Anxiety Disorders

اضطرابی اختالالت

By Dr seddigh

HUMS

Anxiety DisordersNormal & pathologic anxiety

اضطراب فوایداساس بر

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 اشیاevent or situation موقعیتها

social setting اجتماعی مسایل

Subtypes of Specific PhobiaAnimal type

شایعترینNatural environment type

طوفان ، بلندیBlood-Injection-Injury type

Situational type

Other type

مرگ ، بیماری

Facts about Specific PhobiaPrevalence:

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 modelکالسیک شدن شرطی مدل

e.g., dog = CS, bite = UCS

problems: • no memory of a traumatic experience• trauma not produce phobia

Specific PhobiaA. Fear Marked, persistent excessive unreasonable B. Exposure ----- anxity responceC. recognizes : excessive or unreasonableD. 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 - TreatmentInsight-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 OCDPrevalence:

GP 2-3%

Gender: M=F B>G SINGLE>MARRIED

Age of Onset: 20 Y/OM 19 F 22COMORBIDITY:

Obsessive-Compulsive DisorderA. 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 21. 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 - TreatmentCognitive Behavioral Therapies

“Exposure and Response Prevention” (ERP)

Medications

SSRI

Clomipramine

Panic Disorder

Panic attack & Panic Dx

Agoraphobia often develops as a result

Panic DisorderPrevalence:

P.A 3-5.6P.D 1.5-5A 0.6 -6

Gender: 2-3 F = MAge 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

PalpitationsSweatingTrembling/achingSensations of shortness of breath or smotheringFeeling of chokingChest pain/discomfortNausea/abdominal distressFeeling dizzy/unsteady/lightheaded/faintDerealization/depersonalizationFear of losing control/going crazyFear of dyingParesthesias (numbness or tingling sensation)Chills/hot flushes

Panic Disorder with AgoraphobiaA. Both 1 and 2

1. Recurrent, unexpected panic attacks

2. At least one 1 months

1 followinga. 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 21. Recurrent, unexpected panic attacks

2. At least one 1 months

1 followinga. 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) منتشر اضطراب اختالل

More or less constant worry about many issues موقعیتها اکثر در مداوم نگرانی

The worry seriously interferes with functioning جدی عملکرد اختاللPhysical symptoms جسمی عالئم

Headaches سردرد

Stomachaches معده ناراحتیmuscle tension تنشعضالنی Irritability پذیری تحریک

Facts about GADPrevalence:

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

8.9.88

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, Delirium4. Ethanol (5-15%)5. Medical / Metabolic Systems6. Endocrine (thyroid, diabetes), Ears, Eyes, Environ.7. Neurologic (other primary degenerations, etc.)8. Tumor, Toxin, Trauma9. Infection, Idiopathic, Immunologic10. 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 DiseaseDSM-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

SummaryCognitive 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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