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Anxiety Disorders


Published on

“Anxiety Disorders,”
Scarborough, Maine; May 7, 2003
Community presentation, Scarborough Campus of Maine Medical Center.
*Anxiety disorders and how to cope

Published in: Health & Medicine
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Anxiety Disorders

  1. 1. Anxiety Disorders: How to Cope Carlo Carandang, MD Department of Psychiatry Maine Medical Center & Spring Harbor Hospital
  2. 2. Anxiety Disorders Over 19 million Americans suffer from Anxiety Disorders. Anxiety Disorders occur when the anxiety: Chronically reaches overwhelming levels Reduces or eliminates productivity Significantly interferes with an individual’s quality of life.
  3. 3. The five main Anxiety Disorders are: Panic disorder Social Anxiety Disorder Generalized Anxiety Disorder Obsessive Compulsive Disorder Post-Traumatic Stress Disorder
  4. 4. Panic Disorder Presence of recurrent, unexpected panic attacks. Followed by persistent concern about having another attack (anticipatory anxiety). A panic attack is a period of intense fear. Symptoms of a panic attack include: Palpitations, pounding heart, chest pain Sweating, chills or hot flushes Trembling or shaking Sensations of shortness of breath, choking Feeling dizzy, lightheaded, faint Fear of losing control, dying, going crazy
  5. 5. Social Anxiety Disorder Marked and persistent fear of social or performance situations where embarrassment may occur. Social situations provoke an immediate anxiety response. The individual recognizes that the fear is excessive. The situations are avoided or endured with intense anxiety. The distress, avoidance, anticipation interferes with the individual’s normal functioning.
  6. 6. Generalized Anxiety Disorder Excessive worry about a variety of events and activities. Difficulty controlling the worry. Physical symptoms of: Restlessness Fatigue Irritability Muscle tension Difficulty concentrating Sleep disturbance The anxiety, worry and physical symptoms cause the individual marked distress and interferes with normal functioning.
  7. 7. Obsessive Compulsive Disorder Recurrent, persistent, intrusive thoughts, impulses or images. Resisting the obsession means that the anxiety escalates. Compulsive behaviors serve to decrease the anxiety associated with the obsession Compulsive (repetitive) behaviors and/or mental acts: Hand washing Checking Ordering CountingIndividual recognizes that the obsessions and compulsions are unreasonable. It is easier to give in to the intrusive thoughts or execute the compulsive behaviors than tolerate the anxiety.
  8. 8. Post Traumatic Stress Disorder Individual is exposed to a traumatic event (witnessed or experienced) that involved actual or threatened serious injury or death. The experience produced intense fear and helplessness. Later, the individual may experience: Recurrent intrusive recollections of the event (flashbacks, nightmares) Feelings of detachment Guilt feelings Sleep problems and other somatic symptoms Avoidant behaviors Hypervigilance (heightened awareness, easily startled)
  9. 9. Indirect Trauma Can Have Profound Consequences Most of us exposed to disaster through the media.
  10. 10. Children’s Response to Oklahoma City Bombing 69 elementary school children surveyed 2 years after Oklahoma City Bombing. The children lived 100 miles away and knew no one who was killed or injured.
  11. 11. Children’s Response to Oklahoma City Bombing Almost 50% exhibited moderate post- traumatic stress symptoms. 44% of the kids had symptoms of Post- Traumatic Stress Disorder. Disturbing finding: 44% of the kids developed PTSD after exposure to indirect trauma.
  12. 12. Caregiver, Heal Thyself When an adult is emotionally unstable, or has not worked-through their emotions, risks losing their CONNECTION with their kids. Often, adults focus on their kids, while ignoring their own emotional needs during crisis. Kids can sense anxiety in adults, and may feel they are a burden to adults.
  13. 13. Common Reactions Of Kids to Traumatic Events Feelings of anxiety, anger, and sadness Feeling helpless Sleep problems Concentration problems Regression Thinking the event is their fault (younger than 7 or 8 years)
  14. 14. Helping Kids Cope A strong CONNECTION with your kids is the most important factor. Foster CONNECTION with other adults: extended family, neighbors, teachers, clergy.
  15. 15. Helping Kids Cope Adults can talk about their own emotions with kids. Allow kids to express their feelings. If talking is difficult, then do ‘action talk.’ Help kids take action to decrease their sense of helplessness.
  16. 16. When To Seek Further Help For Kids Recurring nightmares and persistently disrupted sleep Social withdrawal Extreme agitation/aggression Pervasively declining school performance Excessive fears
  17. 17. Depression Over 19 million Americans suffer from Depressive Illnesses Depression is more than a temporary “blue” mood or periods of grief after a loss Symptoms of depression: Loss of interest or pleasure Feeling overwhelmingly sad Change in appetite, weight and sleep Increase in fatigue Decrease in energy Poor concentration Feelings of worthlessness and guilt Suicidal thoughts
  18. 18. Treatment for Anxiety & Depressive Disorders Anxiety and depressive disorders are treatable medical illnesses that respond to: Psychotherapy/Counseling Medication A combination of Psychotherapy & Medication
  19. 19. Treatment Works The Surgeon General’s Report on Mental Health states: “The efficacy of mental health treatment is well documented. Moreover, there exists a range of treatments from which people may choose a particular approach to suit their needs and preferences. Based on this finding, the report’s principal recommendation to the American people is to seek help if you have a mental health problem or think you have symptoms of mental illness.” (p. 13)
  20. 20. Drug Class Brand Name Generic Name Target Anxiet y Disorder How I t 's Thought t o Work Alpha- adrenergic agonist Catapres Tenex Clonidine Guanfacine PTSD Reduces ability to produce adrenaline Anticonvulsant s Neurontin Gabapentin Social Anxiety Disorder (SAD) Affects GABA Azaspirones BuSpar Buspirone Generalized Anxiety Disorder (GAD) Enhanced the activity of serotonin Medications Effective for Anxiety Disorders
  21. 21. Benzodiazepines Ativan Centrax Dalmane Klonopin Halcion Librium Paxipam Restoril Serax Tranxene Valium Xanax Lorazepam Prazepam Flurazepam Clonazepam Trixolam Chlordiazepoxide Halazepam Temazepam Oxazepam Clorazepate Diazepam Alprazolam GAD, SAD, Panic Disorder Enhance the function of the GABA Medications Effective for Anxiety Disorders (cont.)
  22. 22. Beta Blockers Inderal Tenormin Propanolol Atenolol SAD Blocks adrenaline receptors (decrease HR) Monoamine Oxidase I nhibitors (MAOI s) Eldepryl Marplan Nardil Parnate Selegiline Isocarboxid Phenelzine Tranylcypro mine Panic Disorder, SAD, PTSD Blocks the effect of an important brain enzyme, preventing the breakdown of serotonin and noradrenaline Medications Effective for Anxiety Disorders (cont.)
  23. 23. Selective Serotonin Reuptake I nhibitors (SSRI s) Celexa Luvox Paxil Prozac Zoloft Citalopram Fluvoxamine Paroxetine Fluoxetine Sertraline Panic Disorder, OCD, SAD, GAD Affects the concentration of the neuro-transmitter serotonin, a chemical in the brain thought to be linked to anxiety disorders Medications Effective for Anxiety Disorders (cont.)
  24. 24. Tricyclic Antidepressa nts (TCAs) Adapin Anafranil Aventyl Elavil Janimine Ludiomil Norpramin Pamelor Pertofrane Sinequan Surmontil Tofranil Vivactil Doxepin Clomiprimine Nortriptyline Amitriptyline Imipramine Maprotiline Desipramine Nortriptyline Desipramine Doxepin Trimipramine Imipramine Protriptyline Panic Disorder, PTSD OCD (Anafranil only) Regulates serotonin and/or nonadrenaline in the brain Medications Effective for Anxiety Disorders (cont.)
  25. 25. Other Antidepressants Desyrel Effexor Remeron Trazodone Venlafaxine Mirtazapine Panic Disorder, OCD, SAD, GAD Affects the concentration of the neuro- transmitter Serotonin, a chemical in the brain thought to be linked to anxiety disorders Medications Effective for Anxiety Disorders (cont.)