ANXIETY DISORDERS Dr nasirian. Anxiety disorders are among the most prevalent mental disorders in...
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IN THE NAME OF GOD ANXIETY DISORDERS Dr nasirian
ANXIETY DISORDERS Dr nasirian. Anxiety disorders are among the most prevalent mental disorders in the general population. Nearly 30 million persons are
Anxiety disorders are among the most prevalent mental disorders
in the general population. Nearly 30 million persons are affected
in the United States, with women affected nearly twice as
frequently as men.
Slide 3
Anxiety disorders are associated with significant morbidity and
often are chronic and resistant to treatment.
Slide 4
(1) panic disorder with or without agoraphobia (2) agoraphobia
with or without panic disorder (3) specific phobia (4) social
phobia (5) obsessive-compulsive disorder (OCD) (6) posttraumatic
stress disorder (PTSD) (7) acute stress disorder (8) generalized
anxiety disorder
Slide 5
Fear versus Anxiety Fear is a response to a known, external,
definite, or nonconflictual threat; anxiety is a response to a
threat that is unknown, internal, vague, or conflictual.
Slide 6
Symptoms of Anxiety
Slide 7
Obsessive-Compulsive Disorder Epidemiology Comorbidity: (major
depressive disorder, social phobia,alcohol use disorders,
generalized anxiety disorder, specific phobia, panic disorder,
eating disorders, and personality disorders,Tourette's
disorder,Tic)
Slide 8
Etiology Biological Factors Neurotransmitters Serotonergic
System Noradrenergic System Neuroimmunology Brain-Imaging Studies
Genetics
Slide 9
Nonpsychiatric Clinical Specialists Likely to See
Obsessive-Compulsive Disorder Patients: Dermatologist Family
practitioner Oncologist, infectious disease internist Neurologist
Neurosurgeon Obstetrician Plastic surgeon Dentist
Slide 10
DSM-IV-TR Diagnostic Criteria for Obsessive-Compulsive Disorder
Either obsessions or compulsions: Obsessions as defined by ;
recurrent and persistent thoughts, impulses, or images that are
experienced, at some time during the disturbance, as intrusive and
inappropriate and that cause marked anxiety or distress the person
attempts to ignore or suppress such thoughts, or to neutralize them
with some other thought or action the person recognizes that the
obsessional thoughts, impulses are a product of his or her own
mind
Slide 11
Compulsions as defined by repetitive behaviors (e.g., hand
washing, ordering, checking) or mental acts (e.g., praying,
counting, repeating words silently) that the person feels driven to
perform in response to an obsession the behaviors or mental acts
are aimed at preventing or reducing distress or preventing some
dreaded event or situation.
Slide 12
At some point during the course of the disorder, the person has
recognized that the obsessions or compulsions are excessive or
unreasonable. The obsessions or compulsions cause: marked distress,
are time-consuming (take more than 1 hour a day), or significantly
interfere with the person's normal functioning, or
relationships
Slide 13
Differential Diagnosis Medical Conditions Tourette's Disorder
Other Psychiatric Conditions
Slide 14
Course and Prognosis Treatment Pharmacotherapy Behavior Therapy
Psychotherapy Other Therapies(psychosurgery,ECT)
Slide 15
Posttraumatic Stress Disorder The person has been exposed to a
traumatic event in which both of the following were present: the
person experienced, was confronted with an event or threatened
death or serious injury, or a threat to the physical integrity of
self or others the person's response involved intense fear,
helplessness, or horror.
Slide 16
reexperience: recurrent and intrusive distressing recollections
of the event recurrent distressing dreams of the event acting or
feeling as if the traumatic event were recurring intense
psychological distress at exposure to internal or external cues
physiological reactivity on exposure to internal or external
cues
Slide 17
Persistent avoidance efforts to avoid thoughts, feelings, or
conversations associated with the trauma efforts to avoid
activities, places, or people that arouse recollections of the
trauma inability to recall an important aspect of the trauma
markedly diminished interest or participation in significant
activities feeling of detachment or estrangement from others
restricted range of affect (e.g., unable to have loving
feelings)
Slide 18
Persistent symptoms of increased arousal difficulty falling or
staying asleep irritability or outbursts of anger difficulty
concentrating hypervigilance exaggerated startle response
Slide 19
Duration of the disturbance is more than 1 month. Acute: if
duration of symptoms is less than 3 months Chronic: if duration of
symptoms is 3 months or more With delayed onset
Generalized Anxiety Disorder Excessive anxiety and worry
occurring more days than not for at least 6 months, about a number
of events or activities (such as work or school performance). The
person finds it difficult to control the worry.
Slide 23
The anxiety and worry are associated with three (or more) of
the following six symptoms restlessness being easily fatigued
difficulty concentrating or mind going blank irritability muscle
tension sleep disturbance
Slide 24
Epidemiology Comorbidity Etiology Treatment
Slide 25
Phobias The term phobia refers to an excessive fear of a
specific object, or situation. Phobias are classified based on the
nature of the feared object or situation, and DSM-IV-TR recognizes
three distinct classes of phobia: Agoraphobia,specific phobia, and
social phobia.
Slide 26
Specific Phobia Approximately 10 percent of individuals in the
United States meet criteria for specific phobia. The condition is
more commonly diagnosed in females than males.
Slide 27
specific phobia often co-occurs with other anxiety or mood
disorders. comorbid disorders tend to cause more impairment than
specific phobia and because individuals with isolated specific
phobia are rarely seen in the clinic. Impairment associated with
specific phobia typically manifests as restricted social or
professional activities.
Slide 28
subtypes of specific phobias: animal type, natural environment
type, blood-injury type, Situational type other
Slide 29
Specific phobia exhibits a bimodal age of onset, with a
childhood peak for animal phobia, natural environment phobia, and
blood-injury phobia and an early adulthood peak for other phobias,
such as situational phobia.
Slide 30
The severity of the condition is believed to remain relatively
constant.
Slide 31
Social phobia A marked and persistent fear of one or more
social or performance situations in which the person is exposed to
unfamiliar people or to possible scrutiny by others. The individual
fears that he or she will act in a way (or show anxiety symptoms)
that will be humiliating or embarrassing.
Slide 32
The person recognizes that the fear is excessive or
unreasonable. The feared social or performance situations are
avoided or else are endured with intense anxiety or distress. The
avoidance, anxious anticipation, or distress in the feared social
or performance situation(s) interferes significantly with the
person's normal routine, occupational (academic) functioning, or
social activities or relationships.
Slide 33
prevalence estimates of social phobia vary widely, from 2 to
approximately 15 percent. Like specific phobia, social phobia
exhibits a female preponderance, although the sex ratio in the
clinic may be more equal.
Slide 34
Panic Attack A discrete period of intense fear or discomfort,
in which four (or more) of the following symptoms developed
abruptly and reached a peak within 10 minutes: palpitations, or
accelerated heart rate sweating trembling or shaking
Slide 35
sensations of shortness of breath feeling of choking chest pain
or discomfort nausea or abdominal distress feeling dizzy, unsteady,
lightheaded, or faint
Slide 36
derealization (feelings of unreality) or depersonalization
(being detached from oneself) fear of losing control or going crazy
fear of dying paresthesias (numbness or tingling sensations) chills
or hot flushes
Slide 37
Panic disorder recurrent unexpected panic attacks at least one
of the attacks has been followed by 1 month (or more) of one (or
more) of the following: persistent concern about having additional
attacks worry about the implications of the attack or its
consequences (e.g., losing control, having a heart attack, going
crazy ) a significant change in behavior related to the
attacks
Slide 38
Differential Diagnosis endocrinological disorders, including
both hypo- and hyperthyroid states, hyperparathyroidism
Pheochromocytomas Episodic hypoglycemia associated with
insulinomas
Slide 39
seizure disorders, vestibular dysfunction, neoplasms, Substance
disorders of the cardiac and pulmonary systems, including
arrhythmias, chronic obstructive pulmonary disease, and asthma
Slide 40
Clues that a medical etiology underlies panic-like symptoms
include: the presence of atypical features such as ataxia,
alterations in consciousness, or bladder dyscontrol; the onset of
panic disorder relatively late in life; or physical signs or
symptoms indicative of a medical disorder.
Slide 41
The lifetime prevalence of panic disorder is in the 1 to 4
percent range. Panic disorder typically has its onset in late
adolescence or early adulthood. exhibit a fluctuating course, with
varying levels of persistence over the lifespan.
Slide 42
Approach to Treatment Medical Evaluation Choosing a Treatment
Modality Medications for Anxiety in Predictable Situations
-Adrenergic Receptor Antagonists, Benzodiazepines
Slide 43
Medications for Chronic Recurrent or Unpredictable Anxiety
SSRIs SNRIs TCA MAOIs others