anxiety disorders

1. Anxiety Disorders

2. Content
 Overview
 Classification
 Epidemiology
 Etiology
 Diagnosis
 Treatment

3. Overview
Normal anxiety VS abnormal anxiety

4. Anxiety disorders in DSM4
 Generalized anxiety disorder
 Obsessive Compulsive Disorder
 Post traumatic stress disorder
 Panic disorder
 Agoraphobia
 Social phobia
 Specific phobia

5. Etiology of Anxiety Disorders
Biological
Genetic
first-
degree relatives
are more affected.
Neurological
basal ganglia
limbic system
frontal cortex
Neuro
Physiological
serotonin

6. Etiology of Anxiety Disorders cont.
Psychological
Psycho-analytic
anxiety is a symptom
of unresolved,
unconscious conflicts
Cognitive-behavioural
selective attention
to negative details
Classic conditioning

7. Generalized anxiety disorder

8. GAD clinical features.
 Physical symptoms
 Cognitive component
 Behavioral component

9. GAD cont.
 prevalence 5%
 men - women
1 2
 Co morbidity 50% have another psychiatric
diagnosis, (major depressive disorder , panic
disorder)
 Age of onset 20 - 35

10. GAD Diagnosis ( DSM4 )
 A. Excessive anxiety and worry for at least 6 months, about a
number of events or activities (such as work or school
performance).
 B. The person finds it difficult to control the worry.
 C. three (or more) of the following symptoms
restlessness
being easily fatigued
difficulty concentrating or mind going blank
irritability
muscle tension
sleep disturbance

11. GAD Prognosis
 Only one third of patients who have generalized
anxiety disorder seek psychiatric treatment.
Many go to general practitioners, internists,
cardiologists, pulmonary specialists .
 generalized anxiety disorder is a chronic
condition that may well be lifelong .

12. GAD case discussion

‫السيدة‬
(
‫س‬
)
32
‫سنة‬
,
‫متزوجة‬
,
5
‫أطفال‬
,
‫منذ‬ ‫تعاني‬
11
‫عام‬ ‫إرهاق‬ ‫من‬ ‫شهرا‬
,
‫القلب‬ ‫خفقان‬
,
‫الحلق‬ ‫و‬ ‫الفم‬ ‫جفاف‬
,
‫اليدين‬ ‫في‬ ‫رجفة‬
,
‫األ‬ ‫في‬ ‫تنميل‬
‫طراف‬
,
‫النوم‬ ‫اضطراب‬
,
‫التركيز‬ ‫اضطراب‬
.

‫السيدة‬ ‫توجهت‬ ‫األعراض‬ ‫هذه‬ ‫بسبب‬
(
‫س‬
)
‫متكررة‬ ‫فحوصات‬ ‫لعمل‬
,
‫بع‬ ‫قامت‬
‫مل‬
‫األعصاب‬ ‫و‬ ‫الباطنة‬ ‫ألطباء‬ ‫متكررة‬ ‫زيارات‬
,
‫أسب‬ ‫أي‬ ‫وجود‬ ‫يثبت‬ ‫لم‬ ‫حيث‬
‫اب‬
‫لمعاناتها‬ ‫عضوية‬

‫أرجأت‬ ‫لكنها‬ ‫و‬ ‫النفسية‬ ‫الصحة‬ ‫مراكز‬ ‫إلى‬ ‫بالتوجه‬ ‫األطباء‬ ‫بعض‬ ‫نصحها‬
‫الزيارة‬
‫مختلفة‬ ‫بأسباب‬ ‫متعللة‬ ‫مرة‬ ‫من‬ ‫أكثر‬
.

‫السيدة‬ ‫لدى‬ ‫كان‬
(
‫س‬
)
‫بمرض‬ ‫المصابة‬ ‫والدتها‬ ‫صحة‬ ‫بشأن‬ ‫القلق‬ ‫من‬ ‫الكثير‬
‫مزمن‬
‫طويلة‬ ‫فترة‬ ‫منذ‬ ‫استقرت‬ ‫و‬ ‫حالتها‬ ‫تحسنت‬ ‫التي‬ ‫و‬ ‫القلب‬ ‫في‬
.

‫السيدة‬
(
‫س‬
)
‫من‬ ‫تعاني‬ ‫أصبحت‬ ‫و‬ ‫االجتماعي‬ ‫التواصل‬ ‫على‬ ‫قدرتها‬ ‫فقدت‬
‫مزاج‬
‫لها‬ ‫المعنوية‬ ‫زوجها‬ ‫مساندة‬ ‫من‬ ‫بالرغم‬ ‫مكتئب‬

13. Obsessive compulsive disorder

14. OCD clinical features
 Obsession
intrusive and inappropriate thoughts, impulses, or
images that are experienced, at some time during the
disturbance, that cause marked anxiety or distress
 Compulsion
repetitive behaviors (e.g., hand washing,) or mental acts
(e.g., counting, repeating words) that the person feels
driven to perform in response to an obsession
*

15. OCD cont.
Prevalence
 Lifetime prevalence 2 -3%
 - men - women
1 1
 Co morbidity
Often co-morbid anxiety disorders, (social phobia
25%), depression (67%), eating disorders
 Age of onset
20 years

16. OCD Diagnosis ( DSM4 )
 A. Either obsessions or compulsions
 B. At some point during the course of the
disorder, the person has recognized that the
obsessions or compulsions are excessive or
unreasonable.

17. OCD Prognosis
20 to 30 % of patients have significant
improvement in their symptoms, and 40 to 50 %
have moderate improvement. The remaining 20
to 40 % of patients either remain ill or their
symptoms worsen

18. OCD case discussion

‫السيدة‬
(
‫م‬
)
,
35
‫سنة‬
,
‫مطلقة‬
,
‫العمر‬ ‫من‬ ‫الخامسة‬ ‫و‬ ‫الرابعة‬ ‫في‬ ‫طفلين‬ ‫لديها‬
,
‫منذ‬ ‫تعاني‬
5
‫الفحص‬ ‫و‬ ‫التدقيق‬ ‫إعادة‬ ‫في‬ ‫يتمثل‬ ‫متكرر‬ ‫سلوك‬ ‫من‬ ‫سنوات‬
.

‫حوالي‬ ‫تقضي‬
5
‫منزلها‬ ‫في‬ ‫المتكرر‬ ‫الفحص‬ ‫و‬ ‫التدقيق‬ ‫في‬ ‫يوميا‬ ‫ساعات‬
,
‫ت‬
‫تأكد‬
‫مكانه‬ ‫في‬ ‫شيء‬ ‫كل‬ ‫أن‬
,
‫مطفأة‬ ‫الكهربائية‬ ‫األجهزة‬ ‫كافة‬ ‫أن‬
(
‫المكوي‬
,
‫الغسا‬
‫لة‬
,
‫الفرن‬
,
) ...

‫و‬ ‫المنزل‬ ‫من‬ ‫التأكد‬ ‫في‬ ‫ساعة‬ ‫نصف‬ ‫حوالي‬ ‫تقضي‬ ‫المنزل‬ ‫من‬ ‫الخروج‬ ‫قبل‬
‫خلوه‬
‫خطر‬ ‫أي‬ ‫من‬
(
‫حريق‬ ‫اشتعال‬
)

‫السيدة‬ ‫تعاني‬ ‫كما‬
(
‫م‬
)
‫معينة‬ ‫طقوس‬ ‫تكرار‬ ‫من‬
(
‫الباب‬ ‫إغالق‬ ‫و‬ ‫فتح‬
3
‫مرات‬
‫متتالية‬
)
‫بداخل‬ ‫باب‬ ‫أي‬ ‫إغالق‬ ‫أو‬ ‫فتح‬ ‫عند‬ ‫أو‬ ‫المنزل‬ ‫مغادرة‬ ‫أو‬ ‫دخول‬ ‫عند‬
‫المنزل‬
.

‫السيدة‬
(
‫م‬
)
‫حي‬ ‫االنفصال‬ ‫إلى‬ ‫النهاية‬ ‫في‬ ‫أدت‬ ‫صعبة‬ ‫عائلية‬ ‫بظروف‬ ‫مرت‬
‫تعيش‬ ‫ث‬
‫طفليها‬ ‫مع‬ ‫والدها‬ ‫منزل‬ ‫في‬ ‫حاليا‬
.

‫السيدة‬ ‫تعرضت‬
(
‫م‬
)
‫حين‬ ‫والديها‬ ‫انفصال‬ ‫بعد‬ ‫صعبة‬ ‫نفسية‬ ‫ضغوط‬ ‫إلى‬
‫في‬ ‫كانت‬
‫عمرها‬ ‫من‬ ‫عشر‬ ‫الخامسة‬
.

19. Post traumatic stress disorder

20. PTSD clinical features.
 Traumatic event
 Re experience
 Avoidance
 Hyper arousal
*

21. PTSD cont.
Prevalence
 lifetime prevalence of PTSD is estimated to be
about 8%
 - men - women
1 2
 Co morbidity
75% have depressive disorders, substance-related
disorders, other anxiety disorders

22. PTSD Diagnosis ( DSM4 )
 A. Exposure to a traumatic event
 B. Re experience
 C. Avoidance
 D. Hyper arousal
*

23. PTSD Prognosis
 The delay can be as short as 1 week or as long as 30
years.
 Course
30 % of patients recover completely
40 % continue to have mild symptoms
20 % continue to have moderate symptoms
10 % remain unchanged or become worse.
After 1 year, about 50 %of pat ients will recover.

24. PTSD case discussion

‫السيد‬
(
(x
27
‫سنة‬
,
‫متزوج‬
,
‫العمر‬ ‫من‬ ‫الثانية‬ ‫في‬ ‫طفلة‬ ‫لديه‬
,
‫ش‬
‫هد‬
‫غزة‬ ‫على‬ ‫الحرب‬ ‫أثناء‬ ‫لمنزل‬ ‫قصفا‬
,
‫منذ‬ ‫بدأ‬
8
‫من‬ ‫بالمعاناة‬ ‫شهور‬
‫مزعجة‬ ‫كوابيس‬ ‫و‬ ‫أحالم‬
,
‫االستثارة‬ ‫سرعة‬
,
‫متكر‬ ‫أفكار‬ ‫و‬ ‫صور‬
‫رة‬
‫القصف‬ ‫بحادثة‬ ‫خاصة‬
.

‫السيد‬ ‫يعاني‬ ‫كما‬
(
(x
‫التركيز‬ ‫على‬ ‫القدرة‬ ‫عدم‬ ‫من‬
,
‫النوم‬ ‫اضطراب‬
,
‫قلق‬ ‫و‬ ‫توتر‬

‫السيد‬ ‫يحاول‬
(
(x
‫بالحدث‬ ‫تذكره‬ ‫أصوات‬ ‫أو‬ ‫أماكن‬ ‫أو‬ ‫مشاهد‬ ‫أي‬ ‫تجنب‬
‫الصادم‬

‫السيد‬ ‫أصبح‬ ‫لذلك‬ ‫نتيجة‬
(
(x
‫منعزال‬
,
‫و‬ ‫عمله‬ ‫إلى‬ ‫الذهاب‬ ‫عن‬ ‫توقف‬
‫االقتصادية‬ ‫ظروفه‬ ‫ساءت‬
.

25. Panic disorder

26. Panic disorder
clinical features
 Palpitations, chest pain, choking sensation,
dizziness, breathlessness, tingling in the hands
and feet, sweating, nausea or abdominal distress.
 Emotional and behavioural symptoms
 Fear of dying, losing control, going mad
 Feeling of unreality - depersonalisation
 Need to exit situation
*

27. Panic disorder cont.
 Prevalence 1% to 5%
men - women
1 2 to 3
 Co morbidity
91% have at least another psychiatric disorder
84% with agoraphobia
10% with major depressive disorder.

28. Panic disorder Diagnosis ( DSM4 )
 Recurrent panic attacks
 1 month of :
concern about having another attack
worry about the implication of the attack
 A discrete period of intense fear or
discomfort, in which four (or more) of panic
symptoms developed abruptly and reached a
peak within 10 minutes

29. Panic disorder prognosis
Onset in late adolescence or early adulthood
Panic disorder, in general, is a chronic disorder,
although its course is variable.
30 to 40 % of patients seem to be symptom free.
50 % have symptoms that are sufficiently mild
not to affect their lives significantly.
10 to 20 % continue to have significant
symptoms.

30. Agoraphobia

31. Agoraphobia clinical features
 Autonomic symptoms - palpitations, sweating
 Psychological symptoms - fear
 Behavioural symptoms - avoidance
 Cognitive symptoms - “ I might have died”

32. Agoraphobia cont.
 Prevalence 2% to 6%
- men - women
1 3
 Co morbidity
75% at least have panic disorder

33. Agoraphobia Diagnosis ( DSM4 )
 Anxiety about being in places or situations from
which escape might be difficult (or embarrassing) or
in which help may not be available in the event of
having an unexpected or situationally predisposed
panic attack or panic-like symptoms.
 The situations are avoided (e.g., travel is restricted) or
else are endured with marked distress or with anxiety
about having a panic attack or panic-like symptoms

34. Agoraphobia prognosis
Most cases of agoraphobia are thought to be
caused by panic disorder. When the panic
disorder is treated, the agoraphobia often
improves with time

35. Panic disorder and Agoraphobia case
discussion

‫السيد‬
(
‫ص‬
)
25
‫عام‬
,
‫أعزب‬
,
‫جامعي‬ ‫طالب‬
,
‫قبل‬ ‫نقله‬ ‫تم‬
9
‫بالمستشفى‬ ‫الطوارئ‬ ‫قسم‬ ‫إلى‬ ‫شهور‬
‫القلب‬ ‫في‬ ‫بخفقان‬ ‫المفاجئة‬ ‫إصابته‬ ‫بسبب‬ ‫بالجامعة‬ ‫محاضرة‬ ‫في‬ ‫تواجده‬ ‫أثناء‬ ‫العام‬
,
‫القدرة‬ ‫عدم‬
‫التنفس‬ ‫على‬
,
‫التوازن‬ ‫على‬ ‫القدرة‬ ‫فقدان‬
,
‫رجفة‬
,
‫السيطرة‬ ‫على‬ ‫القدرة‬ ‫بعدم‬ ‫إحساس‬
,
‫إحساس‬
‫الموت‬ ‫من‬ ‫الخوف‬ ‫و‬ ‫بالرعب‬ ‫شديد‬
,
‫لمدة‬ ‫األعراض‬ ‫استمرت‬
15
‫فجأة‬ ‫انتهت‬ ‫ثم‬ ‫دقيقة‬
.

‫ق‬ ‫عضوي‬ ‫مرض‬ ‫بأي‬ ‫إصابته‬ ‫يتبين‬ ‫لم‬ ‫بالمستشفى‬ ‫الطبية‬ ‫الفحوص‬ ‫جميع‬ ‫إجراء‬ ‫بعد‬
‫إلى‬ ‫يؤدي‬ ‫د‬
‫األعراض‬ ‫تلك‬ ‫حدوث‬
.

‫النفسية‬ ‫الصحة‬ ‫مركز‬ ‫إلى‬ ‫تحويله‬ ‫و‬ ‫مهدئة‬ ‫حقنة‬ ‫إعطائه‬ ‫تم‬
.

‫السيد‬ ‫أرجأ‬
(
‫ص‬
)
‫بالدراسة‬ ‫بانشغاله‬ ‫متعلال‬ ‫النفسي‬ ‫لألخصائي‬ ‫زيارته‬
.

‫السيد‬ ‫أصيب‬ ‫أيام‬ ‫عدة‬ ‫بعد‬
(
‫ص‬
)
‫بالمنزل‬ ‫وجوده‬ ‫خالل‬ ‫السابقة‬ ‫األعراض‬ ‫بنفس‬
,
‫أصب‬ ‫ثم‬
‫يعاني‬ ‫ح‬
‫بمعدل‬ ‫مستمر‬ ‫بشكل‬ ‫النوبة‬ ‫تلك‬ ‫من‬
4
‫إلى‬
5
‫شهريا‬ ‫مرات‬
.

‫بعد‬
4
‫السيد‬ ‫أصبح‬ ‫النوبات‬ ‫بتلك‬ ‫إصابته‬ ‫من‬ ‫شهور‬
(
‫ص‬
)
‫مكتئب‬ ‫مزاج‬ ‫من‬ ‫يعاني‬
,
‫قلق‬
‫من‬ ‫شديد‬
‫التالية‬ ‫بالنوبة‬ ‫إصابته‬ ‫توقع‬
.

‫السيد‬ ‫أصبح‬
(
‫ص‬
)
‫منعزال‬
,
‫أماكن‬ ‫في‬ ‫تواجده‬ ‫عند‬ ‫الشديد‬ ‫القلق‬ ‫من‬ ‫بحالة‬ ‫يصاب‬ ‫أصبح‬
‫يتواجد‬
‫الناس‬ ‫من‬ ‫كبير‬ ‫حشد‬ ‫فيها‬
,
‫العام‬ ‫األماكن‬ ‫يتجنب‬ ‫أصبح‬ ‫و‬ ‫الجامعة‬ ‫إلى‬ ‫الذهاب‬ ‫عن‬ ‫فامتنع‬
‫و‬ ‫ة‬
‫الهلع‬ ‫من‬ ‫أخرى‬ ‫نوبة‬ ‫أصابته‬ ‫إن‬ ‫باإلحراج‬ ‫فيها‬ ‫يشعر‬ ‫قد‬ ‫التي‬ ‫التجمعات‬
.

36. Social Phobia and Specific Phobia

37. Clinical features
Social Phobia
 Fear of acting in a way that will be embarrassing
or humiliating or appear ridiculous
 Feared social situation associated with intense
anxiety and distress - blushing, tremor,butterflies
 Leads to avoidance of social situations that
involve e.g., eating, public speaking – isolation
*

38. Social Phobia cont.
 Prevalence 2% to 13%
- men - women
1 2
 Co morbidity
other anxiety disorders, mood disorders, substance-
related disorders, and bulimia nervosa.

39. Social Phobia( DSM4 )
 A marked and persistent fear of one or more
social or performance situations.
 The person recognizes that the fear is excessive
or unreasonable ..
 Avoidance, interferes significantly with the
person's normal routine

40. Social Phobia prognosis
Social phobia tends to have its onset in late
childhood or early adolescence. Social phobia
tends to be a chronic disorder

41. Social Phobia case discussion

‫السيدة‬
(
‫ل‬
)
27
‫عام‬
,
‫متزوجة‬
,
‫إعدادية‬ ‫مدرسة‬ ‫في‬ ‫معلمة‬ ‫تعمل‬
,
‫عدة‬ ‫من‬ ‫تعاني‬
‫خصوص‬ ‫و‬ ‫الناس‬ ‫من‬ ‫مجموعة‬ ‫مع‬ ‫التواصل‬ ‫أو‬ ‫بمخاطبة‬ ‫تقوم‬ ‫حين‬ ‫تبدأ‬ ‫أعراض‬
‫ا‬
‫لها‬ ‫بالنسبة‬ ‫معروفين‬ ‫الغير‬
,
‫ال‬ ‫خفقان‬ ‫زيادة‬ ‫في‬ ‫تتمثل‬ ‫األعراض‬ ‫تلك‬
‫قلب‬
,
‫جفاف‬
‫الحلق‬ ‫و‬ ‫الفم‬
,
‫تعرق‬
,
‫بالنفس‬ ‫ثقة‬ ‫عدم‬ ‫و‬ ‫تردد‬
,
‫ستتلفظ‬ ‫بأنها‬ ‫إحساس‬
‫غير‬ ‫بأشياء‬
‫اآلخرين‬ ‫قبل‬ ‫من‬ ‫بالسخرية‬ ‫ستواجه‬ ‫منطقية‬
.

‫السيدة‬
(
‫ل‬
)
‫الغرباء‬ ‫بوجود‬ ‫ترتاح‬ ‫ال‬ ‫دوما‬ ‫كانت‬ ‫بأنها‬ ‫تقول‬
,
‫بالرا‬ ‫تشعر‬
‫حين‬ ‫حة‬
‫وحدها‬ ‫تكون‬
,
‫منها‬ ‫اآلخرين‬ ‫سخرية‬ ‫من‬ ‫تخاف‬
,
‫تمنعها‬ ‫لم‬ ‫المشاعر‬ ‫تلك‬ ‫لكن‬
‫من‬
‫االجتماعية‬ ‫حياتها‬ ‫ممارسة‬ ‫و‬ ‫الجامعة‬ ‫في‬ ‫دراستها‬ ‫إنهاء‬
.

‫من‬ ‫تعاني‬ ‫أصبحت‬ ‫جسدية‬ ‫أعراض‬ ‫إلى‬ ‫تحولت‬ ‫و‬ ‫المشاعر‬ ‫تلك‬ ‫ساءت‬ ‫حين‬
‫فلف‬
‫المجتمع‬ ‫مع‬ ‫التواصل‬ ‫و‬ ‫الظهور‬ ‫فكرة‬ ‫لمجرد‬ ‫شديد‬
.

‫ك‬ ‫و‬ ‫بالمدرسة‬ ‫اآلباء‬ ‫مجلس‬ ‫في‬ ‫كعضو‬ ‫تعيينها‬ ‫بعد‬ ‫سوء‬ ‫األعراض‬ ‫ازدادت‬
‫ان‬
‫الناس‬ ‫من‬ ‫كبير‬ ‫عدد‬ ‫مع‬ ‫التواصل‬ ‫عليها‬
.

‫السيدة‬ ‫أصبحت‬
(
‫ل‬
)
‫ح‬ ‫على‬ ‫سلبا‬ ‫أثر‬ ‫مما‬ ‫العمل‬ ‫إلى‬ ‫الذهاب‬ ‫فكرة‬ ‫تطيق‬ ‫ال‬
‫ياتها‬
.

42. Specific phobias

43. Specific phobias

‫الحوادث‬ ‫رهاب‬
Dystychiphobia

‫الحيوان‬ ‫هاب‬ُ‫ر‬
Zoophobia

‫النمل‬ ‫هاب‬ُ‫ر‬
Myrmecophobia

‫السيارات‬ ‫هاب‬ُ‫ر‬
Motorphobia

‫النحل‬ ‫هاب‬ُ‫ر‬
Apiphobia

‫الطير‬ ‫هاب‬ُ‫ر‬
Ornithophobia

‫الدم‬ ‫هاب‬ُ‫ر‬
Haemophobia

‫الجسور‬ ‫هاب‬ُ‫ر‬
Gephyrophobia

‫القطط‬ ‫هاب‬ُ‫ر‬
Felinophobia

‫اإلختناق‬ ‫هاب‬ُ‫ر‬
Anginaphobia

‫التلوث‬ ‫هاب‬ُ‫ر‬
Molysomophobia

‫الشوارع‬ ‫عبور‬ ‫هاب‬ُ‫ر‬
Agyrophobia

‫الظالم‬ ‫هاب‬ُ‫ر‬
Nyctophobia

‫األسنان‬ ‫طبيب‬ ‫هاب‬ُ‫ر‬
Dentophobia

‫األعماق‬ ‫هاب‬ُ‫ر‬
Bathophobia

‫األطباء‬ ‫هاب‬ُ‫ر‬
Iatrophobia

44. Specific phobias

‫الكالب‬ ‫هاب‬ُ‫ر‬
Cynophobia

‫عامة‬ ‫األشياء‬ ‫ل‬ُ‫ك‬ ‫هاب‬ُ‫ر‬
Panophobia

‫الريش‬ ‫هاب‬ُ‫ر‬
Pteronophobia

‫الطيران‬ ‫هاب‬ُ‫ر‬
Aviophobia

ً‫ال‬‫لي‬ ‫الغابات‬ ‫هاب‬ُ‫ر‬
Nyctohylophobia
‫الضفادع‬ ‫هاب‬ُ‫ر‬
Batrachophobia

‫الشعر‬ ‫هاب‬ُ‫ر‬
Chaetophobia, Trichophobia

‫الفرو‬ ‫و‬ ‫الحيوان‬ ‫جلد‬ ‫هاب‬ُ‫ر‬
Doraphobia

‫الخيل‬ ‫هاب‬ُ‫ر‬
Equinophobia, Hippophobia

‫المستشفيات‬ ‫هاب‬ُ‫ر‬
Nosocomephobia

‫الحقن‬ ‫هاب‬ُ‫ر‬
Trypanophobia

‫القفز‬ ‫هاب‬ُ‫ر‬
Catapedaphobia

‫البرق‬ ‫و‬ ‫الرعد‬ ‫هاب‬ُ‫ر‬
Brontophobia

‫العث‬ ‫هاب‬ُ‫ر‬
Mottephobia

‫األبر‬ ‫هاب‬ُ‫ر‬
Aichmophobia, Belonephobia

45. Specific phobias

‫المفتوحة‬ ‫العالية‬ ‫األماكن‬ ‫هاب‬ ُُ
Aeroacrophobia

‫الجراحية‬ ‫العمليات‬ ‫هاب‬ُ‫ر‬
Tomophobia

‫غلقة‬ُ‫م‬‫ال‬ ‫األماكن‬ ‫هاب‬ُ‫ر‬
Claustrophobia

‫القطارات‬ ‫و‬ ‫الحديد‬ ‫سكك‬ ‫هاب‬ُ‫ر‬
Siderodromophobia

‫المطر‬ ‫هاب‬ُ‫ر‬
Ombrophobia, Pluviophobia

‫الفئران‬ ‫هاب‬ُ‫ر‬
Zemmiphobia

‫الزواحف‬ ‫هاب‬ُ‫ر‬
Herpetophobia

‫الثعابين‬ ‫هاب‬ُ‫ر‬
Ophidiophobia

‫العناكب‬ ‫هاب‬ُ‫ر‬
Arachnophobia

‫التقيأ‬ ‫هاب‬ُ‫ر‬
Emetophobia

‫األشعة‬ ‫هاب‬ُ‫ر‬
Radiophobia

46. Clinical features cont.
Specific phobias
 Anxiety provoked only in response to a specific
stimulus or situation
 Panic attacks can occur
 Degree of disability is related to ease or
difficulty of avoiding the feared object
 Feared object usually something that posed a
threat at some time in history - animals, storms,
heights, darkness, blood

47. Specific phobias prognosis
As with other anxiety disorders, limited
prospective epidemiological data exist on the
natural course of specific phobia. Because
patients with isolated specific phobias rarely
present for treatment, research on the course of
the disorder in the clinic is limited .

48. Specific phobias case discussion

‫السيد‬
(
‫ع‬
)
33
‫عام‬
,
‫شديد‬ ‫قلق‬ ‫من‬ ‫يعاني‬
,
‫خفقان‬ ‫سرعة‬
‫القلب‬
,
‫تعرق‬
,
‫بالرجفة‬ ‫إحساس‬
,
‫البطن‬ ‫في‬ ‫آالم‬
,
‫ص‬
‫عوبة‬
‫ضي‬ ‫أماكن‬ ‫في‬ ‫تواجده‬ ‫عند‬ ‫تظهر‬ ‫األعراض‬ ‫تلك‬ ‫التنفس‬
‫أو‬ ‫قة‬
‫مغلقة‬
.

‫السيد‬ ‫أصبح‬
(
‫ع‬
)
‫األماك‬ ‫تلك‬ ‫مثل‬ ‫في‬ ‫التواجد‬ ‫يتجنب‬
‫و‬ ‫ن‬
‫يض‬ ‫مما‬ ‫بها‬ ‫يسكن‬ ‫التي‬ ‫البناية‬ ‫في‬ ‫المصعد‬ ‫خصوصا‬
‫إلى‬ ‫طره‬
‫مع‬ ‫يعيش‬ ‫حيث‬ ‫الخامس‬ ‫الطابق‬ ‫إلى‬ ‫األقدام‬ ‫على‬ ‫الصعود‬
‫أسرته‬
.

49. Treatment of Anxiety Disorders
Pharmacotherapy

50. Treatment of Anxiety Disorders
1. Antidepressants
- SSRIs - paroxetine, citalopram - can initially
worsen panic attacks
- TCAs - imipramine, clomipramine
2. Benzodiazepines - good short term relief but
high risk of dependency - alprazolam

51. Treatment of Anxiety Disorders
Psychotherapy

52. Treatment of Anxiety Disorders
Behavior Therapy
Systematic Desensitization
- Relaxation Training
- Hierarchy Construction
- Desensitization of the Stimulus

53. Treatment of Anxiety Disorders
Behavior Therapy cont.
Therapeutic-Graded Exposure
Flooding
Modeling

54. Treatment of Anxiety Disorders
Cognitive Therapy
Eliciting Automatic Thoughts
Testing Automatic Thoughts
Identifying Maladaptive Assumptions
Testing the Validity of Maladaptive Assumptions

55. Treatment of Anxiety Disorders
Eye Movement Desensitization and Reprocessing
)EMDR)
Phase 1: History and Treatment Planning
Phase 2: Preparation
Phase 3: Assessment
Phase 4: Desensitization
Phase 5: Installation
Phase 6: Body scan
Phase 7: Closure
Phase 8: Reevaluation

56. Questions