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