1 / 31

Anxiety Disorders

Anxiety Disorders. Anita S. Kablinger MD Associate Professor, Departments of Psychiatry and Pharmacology LSUHSC-Shreveport. DSM-IV Anxiety Disorders. Specific phobias Panic disorder Agoraphobia Generalized anxiety disorder Social phobia Obsessive-compulsive disorder PTSD.

haruki
Download Presentation

Anxiety Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Anxiety Disorders Anita S. Kablinger MD Associate Professor, Departments of Psychiatry and Pharmacology LSUHSC-Shreveport

  2. DSM-IV Anxiety Disorders • Specific phobias • Panic disorder • Agoraphobia • Generalized anxiety disorder • Social phobia • Obsessive-compulsive disorder • PTSD

  3. PTSD: Presentation Outline • Introduction/History • Clinical Presentation/DSM-IV Criteria • Differential Diagnosis • Etiology/Risk Factors • Treatment Issues • Prevention

  4. Introduction/History • First appeared in DSM-III (1980) • Recognized by Shakespeare in Henry IV • Civil Wardescriptions • WWI- shell shock and soldier’s heart • WWII- operational fatigue and combat neurosis • Organic origin vs psychogenic derivation

  5. Diagnostic Criteria for PTSD • A. Exposed to traumatic event • The person experienced, witnessed, or was confronted with an event involving actual or threatened death, serious injury or a threat to physical integrity of self or others • The person’s response involved intense fear, helplessness or horror

  6. Diagnostic Criteria for PTSD • B. The traumatic event is reexperienced in one or more of the following ways • Recurrent images, thoughts or perceptions • Recurrent distressing dreams of the event • Acting or feeling as if the event was recurring • Intense psychological distress OR physiologic reactivity at exposure to cues that symbolize or resemble an aspect of the event

  7. C. Persistent avoidance of stimuli associated with trauma and numbing as indicated by 3 or more: Avoiding thoughts, feelings, or discussion, activities, places or people that bring back recollections; sense of foreshortened future Inability to recall; restricted affect Diminished interest or participation Feeling detached or estranged Diagnostic Criteria for PTSD

  8. D. Persistent symptoms of increased arousal by 2 or more: Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hypervigilance Exaggerated startle response E. Duration for more than 1 month Diagnostic Criteria for PTSD

  9. F. Clinically significant impairment in functioning Acute: Less than 3 months Chronic: Greater than or equal to 3 months With delayed onset: Onset at least 6 months after the stressor Diagnostic Criteria for PTSD

  10. Diagnostic Criteria for Acute Stress Disorder • A: Exposed to traumatic event • B. Experiences three or more of: • Subjective sense of numbing, detachment • Reduction in awareness of surroundings • Derealization • Depersonalization • Dissociative amnesia • C. Persistent reexperiencing of the event

  11. Diagnostic Criteria for Acute Stress Disorder • D. Marked avoidance of stimuli that arouse recollections of the trauma • E. Marked symptoms of anxiety or increased arousal • F. Causes significant impairment • G. Lasts 2 days to 4 weeks and occurs within 4 weeks of the trauma

  12. Epidemiology • Prevalence of PTSD: 1-14% community, 3-58% in at-risk populations • 25-30% lifetime prevalence in Vietnam veterans • 85% in concentration camp survivors • May be modulated by cultural differences • All ages; individuals or groups; F>M

  13. Differential Diagnosis • Mental disorder secondary to GMC • (ex. head injury) • Substance-induced disorder • Dissociative disorders • Major depressive episode • Borderline personality disorder • Malingering

  14. Etiological Factors • Magnitude of the stress exposure • Cognitive appraisal factors • Intense fear or helplessness predictive • Sympathetic hyperactivity • Psychological factors • psychodynamic • cognitive • behavioral

  15. Violent crime Sexual trauma Chronic physical abuse Military combat Natural disasters Manufactured disasters Complicated or unexpected bereavements Accidents Captivity Examples of Traumatic Events

  16. Lack of social support Family psychiatric history, esp. anxiety Previous psychiatric history Certain personality traits Early separation of parents Parental poverty Abuse in childhood Childhood behavioral problems Limited education Adverse life-events prior to trauma Female Risk Factors

  17. Six Strongest Predictors of Trauma Exposure • Male • Absence of college education • Extroversion • Neuroticism • Early misconduct • Family psychiatric illness

  18. Six Strongest Predictors for Risk of PTSD • Female • Neuroticism • Early separation from parents • Prior anxiety or depression • Familial anxiety • Familial antisocial personality disorder

  19. Associated Symptoms Important for Treatment • Survival and behavioral guilt • Somatic distress • Paranoia • Interpersonal alienation • Vegetative changes of depression • Hopelessness • Impulsivity

  20. Course and Prognosis • 30% recover completely • 40% continue with mild symptoms • 20% moderate symptoms • 10% unchanged or worsen • Startle, nightmares, irritability and depression often worsen with age • Comorbidity is high (MDD, OCD, Panic, substance abuse)

  21. Treatment: ASD • Talking about the trauma allowing: • confrontation • acceptance • process • integration • Individual or group therapy, hypnosis • Followed by support and superficiality

  22. Treatment: PTSD • Requires multiple modalities • Initial education, support and referrals important to establish trust • Pharmacotherapy • Psychotherapy • Relaxation Training

  23. Treatment: PTSD-Pharmacotherapy • Duration of at least 8-12 weeks • Adequate dosages • Maintenance treatment for at least 1 year • Antidepressants • Mood stabilizers • Propranolol, clonidine • Atypical antipsychotics

  24. Amitriptyline Fluoxetine Sertraline* Paroxetine* Propranolol Clonidine Valproic Acid Carbamazepine 50-300 mg/day 20-60 50-200 20-50 40-160 0.2-0.6 750-1,750 200-1,200 Drug Treatment of PTSD

  25. Lithium Quetiapine Risperidone Olanzapine 300-1,500 mg/day 25-700 0.5-6 2.5-20 Drug Treatment of PTSD

  26. Treatment: PTSD- Individual Psychotherapy • Crisis Intervention • establish rapport, promote acceptance • educate, attend to general health • Trauma-focused psychotherapy • Implosive therapy • Systematic desensitization • Hospitalization may be necessary at times

  27. Points to Remember • If a patient has multiple complaints, think PTSD or personality disorder up front • Under-detected because we don’t ask the right questions • One of the few DSM disorders defined by it’s cause!

  28. DREAMS Detachment Re-experiencing the event Emotional effects Avoidance Month in Duration Sympathetic hyperactivity or hypervigilance

  29. PTSD Questionnaire

  30. DSM-IV Anxiety Disorders • Specific phobias • Panic disorder • Agoraphobia • Generalized anxiety disorder • Social phobia • Obsessive-compulsive disorder • PTSD

More Related