1. Chapter -9 Anxiety disorder

2. Definition  Anxiety is a universal human characteristic involving tension apprehension or even terror  Service as an adaptive mechanism to warn about an external threat by activation the sympathetic nervous system (fight or flight)  Manifestation of anxiety can be described through  Physiology : main brain structure involved in the amygdala (fear condition) Neurotransmitters involved include 5-HT cholecystokinin Cpinephrine norepinephrine da

3.  Physiology- once perception of a given situation is distort which causes one to believe it is threatening in some way  Behavior : once felling threaten one response by escaping or facing the situation thereby causing a disruption in daily functioning  Anxiety become pathological when: fear is generally out of proportion to risk/severity of threat

4.  Response continued beyond existence of threat or becomes generalized to other similar or dissimmilar situation  Social or occupational functioning is impaired Medical workup of anxiety disorder

5.  Routine screering : physical examination CBC, thyroid function test, electrolytes, urinalsis, urine drug screening  Additional screening : neurological consultant, chest x-ray ECG,CT

6.  In generalized anxiety disorder, anxiety is continuous, although it may fluctuate in intensity.  In phobic anxiety disorders, anxiety is intermittent, arising in particular circumstances.  In panic disorder, anxiety is intermittent, but its occurrence is unrelated to any particular circumstances.

7. Classification Anxiety disorder  Agoraphobia  Without a history of panic disorder  Panic disorder with agoraphobia  Social phobia  Specific phobia  Panic disorder without agoraphobia  Generalized anxiety disorder

8. Symptoms of anxiety Psychological arousal  Fearful anticipation  Irritability  Sensitivity to noise  Restlessness  Poor concentration  Worrying thoughts

9. Autonomic arousal Gastrointestinal * Dry mouth * Difficulty in swallowing * Epigastric discomfort * Excessive wind * Frequent or loose motion Respiratory *Constriction in the chest * Difficulty inhaling

10. Cardiovascular * Palpitation * Discomfort in the chest * Awareness of missed beats Genitourinary *Frequent or urgent micturation *Failure of erection *Menstrual discomfort

11. Muscle tension  Tremor  Headache  Aching muscle Hyperventilation  Dizziness  Tingling in the extremities  Feeling of breathlessness Sleep disturbance  Insomnia  Night terror

12. The End