Anxiety by Heena parveen

Anxiety by Heena parveen

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  Anxiety Heena Parveen, M.Pharmacy (Pharmacology), CP&PT. Presentedby:
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  Definition:  Anxiety isa feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel.  Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety. ANXIETY
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  OBJECTIVES  Natural responseand a necessary warning adaptation in humans.  Pathologic disorder when it is excessive and uncontrollable, requires no specific external stimulus, and manifests with a wide range of physical and affective symptoms as well as changes in behavior and cognition disorder.
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  OBJECTIVES • Generalized AnxietyDisorder (GAD) • Social Phobia • Panic Disorder • Agoraphobia • Specific Phobia • Post-Traumatic Stress Disorder (PTSD) • Obsessive-Compulsive Disorder (OCD) TYPES OF ANXIETY
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  OBJECTIVES • Generalized AnxietyDisorder (GAD) – Is characterized by at least 6 months of persistent and excessive anxiety and worry. • Social Phobia – Is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviors. • Panic Disorder – Severe feelings of doom that cause both mental and physical symptoms that can be so intense that some people become hospitalized, worried that something is dangerously wrong with their health. – characterized by two things: • Panic attacks, Fear of getting panic attacks. TYPES OF ANXIETY
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  OBJECTIVES • Agoraphobia – Isanxiety about, or avoidance of, places or situations from which escape might might be difficult (or embarrassing) or in which help may not be available in the event of having a Panic Attack or panic-like symptoms • Specific Phobia – People with a specific phobia experience extreme anxiety and fear if exposed to a particular feared object or situation. Common phobias include fear of flying, spiders and other animals, heights or small spaces. • Post-Traumatic Stress Disorder (PTSD) – Is characterized by the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma. TYPES OF ANXIETY
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  OBJECTIVES • Obsessive-Compulsive Disorder(OCD) Compulsions and obsessions are similar, but exhibit themselves in different ways: • Obsessions: – thought based – Causes mark anxiety or distressed • Compulsions: – behavior based. – Neutralizes anxiety TYPES OF ANXIETY
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  ETIOLOGY  Emotion  Biology Environment  Behaviour  Cognition
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  EPIDEMIOLOGY UNITED STATES STATISTICS •Social phobia is the most common anxiety disorder; • It has an early age of onset— age 11 years -50% & by age 20 years -80% According to: Epidemiological Catchment Area (ECA) study and National Comorbidity Survey (NCS) study • 2.3-2.7% for panic disorder • 4.1-6.6% for generalized anxiety disorder • 2.3-2.6% for OCD • 1-9.3% for PTSD • 2.6-13.3% for social phobia. Further, the NCS reported the following lifetime (and 30-day) prevalence estimates: 6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple (ie, specific) phobia, and 13.3% (and 4.5%) for social phobia
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  EPIDEMIOLOGY International statistics • Cross-nationalstudy - prevalence of panic disorder found lifetime prevalence rates ranging from 0.4% in Taiwan to 2.9% in Italy. • Cross-cultural study - prevalence of OCD found lifetime prevalence rates ranging from 0.7% in Taiwan to 2.5% in Puerto Rico. • In some Far East cultures, individuals with social phobia may develop fears of being offensive to others rather than fears of being embarrassed.
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  PATHOPHYSIOLOGY
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  PATHOPHYSIOLOGY
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  PATHOPHYSIOLOGY
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  PATHOPHYSIOLOGY • Major mediatorsof the symptoms (CNS) of anxiety disorders:  Norepinephrine  Serotonin,  Dopamine  Gamma-aminobutyric acid (GABA) Other neurotransmitter : Corticotropin-releasing factor * • The most commonly considered are the serotoninergic and noradrenergic neurotransmitter systems. under activation over activation
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  PATHOPHYSIOLOGY • Disruption ofthe gamma-aminobutyric acid (GABA) system has also been implicated because of the response of many of the anxiety-spectrum disorders to treatment with benzodiazepines GABA = Glutamate=impact anxiety response • There has also been some interest in the role of corticosteroid regulation and its relation to symptoms of fear and anxiety. • Corticosteroids might increase or decrease the activity of certain neural pathways, affecting not only behavior under stress but also the brain's processing of fear- inducing stimuli. • Although a genetic predisposition to developing an anxiety disorder is likely, environmental stressors clearly play a role in varying degrees.
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  INVESTIGATIONS No biologic markersare specific enough at this time to detect anxiety early, and no research shows that current medications prove efficacious in preventing these disorders. • It is therefore important to screen for specific risk factors: o strong family psychiatric history o concurrent substance abuse.
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  NATURAL HISTORY Levels ofanxiety • Mild Anxiety • Moderate Anxiety • Severe Anxiety • Panic • Anxiety Disorder Complications  Depression (which often occurs with anxiety disorder)  Substance abuse  Trouble sleeping (insomnia)  Digestive or bowel problems  Headaches  Suicide  Poor quality of life
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  MANAGEMENT • Identification ofstress and trigger factors – Identify the problem. When you have identified the situations that are contributing to your anxiety, write down the problem and be very specific in your description, including what is happening, where, how, with whom, why, and what you would like to change. – Come up with as many options as possible for solving the problem, and consider the likely chances that these will help you overcome your problem. – Select your preferred option. – Develop a plan for how to try out the option selected and then carry it out. – If this option does not solve the problem remember that there are other options to try. – Go back to the list and select your next preferred option. • Breathing exercises • Thought management • Lifestyle changes
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  MANAGEMENT Psychological Therapies • Cognitivebehavior therapy • Behaviour therapy
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  Treatment of AnxietyDisorders Treatment usually consists of a combination of pharmacotherapy and/or psychotherapy.
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  bBenzodiazepenes
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  References 1. Text bookof Clinical Pharmacy and Therapeutics 2. Text book of Pharmacology by RANG and DALE’S. 3. Essentials of Medical Pharmacology by Tripathi.