Anxiety Disorders اختلالات اضطرابی By Dr seddigh HUMS

Anxiety Disorders Normal & pathologic anxiety فواید اضطراب بر اساس DSM IV Panic Disorder with Agoraphobia Social Phobia & Specific Phobia Obsessive Compulsive Disorder Generalized Anxiety Disorder PTSD ( Acute Stress Disorder)

Phobias( specific & social) Intense, irrational fear that may focus on: category of objects اشیا event or situation موقعیتها social setting مسایل اجتماعی

Subtypes of Specific Phobia Animal type شایعترین Natural environment type بلندی ، طوفان Blood-Injection-Injury type Situational type Other type بیماری ، مرگ

Facts about Specific Phobia Prevalence: Sp 11 % So 3-13 % Gender: F>M 2:1 BII F=M Age of Onset: Natural environment type &Blood-Injection-Injury type 5-9 y/o Situational type 20 y/o

Development of Phobias Classical conditioning model مدل شرطی شدن کلاسیک e.g., dog = CS, bite = UCS problems: no memory of a traumatic experience trauma not produce phobia

Specific Phobia A.Fear Marked, persistent excessive unreasonable B. Exposure anxity responce C. recognizes : excessive or unreasonable D. avoided E. distress functioning F. Not mental disorder

Some Unusual Phobias Ailurophobia - fear of cats Algobphobia - fear of pain Anthropophobia - fear of men Monophobia - fear of being alone Pyrophobia - fear of fire

Social Phobia A.Marked, persistent fear social or performance humiliating or embarrassing. B. Exposure anxiety response C. recognizes excessive or unreasonable D. avoided E. distress or functioning

Phobias - Treatment Insight-oriented psychotherapy Relaxation Breathing techniques Cognitive Restructuring Exposure Therapy Medication beta blocker MOA Inh,SSRI,BZD,Venlafaxin,Buspiron

Obsessive-Compulsive Disorder (OCD) Obsessions irrational, disturbing thoughts intrude Compulsions repetitive actions alleviate obsessions Checking and washing most common compulsions neural activity caudate nucleus

Facts about OCD Prevalence: GP 2-3% Gender: M=F B>G SINGLE>MARRIED Age of Onset: 20 Y/O M 19 F 22 COMORBIDITY:

Obsessive-Compulsive Disorder A. Either obsessions or compulsions: Obsessions as defined by 1, 2, 3, and 4 thoughts, impulses, or images 1-Recurrent, persistent intrusive inappropriate 2- about real-life problems 3-The person attempts 4- recognizes his or her own mind

Typical Obsessions Doubts turn off ? lock the door? hurt someone hurt or killed criminal dirty or contaminated

Obsessive-Compulsive Disorder Compulsions as defined by 1 and 2 1.Repetitive behaviors or mental acts response to an obsession rules rigidly 2- reducing distress or preventing

Typical Compulsions Checking Cleaning/washing number in a row Doing and then undoing things symmetry Mental acts such as praying, counting, etc.

Obsessive-Compulsive Disorder B. recognized ---- excessive or unreasonable C. distress or functioning due to the D. not restricted Axis I disorder E. not GMC or substance

OCD - Treatment Cognitive Behavioral Therapies “Exposure and Response Prevention” (ERP) Medications SSRI Clomipramine

Panic Disorder Panic attack & Panic Dx Agoraphobia often develops as a result

Panic Disorder Prevalence: P.A P.D A Gender: 2-3 F =M Age of onset: 25 y/o Comorbidity Etiology (CNS, PNS & AUTONOUM)

Panic Attack (not a diagnosis) A.Discrete period B. intense fear or discomfort, C. in which 4 or more D. reach a peak within 10 minutes Palpitations Sweating Trembling/aching Sensations of shortness of breath or smothering Feeling of choking Chest pain/discomfort Nausea/abdominal distress Feeling dizzy/unsteady/lightheaded/faint Derealization/depersonalization Fear of losing control/going crazy Fear of dying Paresthesias (numbness or tingling sensation) Chills/hot flushes

Panic Disorder with Agoraphobia A. Both 1 and 2 1. Recurrent, unexpected panic attacks 2. At least one 1 months 1 following a. additional attacks b. implications consequences c. change in behavior B. Presence of agoraphobia C. not GMC or substance D. not mental disorder

Panic Disorder without Agoraphobia A. Both 1 and 2 1. Recurrent, unexpected panic attacks 2. At least one 1 months 1 following a. additional attacks b. implications consequences c. change in behavior B. Absence of agoraphobia C. not GMC or substance D. not mental disorder

Panic Disorder - Treatment Medication SSRI, TCA, BZD Bupropion,venlafaxine,nefazodone Psychotherapy Relaxation Breathing techniques Behavioral therapy Cognitive Restructuring

Posttraumatic Stress Disorder (PTSD) Follows traumatic event or events such as war, rape, or assault Symptoms include: nightmares flashbacks sleeplessness easily startled depression irritability

Generalized Anxiety Disorder (GAD)اختلال اضطراب منتشر More or less constant worry about many issues نگرانی مداوم در اکثر موقعیتها The worry seriously interferes with functioningاختلال عملکرد جدی Physical symptoms علائم جسمی Headaches سردرد Stomachaches ناراحتی معده muscle tension تنش عضلانی Irritability تحریک پذیری

Facts about GAD Prevalence: 5% Gender:F:M Out 2:1 In 1:1 Age of Onset: unknown

Generalized Anxiety Disorder (GAD) A.Excessive anxiety and worry 6 months, number of events B. difficult to control C. 3 following symptoms 1.Restlessness 2. easily fatigued 3. concentrating 4.Irritability 5.Muscle tension 6.Sleep Disturbance

GAD - Treatment Medication Benzodiazepines,SSRI,Buspirone Cognitive Therapy Relaxation Breathing Techniques

Cognitive Disorders DR SEDDIGH

Definition Cognitive disorders = central feature impairment of memory, attention, perception, and thinking.

A. DSM History called “organic disorders” DSM-IV “cognitive”

B. Assessment Mental Status Exam: 5 major components: 1.Appearance and behavior 2.Mood and affect 3.Thought 4.Perception 5.Sensorium and Intellect Sensorium = consciousness and awareness of surroundings

Cognitive Disorders Types of Cognitive Disorders

A. Delirium 1.Features Key feature consciousness Associated features Clouded sensorium – no clear awareness of surroundings attention memory speech Perceptual disturbances

A. Delirium (cont.) 2.Statistics and course onset course life-long superimposed

2. Statistics and course (cont.) certain people: Elderly Medically ill (e.g., cancer; AIDS) Dementia

A. Delirium (cont.) 3.Causes Drugs: intoxication, withdrawal, poison Delirium tremens Medications Infection Head injury brain trauma

A. Delirium (cont.) 4.Treatment precipitating problem Prevention

B. Dementia 1.Features Key feature impairment of multiple cognitive abilities novel problems First signs: personality change and memory loss

Differential Diagnosis: Top Ten (commonly used mnemonic device: AVDEMENTIA) 1. Alzheimer Disease (pure ~40%, + mixed~70%) 2. Vascular Disease, MID (5-20%) 3. Drugs, Depression, Delirium 4. Ethanol (5-15%) 5. Medical / Metabolic Systems 6. Endocrine (thyroid, diabetes), Ears, Eyes, Environ. 7. Neurologic (other primary degenerations, etc.) 8. Tumor, Toxin, Trauma 9. Infection, Idiopathic, Immunologic 10. Amnesia, Autoimmune, Apnea

B. Dementia (cont.) 2.Statistics and course Incidence prevalence rate, 65-74:1.29% 75-84:3.83% 85+:10.14%

2. Statistics and course (cont.) males and females Onset type over age

B. Dementia (cont.) Alzheimer’s Disease DSM-IV Criteria A. multiple cognitive deficits both: 1)Memory impairment 2)One (or more) of the following: a)Aphasia b)Apraxia c)Agnosia d)Disturbance in executive functioning

DSM-IV criteria (cont.) B. impairment C. Gradual onset - Rule out

3. Alzheimer’s (cont.) Onset usually in 60’s or 70’s (presenile dementia) Definitive diagnosis 1.Gross atrophy 2.Neurofibrillary tangles 3.Senile plaques

B. Dementia (cont.) 4.Causes of dementia Direct cause Plaques and tangles Blocked artery Genetic factors linked to some dementias Multiple genes Single dominant gene boxer’s dementia

4. Causes (cont.) Vascular dementia diet ---- genetic Psychosocial factors education level Social resources and family support

B. Dementia (cont.) 5.Treatment of dementia Limited – drugs Psychological treatments Memory wallet Memory skills training Teach to use navigational cues to avoid getting lost

Summary Cognitive disorders involve an impairment of memory, attention, perception, and thinking that represents a change from previous functioning Delirium – short-lived; treat precipitating factor (e.g., substance withdrawal) or prevent Dementia – gradual, continual decline (e.g., Alzheimer’s) Dementia treatments are limited; help with memory skills

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