ChapterChapter :9 :9

AnxietyAnxietyPresented by: Prof.Mirza Anwar BaigPresented by: Prof.Mirza Anwar Baig

Anjuman-I-Islam's Kalsekar Technical CampusAnjuman-I-Islam's Kalsekar Technical CampusSchool of Pharmacy,New Pavel,Navi School of Pharmacy,New Pavel,Navi

Mumbai,MaharashtraMumbai,Maharashtra

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Overview• What is Anxiety?• What are the different types of

anxiety disorders?• What are the causes?• What are the symptoms?• What are the treatments?

Definition of Anxiety• Anxiety is a feeling of apprehension or fear.

The source of this uneasiness is not always known.

• Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety.

Normal versus Pathologic Anxiety• Normal anxiety is adaptive. It is an inborn

response to threat or to the absence of people or objects that signify safety can result in cognitive (worry) and somatic (racing heart, sweating, shaking, freezing, etc.) symptoms.

• Pathologic anxiety is anxiety that is excessive, impairs function.

Anxiety Facts• Most common mental illness in the U.S. with 19 million of the

adult (ages 18-54) U.S. population affected.

• Anxiety disorders cost more than $42 billion a year.• More than $22 billion are associated with the repeated use of

healthcare services, as those with anxiety disorders seek relief for symptoms that mimic physical illnesses.

• Anxiety is highly treatable (up to 90% of cases), but only one-third of those who suffer from it receive treatment

• Depression often accompanies anxiety disorders

2003 Anxiety Disorders Association of America

Types of Anxiety Disorders• Panic Disorder• Obsessive-Compulsive Disorder• Post-Traumatic Stress Disorder• Phobias• Generalized Anxiety Disorder

1.Panic Disorder• The abrupt onset of an episode of intense fear or

discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms:

• A feeling of danger • The need to escape• Palpitations• Sweating• Shortness of breath • A feeling of choking • Chest pain or discomfort

• Nausea or abdominal discomfort• Dizziness • A sense of things being unreal, • A fear of losing control or "going crazy" • A fear of dying • Chills or hot flushes

1. Panic DisorderThere are three types of Panic Attacks:

1. Unexpected - the attack "comes without warning sign and for no discernable reason.

2. Situational - situations in which an individual always has an attack, for example, upon entering

a tunnel.

3. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving.

2. Obsessive-Compulsive DisorderCharacterized by uncontrollable excessive unreasonable obsessions and compulsions .• Obsessions are recurring inappropriate thoughts

and cause the sufferer anxiety: – Thoughts about contamination, for example, when

an individual fears coming into contact with dirt, germs or "unclean" objects;

– Persistent doubts, for example, whether or not one has turned off the iron or stove, locked the door .

– Extreme need for orderliness; – Aggressive thoughts, for example, urge to yell 'fire'

in a crowded theater

2.Obsessive-Compulsive Disorder• Compulsions are repetitive behaviors or rituals performed by the

OCD sufferer, performance of these rituals neutralize the anxiety caused by obsessive thoughts, relief is only temporary. – Cleaning. Repeatedly washing their hands, showering, or

constantly cleaning their home; – Checking. Individuals may check several or even hundreds of

times to make sure that stoves are turned off and doors are locked;

– Repeating. Some repeat a name, phrase or action over and over;

– Slowness. Some individuals may take an excessively slow and methodical approach to daily activities, they may spend hours organizing and arranging objects;

– Hoarding. unable to throw away useless items, such as old newspapers, junk mail, even broken appliances

In order for OCD to be diagnosed, the obsessions and/orcompulsions must take up a considerable amount of the suffererstime, at least one hour every day, and interfere with normalroutines .

3. Post-Traumatic Stress Disorder• Exposure to traumas such as a serious accident, a natural disaster, or

criminal assault can result in PTSD.

• When the events of a traumatic experience interferes with normal functioning, the person may be suffering from PTSD.

• Symptoms of PTSD are:

Reexperiencing the event, which can take the form of intrusive thoughts and recollections, or recurrent dreams;

–Avoidance behavior in which the sufferer avoids activities, situations, people,and/or conversations which he/she associates with the trauma;

–A general numbness and loss of interest in surroundings;

–Hypersensitivity, including: inability to sleep, anxious

feelings,hypervigilance, irritability and anger.

4.Social Phobia/Anxiety• Social anxiety disorder, also known as social

phobia, is an intense fear of social situations. This fear arises when the individual believes that they may be judged, scrutinized or humiliated by others.

• Individuals with the disorder are acutely aware of the physical signs of their anxiety and fear that others will notice, judge them, and think poorly of them.

• In extreme cases this intense uneasiness can progress into a full blown panic attack.

4.Social Phobia/Anxiety contd:• Common anxiety provoking social situations include:

– public speaking

– talking with people in authority

– making a phone call or answering the phone

– interviewing

– attending and participating in class

– speaking with strangers

– meeting new people

– eating, drinking, or writing in public

– driving

– shopping

5.Generalized Anxiety Disorder• Excessive uncontrollable worry about

everyday things. This constant worry affects daily functioning and can cause physical symptoms.

• GAD can occur with other anxiety disorders, depressive disorders.

5. Generalized Anxiety Disorder contd:

• The focus of GAD worry can shift, usually focusing on issues like job, finances, health of both self and family; but it can also include more issues such as car repairs and being late for appointments.

• The intensity, duration and frequency of the worry are disproportionate to the issue

Specific Disorder Facts• Generalized Anxiety Disorder

– Women are twice as likely to be afflicted than men. – Very likely to exist along with other disorders.

• Obsessive Compulsive Disorder– It is equally common among men and women. – One third of afflicted adults had their first symptoms in

childhood.

• Panic Disorder– Women are twice as likely to be afflicted than men. – Occurs with major depression in very high rates.

2003 Anxiety Disorders Association of America

Specific Disorder Facts• Posttraumatic Stress Disorder

– Women are more likely to be afflicted than men.

• Social Anxiety Disorder– It is equally common among men and women.

• Specific Phobia affects– Women are twice as likely to be afflicted as men

2003 Anxiety Disorders Association of America

Common Causes• There is no one cause for anxiety disorders. Several factors can

play a role – Genetics– Brain biochemistry – Overactive "fight or flight" response

• Can be caused by too much stress– Life circumstances– Personality

• People who have low self-esteem and poor coping skills may be more prone

• Certain drugs, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug.

• In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety.

ANXIETY DISORDERS Etiology- Neurotransmitters

• norepinephrine (NE) – concentrated in locus ceruleus

• serotonin• dopamine in social phobia and OCD

• interactions – serotonin affects locus ceruleus (where NE is produced) and may also influence GABA

Symptoms of AnxietyAnxiety is an emotion often accompanied by various physical symptoms, including:

• Twitching or trembling • Muscle tension • Headaches • Sweating • Dry mouth • Difficulty swallowing • Abdominal pain (may be the only symptom of

stress especially in a child)

Additional Symptoms of AnxietySometimes other symptoms accompany anxiety: • Dizziness • Rapid or irregular heart rate• Rapid breathing • Diarrhea or frequent need to urinate• Fatigue • Irritability, including loss of your temper • Sleeping difficulties • Decreased concentration

Social Effects of Anxiety• Depression

– Not as involved with family and friends the way you used to be

– Lowered quality of relationships– Low energy – Lack of motivation to do the things you once

looked forward to doing • Unable to convey the person that you are• Fear and avoidance of situations where

previous attacks occurred

Treatments• Medications (Drug Therapy): • Behavioral Therapy• Cognitive Behavioral Therapy

Alternative Treatments• Acupuncture• Aromatherapy• Breathing Exercises• Exercise• Meditation• Nutrition and Diet Therapy• Vitamins

Medications• Buspirone: shown to be effective but

usually takes 3-4 weeks, particularly useful in elderly patients

• Benzodiazepines: include Xanax and Valium, act rapidly and successfully but can be addictive and loses effectiveness over time

• Side Effects: dizziness, headaches, nausea, impaired memory

Behavioral and Cognitive Therapy

• Teaches patient to react differently to situations and bodily sensations that trigger anxiety

• Examples: Hyperventilating, writing down list of top fears and doing one of them once a week, spinning in a chair until dizzy; after awhile patients learned to cope with the negative feelings associated with them and replace them with positive ones

Aromatherapy• Calming Effect: vanilla, orange blossom,

rose, chamomile, and lavender• Reducing Stress: Lavender, sandalwood,

and nutmeg• Uplifting Oils: Bergamot, geranium, juniper,

and lavender

Exercise• Benefits: symbolic meaning of the activity

and sport, the distraction from worries, mastery of a sport, biochemical and physiological changes associated with exercise.

• Helps by expelling negative emotions and adrenaline out of your body in order to enter a more relaxed, calm state to deal with issues and conflicts

Meditation• Cultivates calmness to create a sense of

control over life• Practice: Sit quietly in a position

comfortable to you and take a few deep breaths to relax your muscles, next choose a calming phrase, silently repeat the word or phrase for 20 minutes

Nutrition and Diet Therapy• Foods to Eat: whole grains, bananas,

asparagus, garlic, brown rice, green and leafy veggies, soy products, yogurt

• Foods to Avoid: coffee, alcohol, sugar, strong spices, highly acidic foods, foods with white flour

• Keep a diary of the foods you eat and your anxiety attacks; after awhile you may be able to see a correlation

• East small, frequent meals

Vitamins• B-Vitamins stabilize the body’s lactate

levels which cause anxiety attacks (B-6, B-1, B-3)

• Calcium (a natural tranquilizer) and magnesium relax the nervous system; taken in combination before bed improves sleep

• Vitamin C taken in large doses also has a tranquilizing effect

• Potassium helps with proper functioning of adrenal glands

• Zinc has a calming effect on the nervous system

Treatments – Problem-solving training

What is my problem? What is my goal? What solutions can I generate to solve the problem? What might be the consequences of each solution? Try a solution particularly relevant to GAD divides problems into manageable units

Self Love• The most important holistic treatment of all• Laugh: be able to laugh at yourself and

with others; increases endorphin levels and decreases stress hormones

• Let go of frustrations• Do not judge self harshly: don’t expect

more from yourself than you do others• Accept your faults

The End