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Anxiety Disorders اختلالات اضطرابی By Dr seddigh HUMS.

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Presentation on theme: "Anxiety Disorders اختلالات اضطرابی By Dr seddigh HUMS."— Presentation transcript:

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2 Anxiety Disorders اختلالات اضطرابی By Dr seddigh HUMS

3 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)

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

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

6 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

7 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

8 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

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

10 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

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

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

13 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:

14 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

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

16 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

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

18 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

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

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

21 Panic Disorder Prevalence: P.A 3-5.6 P.D 1.5-5 A 0.6 -6 Gender: 2-3 F =M Age of onset: 25 y/o Comorbidity Etiology (CNS, PNS & AUTONOUM)

22 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

23 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

24 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

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

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

27 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

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

29 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

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

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32 Cognitive Disorders DR SEDDIGH 8.9.88

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

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

35 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

36 Cognitive Disorders Types of Cognitive Disorders

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

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

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

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

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

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

43 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

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

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

46 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

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

48 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

49 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

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

51 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

52 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

53 با تشکر از توجه ، تحمل و حوصله شما

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