ANXIETY DISORDERS Dr David Schaefer. History Normal anxiety: - evolutionary - alerting signal - interpersonal Pathological: - most common - selective.

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Presentation transcript:

ANXIETY DISORDERS Dr David Schaefer

History Normal anxiety: - evolutionary - alerting signal - interpersonal Pathological: - most common - selective attention - Yerkes Dobson

Classification Generalised anxiety disorder Panic disorder Agorophobia Specific phobia Social phobia OCD PTSD Substance induced anxiety disorder

Panic Attack Discrete period of intense fear/discomfort Starts suddenly, peaks at 10 mins Palpitations Sweating Trembling/shaking SOB/choaking Chest pain Nausea Dizzy/fainting Derealization/detached Fear losing control,dying Paraesthsia, chills

Panic Disorder Recurrent unexpected panic attacks Worry about additional panic attacks Worry about consequences Behavioural change

Treatment Panic Disorder Emergency- Benzos First line- SSRI (delayed effect) 2 nd line- MAOI - Mirtazepine - TCA- imipramine, clomip - Venlafaxine - Epilim

Panic Disorder-Therapy Psychoeducation Cognitive- ‘false alarm’ Relaxation- muscular, imagery Breathing

Obsessive Compulsive Disorder Obsessions- recurrent intrusive thoughts, impulses, images. Recognise thoughts are their own Compulsions- repetitive behaviours/mental acts in response to obsession or rule. Include: - handwashing, ordering, checking,praying, repeating words, counting Compulsion aimed at reducing stress/preventing event

Treatment OCD SSRI or Clomipramine Add Neuroleptic Citalopram and Clomipramine Mirtazepine and SSRI

Therapy OCD Exposure CBT

Obsessive Compulsive Related Disorders OCD Body Dysmorphic Disorder Hoarding Disorder (new to DSM V) Trichotillomania Excoriation (skin picking) Substance induced Obsessional jealousy

PTSD Exposure to traumatic event Reexperienced: Recurrent recollections Dreams Flashbacks Avoidance Emotional numbing/detachment Hyperarousal- sleep, irritability,startle reflex

Treament PTSD SSRI Add neuroleptic Mirtazepine Venlafaxine ? CMZ, clonidine, lamictin, Epilim ? Benzos

Therapy PTSD Cognitive- world unsafe Exposure therapy- conditioned fear response Eye Movement Desensitisation and Reprocessing Behavioural- breathing, progressive muscular relaxation

Specific Phobia Marked fear specific object/situation Exposure provokes anxietyb response Avoidance Realises fear unreasonable Treatment- exposure therapy - ?B-blockers

Social Anxiety Disorder Fear of social/performance situations Fears humiliation/embarrassment Exposure causes anxiety Avoidance Anxious anticipation Blushing Treatment- emergency- Benzos -1 st line- SSRI - B-blocker- performance - Buspirone - Venlafaxine - Epilim

Therapy SAD CBT- mind reading Exposure therapy

Generalised Anxiety Disorder Excessive anxiety and worry Unable to control worry Symptoms- restlesness - fatigue - poor concentration - irritability - muscular tension - insomnia - Common- prevalence 5-8% - women>men - Many seek help other specialities

Treatment GAD Benzos?- sort-term 2-4 weeks Stessum SSRI- start low dose Mirtazepine Venlafaxine B-blockers ?neuroleptics

Therapy GAD Psycho-education CBT Exercise Relaxation

Summary Common Disorders Often Missed High comorbidity Often missed Treatment medication and therapy