Anxiety means uneasiness or objectless fear. It is a transient psychological reaction to alarming situation which do not interfere with daily life activities. Anxiety is a drive. It is a normal mood and like pain, a warning.
Trait anxiety: habitual tendency to become anxious.
Anxiety state: painful uneasiness of mind due to reaction to threat.
Pathological anxiety: When anxiety interferes the normal life pattern.
Classification of Anxiety disoeder
§-Generalized anxiety disorder
§-Panic disorder
§ -Phobic disorderà Specific phobia
Agoraphobia
Social phobia
§ -Obsessive-compulsive disorder
Generalized anxiety disorder:
§Anxiety is a normal response to danger. When its severity interfere with day to day activities , then it is called generalized anxiety disorder.
§Epidemiology: Prevalence 3%, more common in female than male.
§Etiology: Genetic factor
Environmental factor anxious insecure mothers raise anxious children, early childhood separation from either parent. Separation produces insecurity , which is reactivated in later life.
personality- dependent personality
Current stresses and life events.
Clinical features:
§Psychological arousal: Fearful anticipation, irritability, sensitive to noise, restlessnesss, poor concentration, worrying thought.
§ Autonomic arousal: Gastrointestinal- dry mouth, difficulty in swallowing, epigastric discomfort, frequent motion.
S/S-
§Respiratory Difficulty in breathing, constriction in chest, hyper ventilation.
§Genito-urinary-Frequent micturation, failure of erection (male), menstrual irregularity (female)
§Other symptoms- tremor, headache, sleep disturbance , night terror.
§Signs- face strained, furrowed eye-brow, posture tense, skin pale, sweating in hands, feet ,axillae, ready to tear.
Management
§Psychological: Reassurance, Councelling, Relaxation training , Supportive therapy to solve the problem.
§Physical- 40% patients improve without medication.
anxiolytics--Benzodiazepines
diazepam, alprazolam, clonazepam. Not more than 3 wks.
Beta-blockers, buspirones, low doses antipsychotics
Anti depressantsà TCA, SSRIs.
§Prognosis- Anxiety >6months --- poor prognosis.
80% still present after 3years ( one study)
2/3 patients improved within 6 years. (another study
Panic disorder (episodic anxiety)
Characterized by acute and unprovoked discrete periods of intense fear or discomfort due to intense acute psychological and somatic anxiety symptoms, which are unexpected .
§Core features are- Anxiety builds up quickly
Symptoms are severe
Fear of catastrophic outcome
§ S/S-- Shortness of breath, choking, palpitation, chest discomfort, sweating, fainting attack, numbness, fear of dying.
§Diagnostic Criteria: More than 4 attacks within four wks or 1 attack followed by persistent fear of another attack.
It may be with or without agorassssphobia. Female are affected more.
Etiology
A) Geneticà It is familial. Onset 20-40 year
B) Parental death in childhood or separation from mother
C) May be provoked by excessive caffeine intake
D) Sympathomimatic drugs, carbon dioxide inhalation
Management: Cognitive-behavior therapy 80- 100% success rate
Anti depressant and benzodiazepines- 50-60% success rate.
Phobic disorders
§A phobia is an inappropriate situational anxiety with avoidance. The degree of avoidance is a useful measure of the severity.
3 main groups of phobic disorder-- Specific phobia, Agoraphobia and Social phobias
§Specific Phobia- Persistent inappropriate fear of a circumscribed external object or situation, which leads to avoidance.
Phobia of cats, spiders, height, dark. An immediate anxiety response in their presence. Most of the people develop in. childhood.
§
Agoraphobia: Fear of open public places, fear of being far from home, family and friends. The individual is fearful of being in places or situations where escape may be difficult or help unavailable if a panic attack were to occur. The person becomes anxious in anticipation of going out, particulary when unaccompanied and avoidance occur.
§
Social Phobia: Characterized by the persistent fear of situations in which the person is subject to possible scrutiny by others and also by fears that he may act in a humiliating or embarrassing way ie, eating in a restaurant or public speaking or urinating in public , the individual experiencing distress in social setting.
Occurs in 3-4% of general population.
§Management: Exposure technique
Systematic desensitization-à relaxation training is combined with gradual exposure of phobic stimulus
Drugs- Benzodiazepine, beta- blockers, Tricyclic anti-depressant.
Obsessive-compulsive disorder
§Recurrent persistent thought, impulses, images that enter the mind despite efforts to exclude them.
§Compulsion : Obsessional motor acts
§ Themes of Obsession: Dirt and contamination
§ Aggression
§ Orderliness
§ Illness, sexual thought, religion
§Problems of compulsion: 1) Dirt harm e.g, dermatitis due to excessive hand washing.
§ 2) Interferes with normal life because of the time they require.
Epidemiology and Etiology
§Prevalence -- 1.2- 3.8%
M:F-- 1 :1
§ Etiology--- Genetic
Brain Disorder- Touratte Syndrome, Encephalities
lethargica , Sydenham’s chorea.
Abnormal 5HT function in OCD
Imitative learning by the children from parents
Obsessive Personality disorder
Clinical features: Obsessional thought- unpleasant , obscene and anti religious words and phrases
Obsessional ruminations- internal debates for and against arguments.
§Obsessional doubts: doubts about closing the door.
§Obsessional images: disgusting, violent scenes
§Obsessional impulses: Urges to carry out aggressive , dangerous , embarrassing actions.
§Obsessional phobia: Obsessional fear of illness called “ illness phobia” ,
Obsessional thoughts about harming others by seeing knives.
§Compulsive symptoms- Checking, Cleaning, Counting, Dressing, Touching rituals.
§Other Symptoms-- Anxiety, Depression .
Management of OCD
§Medication: TCA- Clomipramine 200- 250mg/day
§SSRIs- Fluoxetine, Fluvoxamine, paroxetine, Sertraline.
§ Small doses of anti psychotics.
§Benzodiazepines
§Cognitive- behavior therapy: Response prevention
Exposure
Thought stopping
modelling
§Severe resistant cases- Neurosurgery.
Childhood Psychiatric disorder:http://childhoodpsychiatricdisorder.blogspot.com/
