Anxiety Disorder_nayan Maharjan

8/9/2019 Anxiety Disorder_nayan Maharjan

1/52

ANXIETY DISORDERPGI Maharjan Nayan

AUFMC


2/52

OUTLINE

Panic Disorder and Agoraphobia

Specic Phobia and Socia! Phobia

Obsessi"e Co#p$!si"e Disorder

Pos%&%ra$#a%ic S%ress Disorder and Ac$%e S%ressDisorder

Genera!i'ed An(ie%y Disorder

O%her An(ie%y Disorder


3/52

NORMAL ANXIETY

A di)$se* $np!easan%* "ag$e sensa%ion o+apprehension

Acco#panied by, A$%ono#ic sy#p%o#s - $rina%ion

Sy#pa%he%ic response - perspira%ion* pa!pi%a%ions* ches%%igh%ness* s%o#ach disco#+or%* res%!essness

Co##on and %rea%ab!e

Can a)ec% abi!i%y %o carry o$% e"eryday %as.

Does no% #ean yo$/re cra'y* has a 0ea. persona!i%yor has a persona!i%y prob!e#


4/52

ANXIETY VS FEAR

An(ie%y An a!er%ing signa!

Apprehensi"e an%icipa%ion o+ +$%$re danger E(perienced as dysphoric 1$np!easan%2

Acco#panied by so#a%ic sy#%o#s

Fear 3ea! %hrea% or danger e(is%s E(%erna!* deni%e or non&con4ic%$a! %hrea%


5/52

IS ANXIETY ALWAYSPATHOLOGICAL?

NO* i% is a 0arning signa!

So#e an(ie%ies are ad"an%ageo$s 5e!ps in no"e! si%$a%ions 5e!ps #obi!i'e indi"id$a! +or 6$ic. response

An(ie%y can heigh%en one/s a0areness*prepare a de+ense %o %hrea%eningsi%$a%ions

Fear response pro#o%es s$r"i"a! o+indi"id$a! and species


6/52

NO3MAL FEA3 3ESPONSE

Cogni%i"e Appraisa! 3ecogni'e and re#e#ber rea! %hrea%

Physio!ogic Aro$sa! Signa!s danger Enhances a!er%ness

7eha"io$rs F!igh% or F!igh%


7/52

FIGHT OR FLIGHTRESPONSE

8hen 0e +ee!

%hrea%ened* o$r bodiesare hard0ired %o ei%hergh% or 4igh% or r$na0ay


8/52

PE3IP5E3AL MANIFESTATIONOF FIG5T O3 FLIG5T

3ESPONSE Many signs are e(p!ained by sy#pa%he%ic ner"o$s

sys%e# ac%i"a%ion and re!ease o+ norepinephrine+ro# adrena! #ed$!!a

Increase in, 5ear% ra%e

7P

9en%i!a%ion

G!$cose 1%o prope! body in%o ac%ion2

P$pis di!a%e

S0ea%ing

Pi!oerec%ion


9/52

85AT MA: T3IGGE3 AN;IET:

Psycho!ogica! S%ress3e!a%ionship brea.$ps* !oss o+

so#eone c!ose* 0or. press$re*!ac. o+ s!eep* nancia! prob!e#s

Physica! S%ressPhysica! i!!ness* %ra$#a*e(cessi"e $se o+ dr$gs anda!coho!


10/52

85EN DOES AN;IET:7ECOME PAT5OLOGICAL?@ +or any an(ie%ydisorder in %he US

MF

S%rong gene%ic co#ponen%


13/52

PANIC ATTACB


14/52

PANIC ATTACB Discre%e period o+ in%ense +ear or disco#+or%

acco#panied by +o$r or #ore o+ %he ), Pa!pi%a%ion

S0ea%ing

Tre#b!ing

Cho.ing

Ches% pain Di''iness** +ain%ing

Derea!i'a%ion

Fear o+ !osing con%ro!

Fear o+ dying

N$#bness

Chi!!s or ho% 4$shes


15/52

PANIC ATTACBEpisodes ha"e a s$dden onse% and pea.rapid!y $s$a!!y in #in or !ess

O+%en acco#panied by a sense o+ i##inen%

danger or doo# and $rge %o escapeMay presen% %o E3 %he +ear o+ ca%as%rophic#edica! e"en% 1MI* s%ro.e2

3epresen%s %riggering o+ a!ar# responsea


16/52

PANIC ATTACBPanic a%%ac. can be a sy#p%o# o+ Socia!Phobia* PTSD and OCD

No% specic %o panic disorder

May hera!d depression

Secondary %o Under!ying #edica! condi%ion

Medica! Side e)ec%

I!!ici% dr$g $se


17/52

PANIC DISO3DE3

3ec$rren%* $ne(pec%ed panic a%%ac.

Fo!!o0ed by one or #ore o+ %he +o!!o0ing, An%icipa%ion o+ addi%iona! a%%ac.s

8orry abo$% i#p!ica%ions o+ %he a%%ac.s

Change in beha"ior

8i%h or 0i%ho$% agoraphobia


18/52

AGO3AP5O7IA


19/52

AGO3AP5O7IA

Li%era!!y +ear o+ #ar.e% p!ace or open spaces

An(ie%y abo$% being in si%$a%ion +ro# 0hich escape#igh% be dic$!%

O+%en secondary %o panic a%%ac.s

A"oided si%$a%ions inc!$ded, dri"ing* bridged*%$nne!s* e!e"a%ors* airp!anes* #a!!s* si%%ing in %he#idd!e o+ %he ro0


20/52

AGORAPHOBIA: DEMOGRAPHY &EPIDEMIOLOGY

MFLi+e%i#e pre"a!ence, >&?@

Fre6$en%!y presen% in pri#ary care

se%%ing


21/52


22/52

PS:C5OANAL:TIC T5EO3IES

Panic a%%ac.s are res$!%ing +ro# $ns$ccess+$!de+ense agains% an(ie%y pro"o.ing i#p$!ses

De+ense #echanis# in"o!"ed, repression*

disp!ace#en%* a"oidance* and sy#bo!i'a%ion


23/52

SOCIAL

P5O7IASOCIALAN;IET:


24/52

SOCIAL P5O7IASOCIALAN;IET:

Main +ea%$re is %he +ear o+ being j$dged or cri%ici'ed

8orry %ha% %hey 0i!! do so#e%hing si!!y ore#barassing %o o%hers

An(ie%y #ay be !i#i%ed %o a specic socia! si%$a%ion


25/52

SOCIAL P5O7IA DSM I9&T3C3ITE3IA

Signican% +ears o+ si%$a%ion 0here %he person#aybe scr$%ini'ed by o%hers or e#barrassed in ap$b!ic si%$a%ion

Fear is %ha% yo$/!! do so#e%hing %o ca$see#barrass#en% or %hey/!! Hsee yo$ s0ea% 1sho0an(ie%y2

E(pos$re %o a +eared si%$a%ion a!#os% in"ariab!y

pro"o.es an(ie%y Person has insigh% %o %he e(cessi"e na%$re o+ %heir

+ear

Feared si%$a%ions are a"oided


26/52

SOCIAL PHOBIA:DEMOGRAPHIC &

EPIDEMIOLOGYLi+e%i#e Pre"a!ence o+ >J@

MF

5o0e"er in c!inica! sa#p!es* MKF

5igh co#orbidi%y 0i%h a!coho! ab$se anddepression


27/52

SOCIAL PHOBIA: SUBTYPES

Per+or#ance3es%ric%ed %o p$b!ic spea.ing* gi"ingreci%a!* e%c

Co##on b$% $s$a!!y does no% re6$ire

#edica! %rea%#en%Genera!i'ed

In"o!"es a n$#ber o+ di)eren% si%$a%ions

A"oidance is co##onMore se"ere and a)ec%s genera!+$nc%ioning


28/52

SPECIFIC P5O7IA O3 SIMPLEP5O7IA

Persis%en% or irra%iona! +ears o+ cer%ainobjec%s or si%$a%ions

E(a#p!es, sna.es* c!osed&in&spaces*4ying* b!oodinj$ry* s%or#s and bridges

Co##on in genera! pop$!a%ion

Presen% $p %o ?@ #en and @ 0o#en

3are!y ca$ses s$cien% i#pair#en% ordis%ress %o 0arran% diagnosis


29/52


30/52

COMMON SPECIFIC P5O7IASAni#a!s

Sna.es 1Ophidiophobia2Spiders 1Arachnophobia2Dogs 1Cynophobia2

Objec%s7!ood 15e#ophobia2

Si%$a%ions

5eigh%s 1Acrophobia2C!osed Spaces 1C!a$s%rophobia2F!ying 1Aerophobia2Den%is% 1Den%ophobia2


31/52

O7SESSI9E&

COMPULSI9EDISO3DE3 1OCD2


32/52

OCD C5ECBLIST

J Do yo$ 0ash or c!ean a !o%J Do yo$ chec. %hings a !o%&@

Chi!dhood onse% K?@

Chronic so#e%i#es disab!ing MF


39/52

MA=O3 DEFENSEMEC5ANISMS

Iso!a%ion

Undoing

3eac%ion


40/52

GENE3ALIEDAN;IET: DISO3DE3


41/52

GAD, ETIOLOG:

A cer%ain degree o+ an(ie%y is nor#a! and adap%i"e

7io!ogica! and psychosocia!

E(cessi"e 0orries abo$% rea! !i+e prob!e#s s$ch asschoo! and 0or. per+or#ance

Typica!!y see. he!p +or so#a%ic concerns


42/52


43/52

GAD, EPIDEMIOLOG:

Li+e%i#e pre"a!ence, ?J@

M>F

5igh co#orbidi%y 0i%h o%her psychia%ricdisorders

3are %o see P$re GAD in %he c!inics

>nd#os% co##on psychia%ric disorder a+%er

depression in pri#ary care


44/52

POST&T3AUMATICST3ESS DISO3DE3

A.a Hshe!! shoc. a.a Hco#ba% +a%ig$e


45/52

PTSD DSM I9&T3E(pos$re %o a %ra$#a%ic e"en% in 0hich %here is,

& Serio$s ris. o+ dea%h or dis#e#ber#en% %ose!+ or o%hers

Their response is .ey* #$s% in"o!"e,In%ense Fear

5e!p!essness5orror

The %ra$#a%ic e"en% is persis%en%!y e(perienced

Person a"oids re#inder o+ %he %ra$#a

May e(perience a n$#bing o+ e#o%ions

Chronic S%a%e o+ hyper aro$sa! & #$s% !as% #ore %han #on%h


46/52

5O8 IS T5E E9ENT 3E&E;PE3IENCED

Documents

Anxiety Disorder_nayan Maharjan