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1. Anxiety Disorders
Saraswati Dhungana, MD
Lecturer
Department of Psychiatry and Mental Health
Maharajgunj Medical Campus
May 20, 2019
F40-F48 Neurotic, stress-related and somatoform disorders

2. Contents
• Definition
• Epidemiology
• Types
• Etiology
• Diagnosis
• Management

3. Anxiety: Definition
• A feeling of apprehension about a future threat
• Vs Fear: Response to an immediate threat
• Anxiety disorders- group of psychiatric conditions that involve
excessive anxiety

4. Normal Versus Pathologic Anxiety
• Normal anxiety- adaptive
• 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-
excessive
impairs function

5. General Considerations
• Often have an early onset- teens or early twenties
• 2:1 female predominance
• Waxing and waning course over lifetime
• Similar to major depression and chronic diseases
Functional impairment
Quality of life

6. Epidemiology
• Sixth leading cause of disability, in terms of YLDs, in both high-income (HI) and
low- and middle-income (LMI) countries.
• Women are twice as likely as men to have anxiety disorder
• Possible explanations
Women may be more likely to report symptoms
Men more likely to be encouraged to face fears
Women more likely to experience childhood sexual abuse
Women show more biological stress reactivity

7. • Cultural factors
• Culturally specific syndromes
Taijin kyofusho
Japanese fear of offending or embarrassing others
• Ratio of somatic to psychological symptoms appears similar across cultures

8. Types of anxiety disorders
• Panic Disorder
• Phobias
• Generalized Anxiety Disorder
• Specific anxiety disorders

9. Panic Disorder
• The abrupt onset of an episode of intense fear or discomfort
• Peaks in approximately 10 minutes
• Includes at least four of the following symptoms:

10. Signs and symptoms
• A feeling of imminent danger or doom
• The need to escape
• Palpitations
• Sweating
• Trembling
• Shortness of breath or suffocation
feeling
• A feeling of choking
• Chest pain or discomfort
• Nausea or abdominal discomfort
• Dizziness or lightheadedness
• A sense of things being unreal,
depersonalization
• A fear of losing control or "going
crazy"
• A fear of dying
• Tingling sensations
• Chills or hot flushes

11. Panic Disorder- Types
There are three types of Panic Attacks:
1. Unexpected - the attack "comes out of the blue" without warning 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, eg, an individual who
sometimes has attacks while driving.

12. Generalized Anxiety Disorder
• Excessive uncontrollable worry about everyday things.
• Affects daily functioning and can cause physical symptoms.
• Can occur with other anxiety disorders, depressive disorders, or
substance abuse.

13. Generalized Anxiety Disorder Contd..
• The focus of GAD worry can shift, usually focusing on issues like job,
finances, health of both self and family
• The intensity, duration and frequency of the worry are
disproportionate to the issue

14. Social anxiety disorder
An intense fear of social situations.
• Arises when the individual believes that they may be judged,
scrutinized or humiliated by others.
• 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.

15. Common anxiety provoking situations:
• public speaking
• talking with people in authority
• dating and developing close relationships
• 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
• using public bathrooms
• driving
• shopping

16. Specific anxiety disorders
• Disproportionate fear of a particular object or situation
Common examples: fear of flying, snakes, heights, etc.
Fear out of proportion to actual threat
Awareness that fear is excessive
Most specific phobias cluster around a few feared objects and
situations
High comorbidity of specific phobias

17. Specific Anxiety Disorders- Types:

18. Etiology
• Biopsychosocial Model
1. Biological
a. Genetics
b. Neurotransmitters
c. Overactive flight or fright response
2. Psychological
a. Personality
b. Coping
3. Social
a. Learning
b. Adverse social conditions

19. Differential Diagnoses

20. General treatment approaches:
Biopsychosocial model
• Pharmacotherapy
Antidepresssants
Anxiolytics
• Psychotherapy
Cognitive Behavior Therapy
Systemic desensitization
Relaxation

21. Dhat Syndrome

22. Nosology and concepts
• Term first used by Wig in 1960
• Culture bound sexual neurosis
• Preoccupied with loss of semen by nocturnal emissions or in urine
with no objective evidence
• Guilt and undue concern with the debilitating effects of loss of semen
on physical and psychological health

23. Presentation
• Young men, lower socio-economic class
• Vague multiple somatic and psychological symptoms
• Lack of physical strength, fatigue, lethargy, poor concentration,
forgetfulness, etc.
• Anxiety and depressive symptoms
• With or without sexual dysfunction

24. • Extended to include Indian women presenting with somatic
symptoms a/w leucorrhoea
• Explained as due to loss of vital fluid

25. Management
• Considered equivalent to anxiety disorder
• Psychological explanation
• Pharmacological management with Antidepressants

26. Conversion Disorders
• Presence of symptoms or deficits affecting motor or sensory function,
suggesting a medical or neurological disorder
• Sudden onset
• Significant psychosocial stressor
• Clear temporal relationship between stressor and symptoms

27. Contd…
• Symptoms usually not intentionally produced or feigned
• Usually a secondary gain
• Detailed physical examination and medical investigations do not
reveal any disorder or substance use disorder

28. THANK YOU