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Anxiety Disorders

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Disease State Management 1 Report

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Anxiety Disorders

  1. 1. AnxietyPresented by: Perez, Daren Nicole N. BSPH-5A
  2. 2. OBJECTIVES ANXIETY – Natural response and a necessary warning adaptation in humans. – Pathologic disorder when it is excessive and uncontrollable, requires no specific external stimulus, and manifests with a wide range of physical and affective symptoms as well as changes in behavior and cognition disorder. DEFINITION
  3. 3. OBJECTIVES • Generalized Anxiety Disorder (GAD) • Social Phobia • Panic Disorder • Agoraphobia • Specific Phobia • Post-Traumatic Stress Disorder (PTSD) • Obsessive-Compulsive Disorder (OCD) TYPES OF ANXIETY
  4. 4. OBJECTIVES • Generalized Anxiety Disorder (GAD) – Is characterized by at least 6 months of persistent and excessive anxiety and worry. • Social Phobia – Is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviors. • Panic Disorder – Severe feelings of doom that cause both mental and physical symptoms that can be so intense that some people become hospitalized, worried that something is dangerously wrong with their health. – characterized by two things: • Panic attacks. • Fear of getting panic attacks. TYPES OF ANXIETY
  5. 5. OBJECTIVES • Agoraphobia – Is anxiety about, or avoidance of, places or situations from which escape might 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 • Specific Phobia – People with a specific phobia experience extreme anxiety and fear if exposed to a particular feared object or situation. Common phobias include fear of flying, spiders and other animals, heights or small spaces. • Post-Traumatic Stress Disorder (PTSD) – 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. TYPES OF ANXIETY
  6. 6. OBJECTIVES • Obsessive-Compulsive Disorder (OCD) Compulsions and obsessions are similar, but exhibit themselves in different ways: • Obsessions: – thought based – Causes mark anxiety or distressed • Compulsions: – behavior based. – Neutralizes anxiety TYPES OF ANXIETY
  7. 7. ETIOLOGY • Genetic factors • Environmental factors (early childhood trauma, traumatic social experience) • Known or Unrecognized medical condition • Substance-induced anxiety disorder (over-the-counter medications, herbal medications, substances of abuse)
  8. 8. EPIDEMIOLOGY UNITED STATES STATISTICS • Social phobia is the most common anxiety disorder; • it has an early age of onset— age 11 years -50% & by age 20 years -80% According to: Epidemiological Catchment Area (ECA) study and National Comorbidity Survey (NCS) study • 2.3-2.7% for panic disorder • 4.1-6.6% for generalized anxiety disorder • 2.3-2.6% for OCD • 1-9.3% for PTSD • 2.6-13.3% for social phobia. Further, the NCS reported the following lifetime (and 30-day) prevalence estimates: 6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple (ie, specific) phobia, and 13.3% (and 4.5%) for social phobia
  9. 9. EPIDEMIOLOGY International statistics • Cross-national study - prevalence of panic disorder found lifetime prevalence rates ranging from 0.4% in Taiwan to 2.9% in Italy. • Cross-cultural study - prevalence of OCD found lifetime prevalence rates ranging from 0.7% in Taiwan to 2.5% in Puerto Rico. • In some Far East cultures, individuals with social phobia may develop fears of being offensive to others rather than fears of being embarrassed. Prevalence of anxiety disorders by race • The ECA study found no difference in rates of panic disorder among white, African American, or Hispanic populations in the United States. • Some studies have found higher rates of PTSD in minority populations.
  10. 10. EPIDEMIOLOGY Sex ratio for anxiety disorders Anxiety. Chart showing the female-to-male sex ratio for anxiety disorders. Adapted from Kessler et al, 1994.
  11. 11. EPIDEMIOLOGY Age distribution for anxiety disorders Anxiety. Age of onset for anxiety disorders based on specific anxiety disorder type.
  12. 12. PATHOPHYSIOLOGY
  13. 13. PATHOPHYSIOLOGY
  14. 14. PATHOPHYSIOLOGY
  15. 15. PATHOPHYSIOLOGY • Major mediators of the symptoms (CNS) of anxiety disorders:  Norepinephrine  Serotonin,  Dopamine  Gamma-aminobutyric acid (GABA) Other neurotransmitter : Corticotropin-releasing factor * • The most commonly considered are the serotoninergic and noradrenergic neurotransmitter systems. under activation over activation
  16. 16. PATHOPHYSIOLOGY • Disruption of the gamma-aminobutyric acid (GABA) system has also been implicated because of the response of many of the anxiety-spectrum disorders to treatment with benzodiazepines GABA = Glutamate=impact anxiety response • There has also been some interest in the role of corticosteroid regulation and its relation to symptoms of fear and anxiety. Corticosteroids might increase or decrease the activity of certain neural pathways, affecting not only behavior under stress but also the brain's processing of fear-inducing stimuli. • Although a genetic predisposition to developing an anxiety disorder is likely, environmental stressors clearly play a role in varying degrees. All of the disorders are affected in some way by external cues and how they are processed and reacted to.
  17. 17. CLINICAL FEATURES
  18. 18. CLINICAL FEATURES
  19. 19. CLINICAL FEATURES
  20. 20. CLINICAL FEATURES
  21. 21. INVESTIGATIONS No biologic markers are specific enough at this time to detect anxiety early, and no research shows that current medications prove efficacious in preventing these disorders. • It is therefore important to screen for specific risk factors: o strong family psychiatric history o concurrent substance abuse. Efforts since the 1990s have improved the diagnosis of these disorders, but the overall quality of care provided to patients remains substandard and CBT continues to be underused.
  22. 22. INVESTIGATIONS DIFFERENTIAL DIAGNOSIS • Other important causes in the differential include medication-induced anxiety: • Due to epinephrine or other sympathomimetic • Theophylline or other neurostimulant bronchodilators, • Analgesics containing caffeine, • Corticosteroids, • Antivirals • Migraine • Seizure disorders • other CNS-based disorders • Sleep disorders such as restless legs syndrome, sleep apnea, and periodic limb movement. • Heroin abuse
  23. 23. NATURAL HISTORY Levels of anxiety • Mild Anxiety • Moderate Anxiety • Severe Anxiety • Panic • Anxiety Disorder Complications  Depression (which often occurs with anxiety disorder)  Substance abuse  Trouble sleeping (insomnia)  Digestive or bowel problems  Headaches  Suicide  Poor quality of life
  24. 24. NATURAL HISTORY Anxiety and the risk of death in older men and women • An association between anxiety disorders and subsequent mortality was found for men only. • Older men with diagnosed anxiety disorders had 87% higher risk of mortality over 7 years of follow-up. The associations between anxiety and mortality in men remained after adjustment for comorbid depression, the explanatory variables (activity, smoking, drinking, body mass index) and confounders (age, psychiatric treatment, functional limitations and chronic diseases, including heart disease and stroke). • In women with anxiety disorders no association was found with subsequent mortality. The British Journal of Psychiatry Oct 2004, 185 (5) 399-404; DOI: 10.1192/bjp.185.5.399
  25. 25. MANAGEMENT • Identification of stress and trigger factors – Identify the problem. When you have identified the situations that are contributing to your anxiety, write down the problem and be very specific in your description, includin what is happening, where, how, with whom, why, and what you would like to change – Come up with as many options as possible for solving the problem, and consider the likely chances that these will help you overcome your problem. – Select your preferred option. – Develop a plan for how to try out the option selected and then carry it out. – If this option does not solve the problem remember that there are other options to try – Go back to the list and select your next preferred option. • Breathing exercises • Thought management • Lifestyle changes
  26. 26. MANAGEMENT Psychological Therapies • Cognitive behavior theraphy • Behaviour therapy • E-therapies
  27. 27. Treatment of Anxiety Disorders Treatment usually consists of a combination of pharmacotherapy and/or psychotherapy. • DOC: Antidepressant agents are the drugs of choice • Benzodiazepines • Tricyclic antidepressants (TCAs) • Selective serotonin reuptake inhibitors (SSRIs). • Monoamine oxidase inhibitors (MAOIs)
  28. 28. PROGNOSIS • Today, the majority of people with panic disorder and OCD improve significantly within weeks or months of getting proper treatment. The same is true for people with phobias. And many people with PTSD and generalized anxiety disorder also make substantial improvement with treatment. Source: excerpt from Anxiety Disorders Research at the National Institute of Mental Health: NIMH
  29. 29. REFERENCES • http://www.calmclinic.com/anxiety/types • http://www.clevelandclinicmeded.com/medicalpubs/diseasema nagement/psychiatry-psychology/anxiety- disorder/Default.htm#s0055 • http://emedicine.medscape.com/article/286227-clinical • http://www.mindfulnessmd.com/2014/08/09/the-neuroscience- of-anxiety-disorders/ • Mayo Clinic Staff, (2010). Treatments and drugs. Mayo clinic. Retrieved October 25, 2010, from http://www.mayoclinic.com/health/panic- attacks/DS00338/DSECTION=treatments-and-drugs

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