Download ANXIETY DISORDERS

ANXIETY DISORDERS
Yard. Doç. Dr. Berfu Akbaş
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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
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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
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Panic Disorder
Specific Phobia
Social Phobia
Posttraumatic Stress Disorder ( PTSD )
Acute Stress Disorder
Generalized Anxiety Disorder
PANIC DISORDER
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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
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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
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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
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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
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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
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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
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OCD associations with other brain
disorders:
Tourette Syndr.
Syndenhams Chorea
Encephalitis Lethargica
PANDAS
GENERALIZED ANXIETY DISORDER
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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
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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
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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
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Benzodiazepines: GABA A agonist
SSRI’s
TCI’s
MAO inhibitors
B- adrenergic receptor antagonists ( propranolol
Antihistaminics
Buspirone ( HT1a agonist)
Ca channel blockers
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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