ANXIETY DISORDERS

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

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.

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.

Symptoms:Generalized Anxiety disorders:Psychological and congnitive :Excessive anxiety, Poor concentration or mind going blank.

Physical symptomsRestlessness, Fatigue, Sleep disturbance, Irritability

Social Anxiety DisorderSome feared situations Eating or writing in front of others, Interacting with authority figures,

Speaking in public,

Physical symptomsDiarrhea, Sweating, Tachycardia

Posttraumatic stress disorder:Decreased concentration Insomnia

DIAGNOSIS:

Physical and mental status examination.Patients with GAD have irritable bowel syndrome.Anxiety symptoms may associated with medical illness

Cardiovascular

Respiratory systemAnxiety symptoms may psychiatric illnesses

mood disorders

Schizophrenia

Non drug Treatment:

Short –term counseling

Stress management

exercise

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

MECANISM OF ACTION

Pharmacological Treatment for Generalized Anxiety Disorder

Pharmacological Treatment for Social Anxiety Disorder

Pharmacological Treatment of Post Trauma Stress Disorder

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.

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