anxiety disorder_nayan maharjan
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ANXIETY DISORDERPGI Maharjan Nayan
AUFMC
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OUTLINE
Panic Disorder and Agoraphobia
Specic Phobia and Socia! Phobia
Obsessi"e Co#p$!si"e Disorder
Pos%&%ra$#a%ic S%ress Disorder and Ac$%e S%ressDisorder
Genera!i'ed An(ie%y Disorder
O%her An(ie%y Disorder
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NORMAL ANXIETY
A di)$se* $np!easan%* "ag$e sensa%ion o+apprehension
Acco#panied by, A$%ono#ic sy#p%o#s - $rina%ion
Sy#pa%he%ic response - perspira%ion* pa!pi%a%ions* ches%%igh%ness* s%o#ach disco#+or%* res%!essness
Co##on and %rea%ab!e
Can a)ec% abi!i%y %o carry o$% e"eryday %as.
Does no% #ean yo$/re cra'y* has a 0ea. persona!i%yor has a persona!i%y prob!e#
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ANXIETY VS FEAR
An(ie%y An a!er%ing signa!
Apprehensi"e an%icipa%ion o+ +$%$re danger E(perienced as dysphoric 1$np!easan%2
Acco#panied by so#a%ic sy#%o#s
Fear 3ea! %hrea% or danger e(is%s E(%erna!* deni%e or non&con4ic%$a! %hrea%
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IS ANXIETY ALWAYSPATHOLOGICAL?
NO* i% is a 0arning signa!
So#e an(ie%ies are ad"an%ageo$s 5e!ps in no"e! si%$a%ions 5e!ps #obi!i'e indi"id$a! +or 6$ic. response
An(ie%y can heigh%en one/s a0areness*prepare a de+ense %o %hrea%eningsi%$a%ions
Fear response pro#o%es s$r"i"a! o+indi"id$a! and species
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NO3MAL FEA3 3ESPONSE
Cogni%i"e Appraisa! 3ecogni'e and re#e#ber rea! %hrea%
Physio!ogic Aro$sa! Signa!s danger Enhances a!er%ness
7eha"io$rs F!igh% or F!igh%
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FIGHT OR FLIGHTRESPONSE
8hen 0e +ee!
%hrea%ened* o$r bodiesare hard0ired %o ei%hergh% or 4igh% or r$na0ay
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PE3IP5E3AL MANIFESTATIONOF FIG5T O3 FLIG5T
3ESPONSE Many signs are e(p!ained by sy#pa%he%ic ner"o$s
sys%e# ac%i"a%ion and re!ease o+ norepinephrine+ro# adrena! #ed$!!a
Increase in, 5ear% ra%e
7P
9en%i!a%ion
G!$cose 1%o prope! body in%o ac%ion2
P$pis di!a%e
S0ea%ing
Pi!oerec%ion
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85AT MA: T3IGGE3 AN;IET:
Psycho!ogica! S%ress3e!a%ionship brea.$ps* !oss o+
so#eone c!ose* 0or. press$re*!ac. o+ s!eep* nancia! prob!e#s
Physica! S%ressPhysica! i!!ness* %ra$#a*e(cessi"e $se o+ dr$gs anda!coho!
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85EN DOES AN;IET:7ECOME PAT5OLOGICAL?@ +or any an(ie%ydisorder in %he US
MF
S%rong gene%ic co#ponen%
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PANIC ATTACB
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PANIC ATTACB Discre%e period o+ in%ense +ear or disco#+or%
acco#panied by +o$r or #ore o+ %he ), Pa!pi%a%ion
S0ea%ing
Tre#b!ing
Cho.ing
Ches% pain Di''iness** +ain%ing
Derea!i'a%ion
Fear o+ !osing con%ro!
Fear o+ dying
N$#bness
Chi!!s or ho% 4$shes
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PANIC ATTACBEpisodes ha"e a s$dden onse% and pea.rapid!y $s$a!!y in #in or !ess
O+%en acco#panied by a sense o+ i##inen%
danger or doo# and $rge %o escapeMay presen% %o E3 %he +ear o+ ca%as%rophic#edica! e"en% 1MI* s%ro.e2
3epresen%s %riggering o+ a!ar# responsea
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PANIC ATTACBPanic a%%ac. can be a sy#p%o# o+ Socia!Phobia* PTSD and OCD
No% specic %o panic disorder
May hera!d depression
Secondary %o Under!ying #edica! condi%ion
Medica! Side e)ec%
I!!ici% dr$g $se
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PANIC DISO3DE3
3ec$rren%* $ne(pec%ed panic a%%ac.
Fo!!o0ed by one or #ore o+ %he +o!!o0ing, An%icipa%ion o+ addi%iona! a%%ac.s
8orry abo$% i#p!ica%ions o+ %he a%%ac.s
Change in beha"ior
8i%h or 0i%ho$% agoraphobia
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AGO3AP5O7IA
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AGO3AP5O7IA
Li%era!!y +ear o+ #ar.e% p!ace or open spaces
An(ie%y abo$% being in si%$a%ion +ro# 0hich escape#igh% be dic$!%
O+%en secondary %o panic a%%ac.s
A"oided si%$a%ions inc!$ded, dri"ing* bridged*%$nne!s* e!e"a%ors* airp!anes* #a!!s* si%%ing in %he#idd!e o+ %he ro0
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AGORAPHOBIA: DEMOGRAPHY &EPIDEMIOLOGY
MFLi+e%i#e pre"a!ence, >&?@
Fre6$en%!y presen% in pri#ary care
se%%ing
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PS:C5OANAL:TIC T5EO3IES
Panic a%%ac.s are res$!%ing +ro# $ns$ccess+$!de+ense agains% an(ie%y pro"o.ing i#p$!ses
De+ense #echanis# in"o!"ed, repression*
disp!ace#en%* a"oidance* and sy#bo!i'a%ion
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SOCIAL
P5O7IASOCIALAN;IET:
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SOCIAL P5O7IASOCIALAN;IET:
Main +ea%$re is %he +ear o+ being j$dged or cri%ici'ed
8orry %ha% %hey 0i!! do so#e%hing si!!y ore#barassing %o o%hers
An(ie%y #ay be !i#i%ed %o a specic socia! si%$a%ion
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SOCIAL P5O7IA DSM I9&T3C3ITE3IA
Signican% +ears o+ si%$a%ion 0here %he person#aybe scr$%ini'ed by o%hers or e#barrassed in ap$b!ic si%$a%ion
Fear is %ha% yo$/!! do so#e%hing %o ca$see#barrass#en% or %hey/!! Hsee yo$ s0ea% 1sho0an(ie%y2
E(pos$re %o a +eared si%$a%ion a!#os% in"ariab!y
pro"o.es an(ie%y Person has insigh% %o %he e(cessi"e na%$re o+ %heir
+ear
Feared si%$a%ions are a"oided
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SOCIAL PHOBIA:DEMOGRAPHIC &
EPIDEMIOLOGYLi+e%i#e Pre"a!ence o+ >J@
MF
5o0e"er in c!inica! sa#p!es* MKF
5igh co#orbidi%y 0i%h a!coho! ab$se anddepression
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SOCIAL PHOBIA: SUBTYPES
Per+or#ance3es%ric%ed %o p$b!ic spea.ing* gi"ingreci%a!* e%c
Co##on b$% $s$a!!y does no% re6$ire
#edica! %rea%#en%Genera!i'ed
In"o!"es a n$#ber o+ di)eren% si%$a%ions
A"oidance is co##onMore se"ere and a)ec%s genera!+$nc%ioning
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SPECIFIC P5O7IA O3 SIMPLEP5O7IA
Persis%en% or irra%iona! +ears o+ cer%ainobjec%s or si%$a%ions
E(a#p!es, sna.es* c!osed&in&spaces*4ying* b!oodinj$ry* s%or#s and bridges
Co##on in genera! pop$!a%ion
Presen% $p %o ?@ #en and @ 0o#en
3are!y ca$ses s$cien% i#pair#en% ordis%ress %o 0arran% diagnosis
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COMMON SPECIFIC P5O7IASAni#a!s
Sna.es 1Ophidiophobia2Spiders 1Arachnophobia2Dogs 1Cynophobia2
Objec%s7!ood 15e#ophobia2
Si%$a%ions
5eigh%s 1Acrophobia2C!osed Spaces 1C!a$s%rophobia2F!ying 1Aerophobia2Den%is% 1Den%ophobia2
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O7SESSI9E&
COMPULSI9EDISO3DE3 1OCD2
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OCD C5ECBLIST
J Do yo$ 0ash or c!ean a !o%J Do yo$ chec. %hings a !o%&@
Chi!dhood onse% K?@
Chronic so#e%i#es disab!ing MF
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MA=O3 DEFENSEMEC5ANISMS
Iso!a%ion
Undoing
3eac%ion
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GENE3ALIEDAN;IET: DISO3DE3
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GAD, ETIOLOG:
A cer%ain degree o+ an(ie%y is nor#a! and adap%i"e
7io!ogica! and psychosocia!
E(cessi"e 0orries abo$% rea! !i+e prob!e#s s$ch asschoo! and 0or. per+or#ance
Typica!!y see. he!p +or so#a%ic concerns
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GAD, EPIDEMIOLOG:
Li+e%i#e pre"a!ence, ?J@
M>F
5igh co#orbidi%y 0i%h o%her psychia%ricdisorders
3are %o see P$re GAD in %he c!inics
>nd#os% co##on psychia%ric disorder a+%er
depression in pri#ary care
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POST&T3AUMATICST3ESS DISO3DE3
A.a Hshe!! shoc. a.a Hco#ba% +a%ig$e
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PTSD DSM I9&T3E(pos$re %o a %ra$#a%ic e"en% in 0hich %here is,
& Serio$s ris. o+ dea%h or dis#e#ber#en% %ose!+ or o%hers
Their response is .ey* #$s% in"o!"e,In%ense Fear
5e!p!essness5orror
The %ra$#a%ic e"en% is persis%en%!y e(perienced
Person a"oids re#inder o+ %he %ra$#a
May e(perience a n$#bing o+ e#o%ions
Chronic S%a%e o+ hyper aro$sa! & #$s% !as% #ore %han #on%h
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5O8 IS T5E E9ENT 3E&E;PE3IENCED