Anxiety Disorders

Anxiety…• Is it a normal emotion?• Reaction to stress/ threat events• Physical symptoms of anxiety?

– Tremor– Sweating– Palpitations– …

• Mental symptoms of anxiety?– Worry– Can’t relax– Easily startled– ..

• Anxiety: the phenotype.• Anxiety can be

deconstructed, or broken down, into the two core symptoms of fear and worry.

• These symptoms are present in all anxiety disorders, although what triggers them may differ from one disorder to the next.

Aetiology?• Often due to an interaction of biological and

psychosocial factors:• Genetic vulnerability + past trauma + current

stress…

• In the CNS: anxiety is medicated by NT serotonin and noradrenaline

• Peripherally, the symptoms of anxiety are medicated by the autonomic nervous system (esp sympathetic system)

• When does anxiety become a disorder?

• Types of anxiety disorders?– Specific phobias– Social phobia– Panic disorder– Generalized anxiety disorder– Obsessive compulsive disorder– ….and others.

Diagnostic criteria ICD-10

• F40 Phobic anxiety disorders• F40.0 Agoraphobia• .00 Without panic disorder• .01 With panic disorder• F40.1 Social phobias• F40.2 Specific (isolated) phobias• F40.8 Other phobic anxiety disorders• F40.9 Phobic anxiety disorder, unspecified

• F41 Other anxiety disorders• F41.0 Panic disorder [episodic paroxysmal anxiety]• .00 Moderate• .01 Severe• F41.1 Generalized anxiety disorder• F41.2 Mixed anxiety and depressive disorder• F41.3 Other mixed anxiety disorders• F41.8 Other specified anxiety disorders• F41.9 Anxiety disorder, unspecified

Specific phobias…

• A strong, irrational fear of something that poses little or no actual danger.

ICD diagnostic criteria for specific phobia…

• The psychological or autonomic symptoms must be due to anxiety

(not secondary to other symptoms such as delusions or obsessions)

• The anxiety must be restricted to the presence of the particular object or situation

• Phobic situation is avoided whenever possible

Social phobia

• “In any social situation, I feel fear. …..I feel anxious before I even leave the house,

and it becomes worse as I get closer to a class, a party, or whatever. I feel sick in my stomach- it almost felt like I had the flu. My heart pounds, my palms get sweaty.”

ICD criteria to diagnose social phobia…

• All the symptoms are primarily due to anxiety• The anxiety is restricted to (or mostly seen in)

particular social situations• These social situations are avoided as far as

possible

Panic disorder• “For me, a panic attack is almost a violent

experience. I feel like I’m losing control. My heart pounds really hard, I feel like I can’t get my breath, and there’s an overwhelming feeling that things are crashing in on me.

• ….It started 10 years ago. I was sitting in my room and this thing came out of the blue. I felt like I was dying.

• ….In between attacks there is this dread and anxiety that it’s going to happen again. I’m afraid to go back to places where I’ve had an attack”.

Panic disorder…diagnosis:

1. Several ‘attacks’ of anxiety should have occurred during one month

2. The panic attacks occur when there is no objective danger

3. Not confined to any particular situation4. In-between attacks, there is comparative

freedom from anxiety (though pt often has anticipatory anxiety

OCD- diagnostic criteria1. Obsessional thoughts or compulsive acts2. for at least 2 weeks3. Symptoms cause distress or interfere with activities4. The obsessional thoughts are

i. Recognized to be the person’s own thoughts or impulsesii. At least one thought or impulse must be resistediii. The thought of carrying out the act itself must not be

pleasurableiv. The thoughts, images or impulses are unpleasantly

repetitive

Obsessive compulsive disorder

“Getting dressed in the morning was tough, because I had a long routine. If I didn’t follow the routine, I’d get anxious and would have to get dressed again. I worried that if I didn’t follow the routine, my parents were going to die.

This was completely irrational, but the thoughts caused me lots of anxiety.

Because of the time I spent on rituals, I was unable to do a lot of things that were important to me.”

Males = femalesOnset: often childhood or early adult life

Management of anxiety disorders- overview

• Often best management:

Combination of medication +

Psychological therapy

Medication used for anxiety?

• Anxiolytics: usually medication that increases serotonin levels

E.g. SSRI Some TCAs, e.g.Clomipramine

Venlafaxine

Psychological therapies for anxiety disorders…

• Different types of therapies for different disorders

• Basic relaxation strategies maybe helpful in general e.g.– Deep breathing– Progressive muscle relaxation

• More specific therapies:– OCD: Cognitive behaviour therapy– Behaviour therapy