g.a.d & p.d 2
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ANXIETY DISORDERS
Anxiety is a state of tension &apprehension with hyperactivity of
the autonomic nervous system as a
natural response to perceived
threat. Anxiety disorders have three
components.Cognitive component.
Physiological responses.
Behavioral Response.
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BEHAVIORAL RESPONSES
Avoidance of certain situation.Impaired task performance
COGNITIVE COMPONENTSubjective feelings of apprehension.
A sense of impending danger.
A feeling of inability to cope.
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PHYSIOLOGICAL RESPONSES
Increased heart rate. Raised blood pressure.
Muscle tension.
Rapid breathing.
Nausea.
Dry month.Diarrhoea.
Frequent urination.
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Anxiety disorders may be classified
as follows
Generalized anxiety disorder (GAD).Panic disorder.
Phobic disorders agoraphobia,
specific phobias and social phobias.
Obsessive compulsive disorder
(O.C.D)Post traumatic stress disorder (PTSD)
Secondary disorders due to general
medical condition and substances.
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GENERALISED ANXIETY DISORDER
Persistent generalized & excessive
feelings of anxiety not attached to any
particular specific situations but rathercaused by a general tendency to worry
excessively. It may last for months.
There is a sense of impending disorder,
through not specific
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Typical worries include excessive
worries about work or social
performance, exaggerated
concern about finances & thepossibility of becoming ill or
having an accident.
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Common symptoms of GAD
Nervousness, restlessness, trembling.
shortness of breath
SweatingMuscle tension
Feeling jittery, tense and constantly
on edge
Trouble falling or staying asleep
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Poor concentrationIrritable mood, depressed mood
Palpitations
frequent urination
Easily fatigued , light headedness
Difficulty making decisions
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PANIC DISORDER
PANIC ATTACK
A panic attack is a discrete period of
intense fear or discomfort, in which
four or more of the following
symptoms develop abruptly & reached
a peak within ten minutes.Palpitations
Sweating
Trembling and shaking
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Symptoms of panic attacks can be
terrifying & distressing. They may last a
few minutes or longer. In MOST cases,
panic attacks occur in the absence of any
identifiable stimulus.Attacks may be followed by persistent
concerns a bout having another panic
attack. They are mysterious and terrifying
due to their unpredictable quality.
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Many people with panic attacks
develop agoraphobia (a fear of
public places) for fear of having an
attack in public.
Panic disorder can be classified asbeing with or without agoraphobia;
panic disorders tend to appear in
late adolescence or early adulthood
(mid 20s). They are more frequent in
females.
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The situations include
Being outside the home aloneBeing in a crowd or standing on a line
Being on a bridge, elevators.
Travelling in a bus ,train or car
They feel relieved when accompanied
by someone else.It usually develops after the individual
has experienced of panic like
symptoms.
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PHOBIC DISORDERS
Phobias are strong and irrational fears ofcertain object or situations. The word is
derived fromphobos, a Greek god of fear.
People with phobias relies that theirfears are out of proportion to the danger
involved. However, they feel helpless to
deal with fears. Instead, they makestrenuous effort to avoid the phobic
situation or object.
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AGORAPHOBIA.
Its anxiety about being in places or
situations from which escape mightbe difficult (or embarrassing) or in
which help may not be available in
the event of having an unexpected
or situationally predisposed panic
attack or panic like symptoms.
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SOCIAL PHOBIA.
Social phobia is common as panic andagoraphobia disorders. It is experienced byboth men and women. It is chronic disorder
that fluctuates over time and may causemarked impairment in social and occupationalfunctioning if untreated.
The key feature of social phobia is excessivefear of situations in which the person might bescrutinized, evaluated and judged negatively.
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Individuals doing something embarrassing or
acting in a way that may be humiliating. Fear
of specific social situation results in avoidance.
A more generalized social phobia may lead to
almost complete social isolation. Social
phobia is often under-recognized by medical
workers, because they either confuse it with
shyness or judge the secondary depression orsubstance dependence to be the primary
disorder. If a person says, people make me
anxious or nervous, consider social phobia.
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Common situations feared include speaking in
public, writing in the presence of others eating
or drinking in public or using public toilets.
Common (embarrassing) symptoms include
blushing, nausea, shaking and the urge to go
the toilet.
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SPECIFIC PHOBIA
Specific phobias may include fear of dogs,spiders, snakes, elevators, heights andenclosed spaces, airplanes, still water,
injections, illness, or death. Commonsymptoms consists of trembling, acceleratedheart rate, difficulty breathing, light-headedness and sweating. Phobias can
develop at any point in life. Many of themdevelop during childhood, adolescence andearly adulthood.
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Once phobias develop, they seldom go away
on their own. Phobias may broaden and
intensify over time and are twice as common
among women than men. Phobias that begin
during childhood usually disappear without
treatment. However, phobias disappear
without treatment. However, phobias thatdevelop later in life are usually more chronic.
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OBSESSIVE COMPULSIVE DISORDER
(OCD)
Men =women
Usually the OCD has two components: Cognitive (thoughtsof being infected by germs) and behavioral (washing andcleaning rituals). Either occur alone.
Obsessions are persistent, repetitive, intrusive andunwelcome thoughts, images and impulses that invade theindividuals consciousness. They are often abhorrent to theperson, but very difficult to dismiss or control. Thoughtsare recognized as being generated within individual s ownmind versus thought insertion found in schizophrenia.Obsessional thoughts focus on contamination, disasters,violence, harm to self or others, blasphemy, sex or otherdistressing things.
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Compulsions are persistent, repetitive anduncontrollable behavioral urges to perform certainbehaviours, such as washing or cleaning rituals,resisted only with two great difficulty.
Responses to obsessive thoughts and function toreduce anxiety associated with thoughts.
Compulsive rituals result in temporary relief.
Behavioural compulsions are extremely difficult tocontrol.
Rituals include washing, checking things repeatedly,cleaning, counting, or doing tasks in a specific and rigidorder.
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Failure to perform leads to anxiety (perhaps even
a panic attack). Like phobic avoidance responses,
compulsions appear to reduce anxiety.
OCD may lead to avoidance of certain objects or
situations (e.g. dirt, and not leaving the house to
avoid locking doors); life disruption; frustration;irritation to individual, family, friends and
workmates; depression and anxiety.
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POST TRAUMATIC STRESS DISORDER
(PTSD)
Is a syndrome that develops after a person sees,is involved ion, or hears of an extreme traumaticstressor.
stressor can be war, torture, natural disasters,assault, rape, serious accidents MVA)
Reacts with fear and helplessness, reliving theevent and trying to avoid being reminded of the
event. The symptoms must last for more than a month
after the event.
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Epidemiology
Lifetime prevalence 8% in gen pop
10-12 % for women and 5-65 FOR MEN
5-15% will experience subclinical PTSD
Those who have experienced traumatic eventslifetime prevalence is 5-75%
Age: any but mainly young adults coz predisposedto precipitating situations
Marital status: single, divorced, widowed, sociallywithdrawn
SES: Low SES
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Risk factors
Severity of trauma
Duration of trauma
Proximity of a persons exposure to the actual trauma
Hx of depression in 1st degree relatives
Presence of childhood trauma
Inadequate family or peer support system
Being female
Genetic vulnerability to psychiatric illness
Recent excessive alcohol intake
Personality disorder- borderline, dependent, antisocial
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Aetiology
STRESSOR: Subjective meaning to a person
Preexisting biological factors-neurotransmitter
theories- noradrenergic system, endogenous opiate
system Increased activity and responsiveness of the
autonomic nervous system
Psychosocial factors
Previous and after traumatic events
genetic vulnerability
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Clinical features
Painful re-experiencing of the event
Pattern of avoidance and emotional numbing
Constant hyperarousal
MSE reveals: feelings of guilt, rejection, and
humiliation
Dissociative states, panic attacks, hallucinations,
aggression. Violence, poor impulse control,depression, substance related disorders
Cognition- impaired memory, and attention
MANAGEMENT PRINCIPLES OF
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MANAGEMENT PRINCIPLES OF
ANXIETY DISORDERS
Rule out organic or physiological pathology.
Rule out mood and substance abuse problems.
Educate the patient on disorder.Provide training in strategies to control anxiety
symptoms.
Appropriate referrals.
Avoid unnecessary medication especially
sedatives
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BIOLOGICAL MANAGEMENT
Benzodiazepines may be used forsymptoms relief.
AntidepressantsSSRIs + TCAs ( co-
morbid features of mood disorder are
not uncommon)
Beta blockersAntihistamines hydroxyzine in GAD
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PSYCHOLOGICAL MANAGEMENT
Cognitive behavioral therapy is the
most effective approach.
SOCIAL MANAGEMENT
It includes education & support
involving family & relevant
support structures
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