Anxiety disorders MUDr. Adam Fiala Dept. of Psychiatry, Masaryk University, Brno > Anxiety • •reaction on expected danger coming from inner or outer reality •fear, stress •spontaneous, situational, anticipatory •symptoms Intro • •Anxiety disorders –common –with considerable morbidity and social cost –accompained by anxiety, worry, distress Anxiety disorders •1. Panic disorders w/wo agoraphobia •2. Social phobia •3. Generalized anxiety disorder •4. Obsessive - compulsive disorder •5. Posttraumatic stress disorder and acute stress disorder 1. Panic disorders and agoraphobia • •reccurent unexpected panic attacks –discrete periods of intense fear •developed abruptly, peak within 10 minutes •may be associated with certain situations • • > Criteria for panic attack I •Anxiety symptoms –1. palpitation, pounding hearth, or accelerate hearth rate –2. sweating –3. trembling or shaking –4. sensations of shortness of breath or smothering –5. feelikg of choking –6. chest pain or discomfort • Criteria for panic attack II •Anxiety symptoms (cont.) –7. nausea or abdominal distress –8. feeling dizzy, unsteady, light-headed, or faint –9. derealization /feeling of unreality/, depersonalization /being detached from oneself/ –10. fear of losing control or going crazy –11. fear of dying –12. parestesias –13. chills or hot flushes – > 1a/ Panic disorder without agoraphobia •A. –reccurent unexpected panic attack –at least one of the attacks per month •B. –absence of agoraphobia – 1b/ Panic dissorder with agoraphobia •Criteria for agorafobia –A. Anxiety about being in places or situations from which escape might be difficult. –B. The situations are avoided with marked distress or anxiety about having a P.A. 1c/ Agoraphobia without history of panic disorder •A. The presence of agoraphobia related to fear of developing panic like symptoms/dizziness or diarrhea/. •B. Criteria have never been met for panic dissorder. Treatment •Pharmacological –SSRIs –RIMA –Benzodiazepines – only in emergency – • •Psychoterapeutic –Cognitive-behavioral treatment /relaxation, respiratory control, exposure therapy/ 2. Social phobia • > •Fear of one or more social or performance situations in which the person is exposed to unfamiliar people that will be embarassing. > Diagnostic criteria •Fear – marked and persistant –provoked by phobic stimulus –recognised as unreasonable •Phobic situation –avoided by anxiety, distress –interferes with the persons routine, occupational, social etc. activities •Duration - at least 6 months in individuals under age 18 • • Treatment •Pharmacotherapy /RIMA, SSRIs, benzodiazepines only in emergency/ •Psychosocial /CBT/ –exposure therapy • • Specific phobia > 3. Generalized anxiety disorder > GAD • • •Excessive anxiety or worry lasting for 6 months or longer, accompanied by at least three somatic symptoms. GAD - diagnostic criteria I •A. Excessive anxiety and worry •B. Difficult to control it •C. Association with at least three symptoms –muscle tension –feeling on edge –being easily fatigued –difficulty concentrating –irritability –sleep disturbance Treatment •Pharmacotherapy –Antidepressants SSRIs, BZD, beta-blockers • •Psychotherapy –dynamic, supportive, CBT 4. Obsessive-compulsive disorder > OCD •Patient have either obsession and compulsion that are a significant source of distress – –are time - consuming – –interfere significantly with the person´s normal routine, occupational funcioning or social activities or relationships. – – Obsessions •1. Recurrent and persistent thoughts, impulses, or images. •2. Not simply excessive worries about real-life problems. •3. Attempt to ignore or supress them with some other thought or action. •4. Product of one´s mind. Compulsion •1. Repetitive behaviors in response to an obsession which must be rigidly applied. • •2. Behaviors or mental act preventing or reducting distress. • –/handwashing, ordering, checking/ Treatment •Psychotherapy, behavior therapy •Pharmacotherapy –SSRIs, Li, AP • •ECT •Psychosurgery 5.Posttraumatic stress disorder > A. PTSD - diagnostic criteria I •A. Exposition to a traumatic event /death, injury/ with the experience of intense fear, helplessness, horror. • •B. The traumatic event is persistently reexperienced /images, ilusions, flashbacks, dreams.../ • • PTSD - diagnostic criteria II •C. Three or more of the stimuli associated with the trauma •thoughts, feelings, conversations •activities, places, people •inability to recall important aspects of the trauma •markedly dimished interest in significant activities •feeling of detachment from others •restricted range of affects /loving feels etc./ •sense of foreshortened future /doesn´t expect to have a career, marriage, children…/ • PTSD - diagnostic criteria III • •D. Two or more of persistant symptoms – –difficulty falling or staying asleep –irritability or outburst of anger –difficulty concentrating –hyperviligance –exaggarated startle response – PTSD - diagnostic criteria IV • •E. Duration more than one month • •F. The disturbance causes clinically significant distress in social, occupational or other important areas. • Treatment •Pharmacotherapy –Antidepressants SSRIs, mood stabilizers, anxiolytics, anticonvulsants – •Psychotherapy –individual, group, relaxation training References: §Waldinger RJ.: Psychiatry for medical students, Washington, DC : American Psychaitric Press, 1997 •Kaplan HI, Sadock BJ, Grebb JA.: Kaplan and Sadock´s synopsis of psychiatry, Baltimore: Williams and Wilkins, 1997 • • >