ANXIETY DISORDERS

FEAR vs. ANXIETY

Known in origin Definite External source Alerting signal Non-conflictual

Unknown or vague Indefinite Internal in Origin Alarming signal Conflictual

Peripheral Manifestations of Anxiety Diarrhea Dizziness, lightheadedness Hyperhydrosis Hyperreflexia Hypertension Palpitations Pupillary mydriasis Restlessness Syncope Tachycardia Tingling sensations in the extremities Tremors Upset stomach Urinary frequency, hesitancy, urgency

Anxiety Disorders

Panic disorder Specific and social phobia Obsessive and Compulsive disorders Posttraumatic Stress Disorder Acute Stress Disorder Generalized Anxiety Disorder Anxiety due to GMC Substance induced disorder Anxiety disorder NOS

Panic Attacks

Palpitations, pounding heart, tachycardia

Sweating Tremble or shaking Shortness of breath or

smothering Choking sensation Chest pain or discomfort Sense of abdominal

distress

Feeling of dizziness, unsteady,lightheadedness

Fainting sensation Derealization Depersonalization Fear of losing control,

dying, of being crazy Paresthesias Chills or hot flushes

Panic Attack

Is not a codable diagnosis It occurs also in some anxiety disorder It is a discreet period of intense fear or

discomfort which developed suddenly peaked within 10 minutes with four or more symptoms of panic attack

Panic Disorder

Occurrence of 2 or more panic attacks in a month

Presence of one panic attack but preoccupied of having another panic attack within a month’s duration

May occur with agoraphobia or without agoraphobia

Specific Phobias

Ablutophobia – fear of washing or bathing Achluophobia – fear of darkness Aeroacrophobia – fear of heights Agliophobia – fear of pain Agoraphobia – fear of crowded places Aichmophobia – fear of needles Alliumphobia – fear of garlic Altophobia – fear of heights

Haemophobia – fear of blood Gynephobia – Fear of women Cacophobia – fear of ugly people Homophobia – fear of being homosexual Iatrophobia - fear of doctors Ithyphallophobia – fear of having an erect penis Pelladophobia – fear of bald people Penteraphobia – fear of mother-in-law

Specific Phobias

Claustrophobia – fear of being locked Triskaidekaphobia – fear of number 13 Somniphobia – fear of going to sleep Paraskavedekatriaphobia - Fear of Friday the

13th Coprophobia – fear of feces Photophobia - Fear of light. Oneirophobia - Fear of dreams.

Specific Phobias

Is described as recurring obsessions or compulsions “severe enough to be time consuming… or caused mark distress or significant impairment.” People with this disorder recognize that their actions are irrational or disproportionate.

Obsessive – Compulsive Disorder

Obsessions - Compulsions

Contamination Pathological doubt Somatic Need for symmetry Aggressive Sexual Multiple Obsessions

Checking Washing Counting Need to ask or

confess Symmetry and

precision Hoarding Multiple comparisons

Obsession vs Compulsions

Recurrent and intrusive thought, feeling, idea, or sensation.

Increases anxiety

Is a conscious standardized, recurrent pattern of behavior, such as counting, checking, or avoidance.

Compulsions decrease anxiety.

Major Presenting Symptomof Obsessions Concern or disgust with bodily wastes or secretions

(urine, stool, saliva), dirt, germs, environmental toxins. Fear concerns

Fear something terrible may happen (fire, death or illness of loved one, self, or others)

Concern or need for symmetry, order, or exactness. Scrupulosity (excessive praying or religious concerns out

of keeping with patient’s background) Lucky and unlucky numbers Forbidden or perverse sexual thoughts, images, or

impulses Intrusive nonsense sounds, words, or music

Major Presenting Symptoms of Compulsion Excessive or ritualized hand washing, showering, bathing, tooth

brushing, or grooming Repeating rituals (going in and out of door, up and down from

chair) Checking doors, locks, stove, appliances, car brakes Cleaning and other rituals to remove contact with contaminants Touching Ordering and arranging Measures to prevent harm to self or others (e.g., hanging

clothes a certain way) Counting Hoarding and collecting Miscellaneous rituals (e.g., licking, spitting, special dress

pattern)

Posttraumatic Stress Disorder

A set of typical symptoms that develop after a person sees, is involved in, or hears of an “extreme traumatic stressor.”

The symptoms must last for more than a month and impairs important matters of life such as family and work.

The stress is overwhelming enough to affect almost everyone.

It can arise from experiences in war, torture, natural catastrophes, assault, rape, and serious accidents in cars and burning buildings.

Re-experiencing of the traumatic event in their dreams and their daily thoughts, they are determined to evade anything that would bring the event to mind causing hyper arousal.

Clinical Features of PTSD

Painful experiencing of the event A pattern of avoidance and emotional numbing, and fairly

constant hyper arousal The disorder may not develop until months or even years

after the event The MSE often reveals feelings of guilt, rejection,

humiliation. Patients may also describe the dissociative states and

panic attacks, and illusions and hallucinations may be present.

Cognitive testing may reveal that patients have impairments of memory and attention.

Associative symptoms include aggression, violence, poor impulse control, and substance-related disorders.

Clinical Features of PTSD

Persistent symptoms of increased arousal not present before the trauma as indicated by two or more of the ff;Difficulty falling or staying asleepIrritability or outburst of angerDifficulty concentratingHyper vigilanceExaggerated startled responseDuration of the symptoms is more than one month

Acute Stress Disorder

The person has been exposed to a traumatic event Experiencing the distressing event which has three or

more ff dissociative symptoms A traumatic event is persistently re=experienced in one of

the ff way: recurrent images, illusions, thoughts, dreams, flashback episodes

Marked avoidance of stimuli that arouse recollections of the trauma

Marked symptoms of anxiety or increased arousal The disturbance last for a minimum of two days or

maximum of 4 weeks and occurs within 4 weeks of the traumatic events.

Generalized Anxiety Disorder

Is defined as excessive anxiety and worry about several events or activities for a majority of days during at least a six-month period.

The worry is difficult to control and is associated with its somatic symptoms such as muscle tension, irritability, difficulty of sleeping, and dresslessness.

Criteria for GAD

Excessive anxiety and worry (Apprehensive expectation) occurring more days than not for six month

The person find it difficult to control the worry The anxiety and worry are associated with the ff

six symptoms Restlessness Easy fatigueability Difficulty concentrating Irritability Muscle tension Sleep disturbance

Anxiety due to GMC

Hyperthyroidism Congestive heart failure Hepatorenal disease Parkinson’s disease Atrophy in psychosis Multiple sclerosis Respiratory failure Bronchitis Asthmatic attack Addison’s disease Etc.

Substance-Induced Anxiety Disorder

Methamphetamine intoxication Cocaine intoxication Cannabis intoxication Methylenedioxymethamphetamine

intoxication