Anxiety Disorder FKG 2012

8/16/2019 Anxiety Disorder FKG 2012

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Anxiety Disorder

Ronny T Wirasto

Dept of PsychiatryFaculty of Medicine-Faculty of

Dentistry

Gadjah Mada University

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on

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Dopamine

Histamine

Norepinephrine

Epinephrine

Glutamate

Serotonin

GABA (γ-Aminobutyrate Acid)

Glycine

Nitric Oxide

0opeRe1ard

Disease


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• $tress2a reaction to a situation3 not the

situation itself4 not necessarily 5+ad6• #na+ility to cope 1ith environ.ental

de.ands in a healthy *51holeness6,1ay causes the fra/.entation anddisruption of our so.a *+ody, and ourthin7in/ *psyche,8

• This stressful situation .a7es .any

people 1ho experience it3 physically ill8 – y de9nition this reaction of 5stress6 has

the potential to cause physical har.8


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• $tress can +e descri+ed as acircu.stance that distur+s3 or is li7ely

to distur+3 the nor.al physiolo/ical orpsycholo/ical functionin/ of a person

•

di.inish the i.pact of the stressorand restore ho.eostasis

• 5Fi/ht or Fli/ht6 response is .ediated+y hypothala.us3 the sy.patheticnervous syste.3 and the adrenal.edulla8


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EUSTRESS

%ustress or positive stress occurs1hen your level of stress is hi/henou/h to .otivate you to .ove into

action to /et thin/s acco.plished8

DSTRESS

Distress or ne/ative stress occurs1hen your level of stress is either toohi/h or too lo1 and your +ody and&or.ind +e/in to respond ne/atively to

the stressors8


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5.iR-":;-3 .iR-"::

!"" $ociety of iolo/ical Psychiatry


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Psychophysiolo/y

• STRESS•

!"RMA# A!$ET% • A!$ET% DS"RDERS


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• $tress – A reaction to a situation3 not the situation itself

– the arousal3 +oth physical and .ental3 tosituations or events that 1e perceive asthreatenin/ or challen/in/

• %ustress is positive stress occurs 1hen

your level of stress is hi/h enou/h to.otivate you to .ove into action to /etthin/s acco.plished

• Distress is Distress or ne/ative stress

occurs 1hen your level of stress is eithertoo hi/h or too lo1 and your +ody and&or.ind +e/in to respond ne/atively to thestressors


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'or.al anxiety

• Anxiety is nor.al for the infant 1hois threatened +y separation fro.parents or +y loss of love

– for the children on their 9rst day inschool3

– for adolescents on their 9rst date

– for adults 1hen they thin7 a+out old a/eand death

– for anyone 1ho is faced 1ith illness


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Anxiety Disorder

• an inappropriate response to /ivensti.ulus +ased on its intensity or itsduration

• Prolon/ed Anxiety

• #nvolved C

– Physical Responses

– Psycholo/ical Responses *copin/.echanis.,

– $ocial Responses


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• iolo/y

• Psycholo/y

• $ocial-environ.ent

Threatenin/EEEE

%tiolo/y -Psychophysiopatholo/y


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Types (f Anxiety

• Generalied Anxiety Disorder

• $ocial Anxiety

•

Post Trau.atic $tress Disorder• (+sessive o.pulsive Disorder

• Pho+ic Disorders

•

Panic Disorder 1ith or 1ithouta/orapho+ia

• Atypical Anxiety Disorder


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Dia/nostic riteria for GAD

Motor Tension Autonomic&yperacti'ity

ii*ance or Scannin

Tre.+lin/ $hortness of +reath Feelin/ 7eyed up or on%d/e

Muscle tension Palpitations ortachycardia

$tartlin/ easy

Restlessness $1eatin/ or cold cla..yhands

Diculty concentratin/

%asily fati/ued Dry .outh Trou+le fallin/ asleep orstayin/ asleep

Diiness or

li/htheadedness

#rrita+ility

'ausea3 diarrhea3 or G#distress0ot or cold Hashes

FreIuent urination


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P0(# D#$(RD%R$

• Persistent irrational fear attached to ano+ject or situation that does not pose asi/ni9cant threat

•

Anticipatory anxiety > avoidance ofsituation

• A/orapho+ia

– $i.ple&$peci9c Pho+ias

– $ocial Pho+ias


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$P%$#F# P0(#A

• Acrophobia• Aoraphobia• Ai*orophobia•

&ydrophobia• +*austrophobia• +ynophobia• Myosophobia•

,yrophobia• $enophobia• oophobia

• .ear o/ heihts• .ear o/ open p*aces• .ear o/ cats•

.ear o/ 0ater• .ear o/ c*osed spaces• .ear o/ dos• .ear o/ dirt and

erms• .ear o/ 1re• .ear o/ straners• .ear o/ anima*s


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PA'# ATTAJ$• Discrete period of intense apprehension or

terror 1ithout any real acco.panyin/ dan/eracco.panied +y at least < of the follo1in/sy.pto.sC – Palpitations3 s1eatin/3 tre.+lin/3 shortness of

+reath3 feelin/ of cho7in/3 chest pain3 a+do.inaldistress3 diiness3 depersonaliation3 fear of

losin/ control3 fear of dyin/3 paresthesias*nu.+ness,3 chills or hot Hashes

PA'# D#$(RD%R• Recurrent unexpected panic attac7s that causepresistent 1orry a+out recurrences of

co.plication fro. attac7s or +ehavioralchan/e in response to attac7 for at least one.onth


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($%$$#K% (MPU)$#K% D#$(RD%R

*(D,• %xperience of recurrent o+sessions or

co.pulsions that are ti.e consu.in/ orcause si/ni9cant distress or i.pair.ent

• (+sessions – Recurrent intrusive and persistent thou/hts3

ideas3 i.a/es3 or i.pulses

• o.pulsions

– Ritualistic +ehaviors person is co.pelled toperfor.

• Reduce anxiety

• Delay to perfor. ritual results in increasin/ tension


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'onpsychiatric linical $pecialists )i7ely to$ee Patients 1ith (+sessive-o.pulsive

Disorder

• Der.atolo/ist• Fa.ily Practitioner• (ncolo/ist3 infectious disease internist• 'eurosur/eon• (+stetrician• Pediatrician•

Pediatric cardiolo/ist• Dentist


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$y.pto.s of (D

"bsessions• +ontamination• ,atho*oica* doubt• Somatic• !eed /or symmetry

• Aressi'e• Se2ua*• Mu*tip*e obsessions• "ther

+ompu*sions• +hec3in• +ountin• Washin• !eed to as3 or con/ess

• Symmetry andprecision• &oardin• Mu*tip*e comparisons


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P($T-TRAUMAT# D#$TR%$$ D#$(RD%R*PT$D,

• Develop.ent of characteristic sy.pto.safter exposure to severe of extraordinarystressor

• Three cardinal featuresC – 0yperarousal3 recurrent ni/ht.ares3 and

Hash+ac7s

• $i/n&$y.pto. C – Denial3 re-experience of event3 perceptual

distortions3 feelin/s of disor/aniation 1henthin7in/ a+out the event3 .e.ory i.pair.ent3over/eneraliation of other sensory inputs3exa//erated startle reaction3 so.atic sy.pto.s3altered states of consciousness3 recurrentni/ht.ares


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$elesai

%.ail C ronny:1Lyahoo8co.

Psi7iatero/ja

LPsi7iatero/ja

mailto:[email protected]:[email protected]


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Anxiety Disorder FKG 2012