Definition Anxiety is a pathological state characterized by afeeling of dread accompanied by somatic signs thatindicate a hyperactive autonomic nervous system. It is differentiated from fear, which is a response to aknown and reasonable cause.
A- Biological Excessive autonomic reaction with increasedsympathetic tone, results in increased release ofcatecholamines. Increased norepinephrine metabolites (3-methoxy 4-hydroxyphenyl glycol). Hyperactivity in locus ceruleus (centre of adrenergicneurones). Decreased GABA causes CNS hyperactivity.
B- Learning theory Anxiety is produced by frustration or stress. Onceexperienced, anxiety becomes a conditionedresponse to other, less severe, frustrating orstressful situation----- “Classical conditioning”. Social learning theory: may be learned throughidentification and imitation of anxiety patterns inparents.
Clinical subtypes1) Panic disorder2) Generalized anxiety disorder.3) Specific phobia.4) Social phobia.5) Obsessive compulsive disorder.6) Post-trauamtic stress disorder.7) Substance-induced anxiety disorder.8) Anxiety disorder due to general medical condition.
Obsessive-compulsive disorder (OCD) Obsessions: Repetitive thoughts, impulses, images or ruminations. Resistence to this repetition, which is associated withincreased anxiety. Realization that these thoughts, impulses or images areunreasonable, unpleasant and unwanted. Recognition that they are the product of one’s own mind(not imposed from without as in thought insertion).
Compulsions: Repetitive behaviours or mental acts are performed inresponse to an obsessions. The behaviours or mental acts aim at preventing orreducing distress. They are significantly interfere with the patient’sfunctioning. Not substance-induced or not due to general medicalconditions.
Specific phobiaA. Excessive, unreasonable and persistent fear cued bythe presence of a specific object, e.g., Animal type. Natural environment type (e.g., heights, storms, water). Blood-injection-injury type. Situational type (e.g., airplanes, elevators, closed or openedplaces).B. The person recognizes that the fear is excessive orunreasonable.C. The person avoids the feared situation.
Social phobia Excessive, unreasonable and persistent fear of socialsituations. Exposure to the feared social situations provokesanxiety. The person recognizes that his fear is excessive andunreasonable. The person avoids the feared situations.
Panic disorder Definition:Recurrent unexpected panic attacks, followedby one month or more of persistent concernabout having additional attacks, and significantchange in behaviour.
Panic attack Intense fear or discomfort, in which four or more of thefollowing symptoms developed abruptly and reached apeak within 10 minutes. Palpitaion, sweating, trembling, tachypnea, feeling ofchoking, chest pain, nausea, dizziness, derealization(feelings of unreality), depersonalization (being detachedfrom oneself), fear of going crazy, fear of dying,numbness and hot flushes. Not substance-induced or not due to general medicalcondition.
Generalized anxiety disorder (GAD) Excessive anxiety and worry for 6 months or more aboutactivities of daily living. The anxiety and worry are associated with three or more ofthe following: Restlessness, easily fatigued, difficulty concentratingirritability, muscle tension and sleep disturbance. Significant impairement in social , occupational functions. Not substance-induced or not due to general medicalcondition.
Posttraumatic stress disorder (PTSD) The person exposed to or witnessed a traumatic event thatinvolved actual or threatened death or serious injury to self orothers. Re-experiencing of the traumatic event in dreams, images orthoughts. Avoidance of thoughts, places, and persons associated with thetrauma. Increased arousal; ittitability, difficulty falling asleep, andhypervigilance. Duration of the disturbance is more than one month. D.D if the duration less than one month, it is called acutestress disorder.