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Anxiety disorders

Learn about different types of anxiety disorders, including Generalized Anxiety Disorder, Panic Disorder, and Phobic Disorders. Explore the causes, symptoms, and treatment options for each disorder. Dr. Eman Abahussain, a psychiatry consultant from KKUH and KAUH, provides expert insights.

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Anxiety disorders

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  1. Anxiety disorders Dr. Eman Abahussain psychiatry consultant,kkuh,kauh.

  2. Normal vs. Abnormal anxiety Anxiety Disorders: 1- GAD 2-Panic disorder 3- Agoraphobia 4- Social phobia 5- Specific phobia 6- Acute & PTSD 7- OCD

  3. fear: is a response to a known external definite threat Anxiety: is a response to a threat that is unknown internal vague or conflictual.

  4. :features of anxiety

  5. Generalized Anxiety Disorder Criteria: 6 months duration – most of the time Excessive worries about many events Multiple physical & psychological features Difficult to control Significant impairment in function Not due to GMC , substance abuse or other axis I psychiatric disorder

  6. : COMORBIDITY: 50-90% other mental disorders. Epidemiology: women > menPrevalence : 3 – 5 %. Age of onset vary , range : 20 – 55 years. Pt. usually consults medical (non-psychiatric) specialties, and / or faith-healers first. MSE : Tense posture, excessive movement e.g. hands (tremor) & head, excessive blinking Sweating Difficulty in inhalation.

  7. DDx : Normal reaction to stress. Anxiety due to physical problems: anemia –hyperhyroidism - BA - Rx – sub. A. Panic disorder. Adjustment disorder with anxious mood. Somatization disorder. Hypochondriasis. Mixed anxiety & depressive disorder. Depressive disorders. Psychotic disorders.

  8. Course & Prognosis chronic, fluctuating & worsens with stress. it may cause Secondary depression . Poor Prognostic Factors: • Very severe symptoms • Personality problems • Uncooperative patient.

  9. Management of GAD • Rule out common physical causes. • Explain the nature of the illness & symptoms. • Reassure that symptoms are not due to a physical disease. • Draw attention to psychological factors. • Cognitive-Behavioral Treatment (CBT). • Short course(2/52) BDZ e.g. lorazepam. • Long term Rx: SSRI-SNRI-TCA - 6 months after initial response to treatment,(NICE guidelines),few studies examine relapse prevention .

  10. Panic Disorder Panic attack : • a symptom not a disorder. • Can be part of many disorders: panic disorder, GAD, phobias, sub. Abuse acute & PTSD • It is adiscreate period of intense fear or discomfort,in which 4 of the anxiety symptoms developed abruptly and reached apeak within 10 min .

  11. Symptoms of panic attack: • Palpitation • Sweating • Trembling • Shortness of breath • Feeling of choking • Chest pain • Feeling dizzy • Fear of dying • paresthesias

  12. Panic Disorder: Disorder with specific criteria: 1- unexpected recurrent panic attacks (+/- situationally bound). 2- one month period (or more) of persistent concern about having another attack or worry about the implications of the attack, or change in behavior related to the attacks. 3- Not due to other disorders

  13. Epidemiology Women > men Prevalence : 1– 3 % Age at onset : 20 --- 35 years Etiology Genetic predisposition Disturbance of neurotransmitters NE & 5 HT in the locus ceruleus ( alarm system in the brain ) Behavioral conditioning

  14. Prognosis: • 30-40% became symptoms free • 50%have mild symptoms • 10-20%continue to have significant symptoms

  15. Management Rule out physical causes. Support & reassurance CBT: cognitive therapy( instructions about a patient false beliefs and information about panic attack) behavioral therapy (relaxation, breathing training, in vivo exposure) Medications: BNZ , SSRIs, TCAs Treatment should continue for 12 months or more.

  16. Phobic Disorders

  17. OCD • 1-obsessions: • Recurrent persistent intrusive thoughts impulses or images from his own mind, that cause marked distress and anxiety, pt tries to suppress them with some other thoughts or actions. • 2-compulsions: • Repetitive behaviors or mental acts that pt feels driven to do . • 3- they are excessive or unreasonable • 4- cause marked distress or time consuming or interfer with function.

  18. :Main themes -Contamination & washing - pathological doubt, Checking & counting Ablution, prayers… -intrusive thoughts: Images of aggression , Self- harm ,Sexual act. -symmetry, and slowness -other symptoms: religious obsessions

  19. Epidemiology Males = Females Lifetime prevalence = 2-3 % Mean age of onset = 20 – 25 yeas

  20. Course and prognosis: the course is usually long but variable ,some have fluctuating course and others constant one. 20-30%have significant improvement 40-50% moderate improvement. 20-40%remain ill or even worse.

  21. D D • Anxiety, panic and phobia. • Depressive disorders. • Hypochondriasis • Schizophrenia. • Organic mental disorders. • OCPD: perfectionism, orderliness…

  22. Treatment Pharmacobehavioral : 1- Pharmacological: - SSRIs : fluoxetine - paroxetine clomipramine Duration of treatment 12 months and more. 2- Behavioral : exposure & response prevention others

  23. Prognosis Good p. Factors Bad p. Factors • Non – severe • No OCPD • Depressed / anxious mood • Compliance with T • Family support • very – severe • OCPD • No Depressed / anxious mood • Non- Compliance with treatment. • No Family support

  24. Thanks

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