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Anxiety, anxiety disorders, somatoform disorders Zoltán Hidasi Anxiety • • • • • • Definition Normal anxiety Signs and symptoms Anxiety disorders Anxiolitic therapy Special importance for dentists Fear v. anxiety • Anxiety: Feeling of apprehension caused by anticipation of danger (internal or external) – threat: unknown, internal, vague, conflictual • Fear: anxiety caused by conciously recognized and realistic danger – threat: known, external, definite, nonconflictual Normal v. pathological anxiety • Alerting signal - warning for danger – lifesaving effect • Is anxiety adaptive? – Bodily damage, pain, helplessness, possible punishment, frustration of social or bodily needs • helps dealing with threats (taking steps to prevent threat or lessen consequencies) Symptoms of anxiety • Subjective - psychological - verbal – unpleasant emotion – learning, concentration, making associations – perception, thinking • Behavioural - motor symptoms – psychomotor retardation or agitation (restlessness), mimics, gestures • Vegetative symptoms Autonomic symptoms • • • • • • • • • • • hyperhydrosis, flushing hypertension tachycardia, tachypnoe palpitations syncope, dizziness dry mouth diarrhea upset stomach urinary frequency, urgency hyperreflexia pupillary mydriasis Anxiety in dentistry • • • • common feature trait anxiety anxiety disorders treating anxiety Anxiety disorders (DSM IV TR) lifetime prevalence: 30.5% fm, 19.2% m • • • • • • Panic disorder and agoraphobia Specific phobia and social phobia Obsessive-compulsive disorder Posttraumatic stress disorder Generalized anxiety disorder Other anxiety disorders – due to a general medical condition – substance induced anxiety disorder Panic disorder, Agoraphobia • lifetime prevalence: 1.5-5% • Panic attacks (20-30 minutes - extreme fear, fear of dying, palpitations, sweating, trembling, short of breath, chest pain, nausea, dizziness, etc. ) • Anticipatory anxiety • Agoraphobia: fear of being alone in public places Specific phobias, Social phobia • Phobia: Excessive fear of a specific object, circumstance or situation (unreasonable, marked, persistent) • 6 month prevalence: 5-10% • Exposure: immediate anxiety • Types: animal type, natural environment type (e.g., storms, water), blood-injection-injury type, situational type (e.g., airplanes), other • Social phobia: social performance Obsessive-compulsive Disorder • Lifetime prevalence: 2-3% • obsessions (recurrent, persistent, intrusive thoughts causing anxiety) • compulsions (repetitive behaviors or mental acts responding to obsessions) • ego-alien (absurd, irrational) • symptom patterns (contamination, pathological doubt, intrusive thoughts, symmetry, etc.) Therapy of anxiety disorders • Pharmacotherapy – Benzodiazepines (alprazolam, clonazepam) – Buspirone – Antidepressants (SSRI, heterocyclic, MAOI, others) • Psychotherapy – cognitive-behaviour therapy – relaxation Somatization • Somatization: somatic complaints or symptoms of psychological (mental) origin • Somatoform disorders – – – – – somatization disorder conversion disorder hypochondriasis body dysmorphic disorder pain disorder • Other mental disorders with somatic complaints and symptoms Mental disorders with somatic complaints and/or symptoms • • • • • • • Somatoform disorders Mood disorders Anxiety disorders Eating disorders Schizophrenia and related disorders Substance use disorders Organic psychiatric disorders Somatization disorder • lifetime prevalence : 0.2-2% women • many somatic complaints affecting many organ systems (pain, gastrointestinal,sexual, pseudoneurological) • chronic, before 30 years Conversion disorder • m : f 1:2 - 1:10 prevalence? • one or more neurological symptoms with no neurological origin • Symptoms: – motor (involuntary movements, tics, seizures, paralysis, astasia-abasia, etc.) – sensory deficits (anesthesia, blindness, etc.) – visceral symptoms (vomiting, diarrhea, syncope) Hypochondriasis • 6 month prevalence: 4-6% • peoccupation with fears of having a serious disease • misinterpretation of bodily symptoms, sensations • preoccupation persists Anxiety-somatoform disorders • • • • • • fear anxiety depression autonomic reactions somatic complaints somatic symptoms