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ANXIETY DISORDERS
FEAR vs. ANXIETY
Known in origin Definite External source Alerting signal Non-conflictual
Unknown or vague Indefinite Internal in Origin Alarming signal Conflictual
Peripheral Manifestations of Anxiety Diarrhea Dizziness, lightheadedness Hyperhydrosis Hyperreflexia Hypertension Palpitations Pupillary mydriasis Restlessness Syncope Tachycardia Tingling sensations in the extremities Tremors Upset stomach Urinary frequency, hesitancy, urgency
Anxiety Disorders
Panic disorder Specific and social phobia Obsessive and Compulsive disorders Posttraumatic Stress Disorder Acute Stress Disorder Generalized Anxiety Disorder Anxiety due to GMC Substance induced disorder Anxiety disorder NOS
Panic Attacks
Palpitations, pounding heart, tachycardia
Sweating Tremble or shaking Shortness of breath or
smothering Choking sensation Chest pain or discomfort Sense of abdominal
distress
Feeling of dizziness, unsteady,lightheadedness
Fainting sensation Derealization Depersonalization Fear of losing control,
dying, of being crazy Paresthesias Chills or hot flushes
Panic Attack
Is not a codable diagnosis It occurs also in some anxiety disorder It is a discreet period of intense fear or
discomfort which developed suddenly peaked within 10 minutes with four or more symptoms of panic attack
Panic Disorder
Occurrence of 2 or more panic attacks in a month
Presence of one panic attack but preoccupied of having another panic attack within a month’s duration
May occur with agoraphobia or without agoraphobia
Specific Phobias
Ablutophobia – fear of washing or bathing Achluophobia – fear of darkness Aeroacrophobia – fear of heights Agliophobia – fear of pain Agoraphobia – fear of crowded places Aichmophobia – fear of needles Alliumphobia – fear of garlic Altophobia – fear of heights
Haemophobia – fear of blood Gynephobia – Fear of women Cacophobia – fear of ugly people Homophobia – fear of being homosexual Iatrophobia - fear of doctors Ithyphallophobia – fear of having an erect penis Pelladophobia – fear of bald people Penteraphobia – fear of mother-in-law
Specific Phobias
Claustrophobia – fear of being locked Triskaidekaphobia – fear of number 13 Somniphobia – fear of going to sleep Paraskavedekatriaphobia - Fear of Friday the
13th Coprophobia – fear of feces Photophobia - Fear of light. Oneirophobia - Fear of dreams.
Specific Phobias
Is described as recurring obsessions or compulsions “severe enough to be time consuming… or caused mark distress or significant impairment.” People with this disorder recognize that their actions are irrational or disproportionate.
Obsessive – Compulsive Disorder
Obsessions - Compulsions
Contamination Pathological doubt Somatic Need for symmetry Aggressive Sexual Multiple Obsessions
Checking Washing Counting Need to ask or
confess Symmetry and
precision Hoarding Multiple comparisons
Obsession vs Compulsions
Recurrent and intrusive thought, feeling, idea, or sensation.
Increases anxiety
Is a conscious standardized, recurrent pattern of behavior, such as counting, checking, or avoidance.
Compulsions decrease anxiety.
Major Presenting Symptomof Obsessions Concern or disgust with bodily wastes or secretions
(urine, stool, saliva), dirt, germs, environmental toxins. Fear concerns
Fear something terrible may happen (fire, death or illness of loved one, self, or others)
Concern or need for symmetry, order, or exactness. Scrupulosity (excessive praying or religious concerns out
of keeping with patient’s background) Lucky and unlucky numbers Forbidden or perverse sexual thoughts, images, or
impulses Intrusive nonsense sounds, words, or music
Major Presenting Symptoms of Compulsion Excessive or ritualized hand washing, showering, bathing, tooth
brushing, or grooming Repeating rituals (going in and out of door, up and down from
chair) Checking doors, locks, stove, appliances, car brakes Cleaning and other rituals to remove contact with contaminants Touching Ordering and arranging Measures to prevent harm to self or others (e.g., hanging
clothes a certain way) Counting Hoarding and collecting Miscellaneous rituals (e.g., licking, spitting, special dress
pattern)
Posttraumatic Stress Disorder
A set of typical symptoms that develop after a person sees, is involved in, or hears of an “extreme traumatic stressor.”
The symptoms must last for more than a month and impairs important matters of life such as family and work.
The stress is overwhelming enough to affect almost everyone.
It can arise from experiences in war, torture, natural catastrophes, assault, rape, and serious accidents in cars and burning buildings.
Re-experiencing of the traumatic event in their dreams and their daily thoughts, they are determined to evade anything that would bring the event to mind causing hyper arousal.
Clinical Features of PTSD
Painful experiencing of the event A pattern of avoidance and emotional numbing, and fairly
constant hyper arousal The disorder may not develop until months or even years
after the event The MSE often reveals feelings of guilt, rejection,
humiliation. Patients may also describe the dissociative states and
panic attacks, and illusions and hallucinations may be present.
Cognitive testing may reveal that patients have impairments of memory and attention.
Associative symptoms include aggression, violence, poor impulse control, and substance-related disorders.
Clinical Features of PTSD
Persistent symptoms of increased arousal not present before the trauma as indicated by two or more of the ff;Difficulty falling or staying asleepIrritability or outburst of angerDifficulty concentratingHyper vigilanceExaggerated startled responseDuration of the symptoms is more than one month
Acute Stress Disorder
The person has been exposed to a traumatic event Experiencing the distressing event which has three or
more ff dissociative symptoms A traumatic event is persistently re=experienced in one of
the ff way: recurrent images, illusions, thoughts, dreams, flashback episodes
Marked avoidance of stimuli that arouse recollections of the trauma
Marked symptoms of anxiety or increased arousal The disturbance last for a minimum of two days or
maximum of 4 weeks and occurs within 4 weeks of the traumatic events.
Generalized Anxiety Disorder
Is defined as excessive anxiety and worry about several events or activities for a majority of days during at least a six-month period.
The worry is difficult to control and is associated with its somatic symptoms such as muscle tension, irritability, difficulty of sleeping, and dresslessness.
Criteria for GAD
Excessive anxiety and worry (Apprehensive expectation) occurring more days than not for six month
The person find it difficult to control the worry The anxiety and worry are associated with the ff
six symptoms Restlessness Easy fatigueability Difficulty concentrating Irritability Muscle tension Sleep disturbance
Anxiety due to GMC
Hyperthyroidism Congestive heart failure Hepatorenal disease Parkinson’s disease Atrophy in psychosis Multiple sclerosis Respiratory failure Bronchitis Asthmatic attack Addison’s disease Etc.
Substance-Induced Anxiety Disorder
Methamphetamine intoxication Cocaine intoxication Cannabis intoxication Methylenedioxymethamphetamine
intoxication