Anxiety disorders are characterized by excessive anxiety and associated symptoms that impair functioning. There are several types, including generalized anxiety disorder, social anxiety disorder, and post-traumatic stress disorder. Physiologically, anxiety disorders are linked to abnormalities in neurotransmitter systems like norepinephrine, GABA, and serotonin. Symptoms vary by disorder but can include excessive worry, poor concentration, restlessness, sleep issues, sweating, and fast heartbeat. Diagnosis involves medical exams and ruling out other potential causes. Treatment includes counseling, stress management, exercise, benzodiazepines, antidepressants, and beta blockers, though these carry side effects like sedation and nausea.

1. ANXIETY DISORDERS

2. DEFINITION:
Anxiety disorders include a constellation of disorders in which anxiety
and associated symptoms are experienced at level of severity that impairs
functioning.
Types of Anxiety Disorder
 1.Generalised Anxiety Disorder.
 2.Social Anxiety Disorder.
 3.Post Trauma Stress Disorder

3. PATHOPHYSIOLOGY:
Noradrenergic model :
 The locus ceruleus may have a role in regulating anxiety, as it activates
norepinephrine (NE) release and stimulates the sympathetic and
parasympathetic nervous systems.
 Chronic noradrenergic overactivity downregulates
α2 adrenoreceptors in patients with generalized anxiety disorder (GAD) and
posttraumatic stress disorder (PTSD).
 Patients with social anxiety disorder (SAD) appear to have a
hyperresponsive adrenocortical response to psychological stress.
γ- aminobutyric acid (GABA) receptor model:
 Anxiety symptoms may be linked to underactivity of GABA systems or
downregulated central BZ receptors.
 Abnormalities of GABA inhibition may lead to increased response to stress
in PTSD patients.

4. Serotonin (5-HT) model:
 The 5-HT and 5-HT2 antagonist meta-chlorophenylpiperazine (m-CPP)
causes increased anxiety in PTSD patients.
 Dysregulation of the hypothalamic-pituitary-adrenal axis may be a risk
factor for eventual development of PTSD.

5. Symptoms:
Generalized Anxiety disorders:
Psychological and congnitive :
 Excessive anxiety, Poor concentration or mind going blank.
Physical symptoms
 Restlessness, Fatigue, Sleep disturbance, Irritability
Social Anxiety Disorder
Some feared situations
 Eating or writing in front of others, Interacting with authority
figures, Speaking in public,
Physical symptoms
 Diarrhea, Sweating, Tachycardia
Posttraumatic stress disorder:
 Decreased concentration
 Insomnia

6. DIAGNOSIS:
 Physical and mental status examination.
 Patients with GAD have irritable bowel syndrome.
 Anxiety symptoms may associated with medical illness
Cardiovascular
Respiratory system
 Anxiety symptoms may psychiatric illnesses
mood disorders
Schizophrenia

7. Non drug Treatment:
 Short –term counseling
 Stress management
 exercise

8. Drug management:
Benzodiazepines - Diazepam - 2-40 mg/day
Oxazepam - 30-120mg/day
Lorazepam - 0.5-10 mg/day
Azapirones - Buspirone - 15-60 mg/day
Gepirone
Antihistamines - Hydroxyzine 200-400mg/day
β blocker - propranolol

9. MECANISM OF ACTION

10. Pharmacological Treatment for Generalized Anxiety Disorder

11. Pharmacological Treatment for Social Anxiety Disorder

12. Pharmacological Treatment of Post Trauma Stress Disorder

13. Adverse effect:
Benzodiazepines: sedation, vertigo , increased appetite weight gain.
Azapirone: dizziness,nausea,headache.
Antihistamines: confusion,nausea, constipation.
β- blockers - bradycardia,wheezing
Drug intractions:
BZs : The combination of BZs with alcohol or other CNS depressants
may be fatal.
Antacids - decreased rate of benzodiazepine absorption
β blocker :combination with cimitidine increase metabolism of propranolol.

14. THANK YOU