying, losing
control or going mad.
• Panic disorder should not be given as the main
diagnosis if the patient has a depressive
disorder at the time the panic start; in these
circumstances the panic attacks are probably
secondary to depression.

29. Criteria for Panic Attack
Note: A Panic Attack is not a codable disorder. Code the
specific diagnosis in which the Panic Attack occurs (e.g Panic
Disorder With Agoraphobia).
• A discrete period of intense fear or discomfort. in which
four (or more) of the following symptoms developed
abruptly and reached a peak within 10 minutes:
(1) palpitations. pounding heart, or accelerated heart rate
(2) sweating
(3) trembling or shaking
(4) sensations of shortness of breath or smothering
(5) feeling of choking

30. Criteria for Panic Attack
(6) chest pain or discomfort
(7) nausea or abdominal distress
(8) feeling dizzy, unsteady, lightheaded, or faint
(9) derealization (feelings of unreality) or
depersonalization (being detached from oneself)
(10) f ear of losing control or going crazy
(11) fear of dying
(12) paresthesias (numbness or tingling
sensations)
(13) chills or hot f lushes

31. Panic Disorder with Agoraphobia
• is characterized by both recurrent unexpected
Panic Attacks and Agoraphobia.

32. Panic Disorder without Agoraphobia
is characterized by recurrent unexpected Panic
Attacks about which there is persistent concern.

33. Generalized Anxiety Disorder
• This is characterized by an insidious onset,
usually chronic course which may or may not
be punctuated by repeated panic attacks
(episodes of acute anxiety).
• The symptoms of anxiety should last for at
least a period of 6 months for a diagnosis of
generalized anxiety disorder to be made.

34. Obsessive-Compulsive Disorder
is characterized by obsessions (which cause
marked anxiety or distress) and / or by
compulsions (which serve to neutralize anxiety).

35. STRESS AND ADJUSTMENT DISORDERS
Post traumatic Stress Disorder
is characterized by the re experiencing of an
extremely traumatic event accompanied by
symptoms of increased arousal and by
avoidance of stimuli associated with the trauma.

36. Acute Stress Disorder
is characterized by symptoms similar to those of
Posttraumatic Stress Disorder that occurs
immediately in the aftermath of an extremely
traumatic event.

37. CLINICAL FEATURES OF ANXIETY
• The symptoms of anxiety can be broadly classified in
two groups: physical and psychological
1. Physical symptoms
Motoric symptoms
• Tremors; restlessness; muscle twitches; fearful facial
expression
Autonomic and Visceral symptoms
• Palpitations;tachycardia;sweating;flushes;dyspnea;hyp
erventilation;constricyion in the chest; dry mouth;
frequency and hesitancy of micturition, dizziness,
diarrhea, midiasis

38. 2. Psychological symptoms
Cognitive symptoms
• Poor concentration; distractibility; hyper
arousal; vigilance or scanning; negative
automatic thoughts.
Perceptual symptoms
• Derealisation, depersonalization

39. Affective symptoms
• Diffuse, unpleasant and vague sense of
apprehension, fearfulness, inability to relax,
irritability, feeling of impending doom(when
severe)
Other symptoms
• Insomnia; increased sensitivity to noise;
exaggerated startle response

40. References
• Ahuja N. (2006), A Short Textbook of
PSYCHIATRY, 6th edition, New Delhi: Jaypee
brothers, medical Publishers (p) Ltd.
• Townsend M.C (2011), Essentials of Psychiatric
Mental Health Nursing, 5th edition, Philadelphia:
F.A Davis Company.
• American psychiatric association, (2000),
Diagnostic and statistical manual of mental
health disorders, 4th edition. Washington D.C. the
American psychiatric association