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ANXIETY DISORDERS Yard. Doç. Dr. Berfu Akbaş A diffuse, unpleasant, vague sensation of apprehension, often accompanied by autonomic symptoms; palpitations, perspiration, headache, tightness in the chest, mild stomach discomfort, restlessness, dizziness, diarrhea, tremors, urinary frequency, hesitancy. Normal Anxiety : advantageous response to a threatening situation Pathological Anxiety: inappropriate response to a given stimulus. Fear: A response to a known, external, definite threat Epidemiology: women life-time prevalence: % 30.5 Men : % 17.7 Autonomic Nervous System Neurotransmitters: Norepinephrine, serotonin, GABA Neuroanatomy:Locus cereleus, raphe nuclei, limbic system, temporal lobes Genetics: Anxiety Disorders Panic Disorder Specific Phobia Social Phobia Posttraumatic Stress Disorder ( PTSD ) Acute Stress Disorder Generalized Anxiety Disorder PANIC DISORDER Epidemiology: PD:1.5-5%,PA: 3-5.6% A: 0.6-6% DSM-IV-TR CRITERIA FOR PANIC DISORDER 1- Recurrent unexpected panic attacks 2- Persistent concern about having additional attacks 3- Worry about its consequences ( going crazy..) 4- Significant change in behaviour 5- Absence / presence of agoraphobia 6- Panic attacks are not due to a substance or a medical condition or another mental disorder 4 * * * * * * * * * * * * * PANIC ATTACK or more of the following symtoms: palpitations sweating trembling or shaking shortness of breath feeling of choking chest pain nausea or abdominal discomfort feeling dizzy, lightheaded, faint derealization- depersonalization fear of losing control or going crazy fear of dying numbness or tingling sensations chills or hot flushes COURSE AND PROGNOSIS Onset: early adulthood %30-40→long term symptom free %50→mild symptoms %10-20→significant symptoms %40-80→depression develops %20-40→alcohol adn substance dependance TREATMENT: Benzodiazepines ( alprazolam, lorazepam ) SSRI’s ( paroxetine, sertraline, citalopram ) Cognitive behaviour therapy SPECIFIC PHOBIA A phobia is defined as an irrational fear that produces conscious avoidance of the fearred subject, activity or situation. 5-10% Animals ( ailurophobia-cats, cynophobia-dogs, storms,acrophobia-height, mysophobiagerms,nasophobia-illness, death) Treatment: Exposure therapy ß-adrenergic receptor antagonists benzodiazepines SOCIAL PHOBIA 3-13%, teens A marked fear of social or performance situations in which the person is exposed to unfamiliar people. The individual fears that he will act in a way that will be humiliating or embarrassing. Exposure to the feared social situation provokes anxiety which may take the form of panic attack The person recognizes that the fear is excessive or unreasonable. The feared social or performance situations are avoided Treatment: SSRI’s, benzodiazepines Behavioral and cognitive therapy OBSESSIVE-COMPULSIVE DISORDER OBSESSION: a recurrent, intrusive thought, feeling, idea or sensation. Most common; contamination, pathologic doubt, sexual-aggressive doubts COMPULSION: a conscious, standardized, recurrent behaviour ( counting, checking, avoiding) most common; washing, checking, counting, need to ask or confess, symmetry ) Ego-dystonic ( the person knows that its excessive, irrational, and does not want ) %2-3, ~ 20 years. Serotonergic system, orbitofrontal cortex, caudates and thalamus. %20-30 improve, %20-40 remain ill or worsen. Treatment: SSRI’s, clomipramine Behaviour therapy OCD associations with other brain disorders: Tourette Syndr. Syndenhams Chorea Encephalitis Lethargica PANDAS GENERALIZED ANXIETY DISORDER Excessive anxiety and worry about a number of events or activities. Anxiety and worry is associated with at least 3 of the followings: restlessness, being easily fatiqued, difficulty in concentrating, irritability, muscle tenion, sleep disturbance. Treatment: Cognitive and behavioral therapy SSRI’s, benzodiazepines POSTRAUMATIC STRESS DISORDER Develops after a person sees, is involved in or hears of an extreme traumatic stressor. The persons response involves intense fear, helplessness or horror. The event is persistantly reexperienced as images, flashbacks, thoughts, dreams. Intense psychological distress at exposure to cues that symbolize or resemble the event Persistance avoidance of the stimuli and numbing of general responsiveness Sleep disturbances, irritability, hypervigilance, difficulty concentrating, exaggerated startle response 1 week-30 years ACUTE STRESS DISORDER Develops after a person sees, is involved in or hears of an extreme traumatic stressor. The persons response involves intense fear, helplessness or horror A subjective sense of numbing, detachment, absence of emotions Derealization, depersonalization, Dissociative amnesia The event is persistantly reexperienced as images, flashbacks, thoughts, dreams Sleep disturbances, irritability, hypervigilance, difficulty concentrating, exaggerated startle response Pharmacotherapy Benzodiazepines: GABA A agonist SSRI’s TCI’s MAO inhibitors B- adrenergic receptor antagonists ( propranolol Antihistaminics Buspirone ( HT1a agonist) Ca channel blockers ANXIETY DISORDER DUE TO A GENERAL MEDICAL CONDITION Thyroid disorders ( hyper-hypothyroidism ) Hypoglycemia Neurological Disorders ( MS, epilepsy, CVD, Parkinson) Anemia Cardiomyopathies, hypoxia, cardiac arrytmias SLE, RA, PAN ALCOHOL – DRUG WITHDRAWAL caffeine