Pathophysiology of anxiety

1. ChapterChapter :9:9
AnxietyAnxiety
Presented by: Prof.Mirza Anwar BaigPresented by: Prof.Mirza Anwar Baig
Anjuman-I-Islam's Kalsekar Technical CampusAnjuman-I-Islam's Kalsekar Technical Campus
School of Pharmacy,New Pavel,NaviSchool of Pharmacy,New Pavel,Navi
Mumbai,MaharashtraMumbai,Maharashtra
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2. Overview
• What is Anxiety?
• What are the different types of
anxiety disorders?
• What are the causes?
• What are the symptoms?
• What are the treatments?

3. Definition of Anxiety
• Anxiety is a feeling of apprehension or fear.
The source of this uneasiness is not always
known.
• Anxiety disorders are a group of psychiatric
conditions that involve excessive anxiety.

4. Normal versus Pathologic Anxiety
• Normal anxiety is adaptive. It is an inborn
response to threat or to the absence of
people or objects that signify safety can
result in cognitive (worry) and somatic
(racing heart, sweating, shaking, freezing,
etc.) symptoms.
• Pathologic anxiety is anxiety that is
excessive, impairs function.

5. Anxiety Facts
• Most common mental illness in the U.S. with 19 million of the
adult (ages 18-54) U.S. population affected.
• Anxiety disorders cost more than $42 billion a year.
• More than $22 billion are associated with the repeated use of
healthcare services, as those with anxiety disorders seek
relief for symptoms that mimic physical illnesses.
• Anxiety is highly treatable (up to 90% of cases), but only
one-third of those who suffer from it receive treatment
• Depression often accompanies anxiety disorders
2003 Anxiety Disorders Association of

6. Types of Anxiety Disorders
• Panic Disorder
• Obsessive-Compulsive Disorder
• Post-Traumatic Stress Disorder
• Phobias
• Generalized Anxiety Disorder

7. 1.Panic Disorder
• The abrupt onset of an episode of intense fear or
discomfort, which peaks in approximately 10
minutes, and includes at least four of the following
symptoms:
• A feeling of danger
• The need to escape
• Palpitations
• Sweating
• Shortness of breath
• A feeling of choking
• Chest pain or discomfort
• Nausea or abdominal discomfort
• Dizziness
• A sense of things being unreal,
• A fear of losing control or "going
crazy"
• A fear of dying
• Chills or hot flushes

8. 1. Panic Disorder
There are three types of Panic Attacks:
1. Unexpected - the attack "comes without
warning sign and for no discernable reason.
2. Situational - situations in which an individual
always has an attack, for example, upon entering
a tunnel.
3. Situationally Predisposed - situations in which
an individual is likely to have a Panic Attack, but
does not always have one. An example of this
would be an individual who sometimes has attacks
while driving.

9. 2. Obsessive-Compulsive Disorder
Characterized by uncontrollable excessive
unreasonable obsessions and compulsions .
• Obsessions are recurring inappropriate thoughts
and cause the sufferer anxiety:
– Thoughts about contamination, for example, when
an individual fears coming into contact with dirt, germs or
"unclean" objects;
– Persistent doubts, for example, whether or not one
has turned off the iron or stove, locked the door .
– Extreme need for orderliness;
– Aggressive thoughts, for example, urge to yell 'fire'
in a crowded theater

10. 2.Obsessive-Compulsive Disorder
• Compulsions are repetitive behaviors or rituals performed by the
OCD sufferer, performance of these rituals neutralize the anxiety
caused by obsessive thoughts, relief is only temporary.
– Cleaning. Repeatedly washing their hands, showering, or
constantly cleaning their home;
– Checking. Individuals may check several or even hundreds of
times to make sure that stoves are turned off and doors are
locked;
– Repeating. Some repeat a name, phrase or action over and
over;
– Slowness. Some individuals may take an excessively slow and
methodical approach to daily activities, they may spend hours
organizing and arranging objects;
– Hoarding. unable to throw away useless items, such as old
newspapers, junk mail, even broken appliances
In order for OCD to be diagnosed, the obsessions and/or
compulsions must take up a considerable amount of the sufferers
time, at least one hour every day, and interfere with normal
routines .

11. 3. Post-Traumatic Stress Disorder
• Exposure to traumas such as a serious accident, a natural disaster, or
criminal assault can result in PTSD.
• When the events of a traumatic experience interferes with normal
functioning, the person may be suffering from PTSD.
• Symptoms of PTSD are:
Reexperiencing the event, which can take the form of intrusive
thoughts and recollections, or recurrent dreams;
–Avoidance behavior in which the sufferer avoids activities,
situations, people,and/or conversations which he/she associates with
the trauma;
–A general numbness and loss of interest in surroundings;
–Hypersensitivity, including: inability to sleep, anxious
feelings,hypervigilance, irritability and anger.

12. 4.Social Phobia/Anxiety
• Social anxiety disorder, also known as social
phobia, is an intense fear of social situations. This
fear arises when the individual believes that they
may be judged, scrutinized or humiliated by others.
• Individuals with the disorder are acutely aware of
the physical signs of their anxiety and fear that
others will notice, judge them, and think poorly of
them.
• In extreme cases this intense uneasiness can
progress into a full blown panic attack.

13. 4.Social Phobia/Anxiety contd:
• Common anxiety provoking social situations include:
– public speaking
– talking with people in authority
– making a phone call or answering the phone
– interviewing
– attending and participating in class
– speaking with strangers
– meeting new people
– eating, drinking, or writing in public
– driving
– shopping

14. 5.Generalized Anxiety Disorder
• Excessive uncontrollable worry about
everyday things. This constant worry
affects daily functioning and can cause
physical symptoms.
• GAD can occur with other anxiety disorders,
depressive disorders.

15. 5. Generalized Anxiety Disorder contd:
• The focus of GAD worry can shift,
usually focusing on issues like job,
finances, health of both self and family;
but it can also include more issues such
as car repairs and being late for
appointments.
• The intensity, duration and frequency of
the worry are disproportionate to the
issue

16. Specific Disorder Facts
• Generalized Anxiety Disorder
– Women are twice as likely to be afflicted than men.
– Very likely to exist along with other disorders.
• Obsessive Compulsive Disorder
– It is equally common among men and women.
– One third of afflicted adults had their first symptoms in
childhood.
• Panic Disorder
– Women are twice as likely to be afflicted than men.
– Occurs with major depression in very high rates.
2003 Anxiety Disorders Association of America

17. Specific Disorder Facts
• Posttraumatic Stress Disorder
– Women are more likely to be afflicted than men.
• Social Anxiety Disorder
– It is equally common among men and women.
• Specific Phobia affects
– Women are twice as likely to be afflicted as men
2003 Anxiety Disorders Association of

18. Common Causes
• There is no one cause for anxiety disorders. Several factors can
play a role
– Genetics
– Brain biochemistry
– Overactive "fight or flight" response
• Can be caused by too much stress
– Life circumstances
– Personality
• People who have low self-esteem and poor coping skills
may be more prone
• Certain drugs, can lead to symptoms of anxiety due to either side
effects or withdrawal from the drug.
• In very rare cases, a tumor of the adrenal gland
(pheochromocytoma) may be the cause of anxiety.

19. ANXIETY DISORDERS
Etiology- Neurotransmitters
• norepinephrine (NE) – concentrated in locus ceruleus
• serotonin
• dopamine in social phobia and OCD
• interactions – serotonin affects locus ceruleus (where NE
is produced) and may also influence GABA

20. Symptoms of Anxiety
Anxiety is an emotion often accompanied by
various physical symptoms, including:
• Twitching or trembling
• Muscle tension
• Headaches
• Sweating
• Dry mouth
• Difficulty swallowing
• Abdominal pain (may be the only symptom of
stress especially in a child)

21. Additional Symptoms of Anxiety
Sometimes other symptoms accompany
anxiety:
• Dizziness
• Rapid or irregular heart rate
• Rapid breathing
• Diarrhea or frequent need to urinate
• Fatigue
• Irritability, including loss of your temper
• Sleeping difficulties
• Decreased concentration

22. Social Effects of Anxiety
• Depression
– Not as involved with family and friends the way
you used to be
– Lowered quality of relationships
– Low energy
– Lack of motivation to do the things you once
looked forward to doing
• Unable to convey the person that you are
• Fear and avoidance of situations where
previous attacks occurred

23. Treatments
• Medications (Drug Therapy):
• Behavioral Therapy
• Cognitive Behavioral Therapy

24. Alternative Treatments
• Acupuncture
• Aromatherapy
• Breathing Exercises
• Exercise
• Meditation
• Nutrition and Diet Therapy
• Vitamins

25. Medications
• Buspirone: shown to be effective but
usually takes 3-4 weeks, particularly useful
in elderly patients
• Benzodiazepines: include Xanax and
Valium, act rapidly and successfully but can
be addictive and loses effectiveness over
time
• Side Effects: dizziness, headaches, nausea,
impaired memory

26. Behavioral and Cognitive Therapy
• Teaches patient to react differently to situations
and bodily sensations that trigger anxiety
• Examples: Hyperventilating, writing down list of
top fears and doing one of them once a week,
spinning in a chair until dizzy; after awhile patients
learned to cope with the negative feelings
associated with them and replace them with
positive ones

27. Aromatherapy
• Calming Effect: vanilla, orange blossom,
rose, chamomile, and lavender
• Reducing Stress: Lavender, sandalwood,
and nutmeg
• Uplifting Oils: Bergamot, geranium, juniper,
and lavender

28. Exercise
• Benefits: symbolic meaning of the activity
and sport, the distraction from worries,
mastery of a sport, biochemical and
physiological changes associated with
exercise.
• Helps by expelling negative emotions and
adrenaline out of your body in order to
enter a more relaxed, calm state to deal
with issues and conflicts

29. Meditation
• Cultivates calmness to create a sense of
control over life
• Practice: Sit quietly in a position
comfortable to you and take a few deep
breaths to relax your muscles, next choose
a calming phrase, silently repeat the word
or phrase for 20 minutes

30. Nutrition and Diet Therapy
• Foods to Eat: whole grains, bananas,
asparagus, garlic, brown rice, green and
leafy veggies, soy products, yogurt
• Foods to Avoid: coffee, alcohol, sugar,
strong spices, highly acidic foods, foods
with white flour
• Keep a diary of the foods you eat and your
anxiety attacks; after awhile you may be
able to see a correlation
• East small, frequent meals

31. Vitamins
• B-Vitamins stabilize the body’s lactate
levels which cause anxiety attacks (B-6, B-
1, B-3)
• Calcium (a natural tranquilizer) and
magnesium relax the nervous system;
taken in combination before bed improves
sleep
• Vitamin C taken in large doses also has a
tranquilizing effect
• Potassium helps with proper functioning of
adrenal glands
• Zinc has a calming effect on the nervous
system

32. Treatments – Problem-solving
training
What is my problem? What is my goal? What
solutions can I generate to solve the problem?
What might be the consequences of each
solution? Try a solution
particularly relevant to GAD
divides problems into manageable units

33. Self Love
• The most important holistic treatment of all
• Laugh: be able to laugh at yourself and
with others; increases endorphin levels and
decreases stress hormones
• Let go of frustrations
• Do not judge self harshly: don’t expect
more from yourself than you do others
• Accept your faults

34. The End