1. ANXIETY DISORDERS Dr David Schaefer

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

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

4. 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

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

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

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

8. 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

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

10. Therapy OCD Exposure CBT

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

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

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

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

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

16. 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

17. Therapy SAD CBT- mind reading Exposure therapy

18. 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

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

20. Therapy GAD Psycho-education CBT Exercise Relaxation

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