Anxiety…• Is it a normal emotion?• Reaction to stress/ threat events• Physical symptoms of anxiety?– Tremor– Sweating– Palpitations– …• Mental symptoms of anxiety?– Worry– Can’t relax– Easily startled– ..
• Anxiety: the phenotype.• Anxiety can bedeconstructed, or brokendown, into the two coresymptoms of fear andworry.• These symptoms arepresent in all anxietydisorders, although whattriggers them may differfrom one disorder to thenext.
Aetiology?• Often due to an interaction of biological andpsychosocial factors:• Genetic vulnerability + past trauma + currentstress…• In the CNS: anxiety is medicated by NTserotonin and noradrenaline• Peripherally, the symptoms of anxiety aremedicated by the autonomic nervous system(esp sympathetic system)
• When does anxiety become a disorder?• Types of anxiety disorders?– Specific phobias– Social phobia– Panic disorder– Generalized anxiety disorder– Obsessive compulsive disorder– ….and others.
Diagnostic criteria ICD-10• F40 Phobic anxiety disorders• F40.0 Agoraphobia• .00 Without panic disorder• .01 With panic disorder• F40.1 Social phobias• F40.2 Specific (isolated) phobias• F40.8 Other phobic anxiety disorders• F40.9 Phobic anxiety disorder, unspecified
• F41 Other anxiety disorders• F41.0 Panic disorder [episodic paroxysmal anxiety]• .00 Moderate• .01 Severe• F41.1 Generalized anxiety disorder• F41.2 Mixed anxiety and depressive disorder• F41.3 Other mixed anxiety disorders• F41.8 Other specified anxiety disorders• F41.9 Anxiety disorder, unspecified
Specific phobias…• A strong, irrational fear of something thatposes little or no actual danger.
ICD diagnostic criteria for specific phobia…• The psychological or autonomic symptomsmust be due to anxiety(not secondary to other symptoms such asdelusions or obsessions)• The anxiety must be restricted to the presenceof the particular object or situation• Phobic situation is avoided whenever possible
Social phobia• “In any social situation, I feel fear.…..I feel anxious before I even leave the house,and it becomes worse as I get closer to a class,a party, or whatever. I feel sick in my stomach-it almost felt like I had the flu. My heartpounds, my palms get sweaty.”
ICD criteria to diagnose social phobia…• All the symptoms are primarily due to anxiety• The anxiety is restricted to (or mostly seen in)particular social situations• These social situations are avoided as far aspossible
Panic disorder• “For me, a panic attack is almost a violentexperience. I feel like I’m losing control. My heartpounds really hard, I feel like I can’t get my breath,and there’s an overwhelming feeling that things arecrashing in on me.• ….It started 10 years ago. I was sitting in my roomand this thing came out of the blue. I felt like I wasdying.• ….In between attacks there is this dread and anxietythat it’s going to happen again. I’m afraid to go backto places where I’ve had an attack”.
Panic disorder…diagnosis:1. Several ‘attacks’ of anxiety should haveoccurred during one month2. The panic attacks occur when there is noobjective danger3. Not confined to any particular situation4. In-between attacks, there is comparativefreedom from anxiety (though pt often hasanticipatory anxiety
OCD- diagnostic criteria1. Obsessional thoughts or compulsive acts2. for at least 2 weeks3. Symptoms cause distress or interfere with activities4. The obsessional thoughts arei. Recognized to be the person’s own thoughts or impulsesii. At least one thought or impulse must be resistediii. The thought of carrying out the act itself must not bepleasurableiv. The thoughts, images or impulses are unpleasantlyrepetitive
Obsessive compulsive disorder“Getting dressed in the morning was tough, because Ihad a long routine. If I didn’t follow the routine, I’dget anxious and would have to get dressed again. Iworried that if I didn’t follow the routine, my parentswere going to die.This was completely irrational, but the thoughts causedme lots of anxiety.Because of the time I spent on rituals, I was unable todo a lot of things that were important to me.”Males = femalesOnset: often childhood or early adult life
Management of anxiety disorders- overview• Often best management:Combination of medication+Psychological therapy
Medication used for anxiety?• Anxiolytics: usually medication that increasesserotonin levelsE.g. SSRISome TCAs, e.g.ClomipramineVenlafaxine
Psychological therapies for anxiety disorders…• Different types of therapies for differentdisorders• Basic relaxation strategies maybe helpful ingeneral e.g.– Deep breathing– Progressive muscle relaxation• More specific therapies:– OCD: Cognitive behaviour therapy– Behaviour therapy