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Anxiety Disorders Seminar.pptx
- 1. Presenters name: 1. SreeDeivy Nair 2. Mokham Singh 3. Sivasangari
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- 4. - It ischaracterized most commonly as a diffuse, unpleasant, vague sense of apprehension,often accompanied by autonomic symptoms such as headache, perspiration, palpitations, tightness in the chest, mild stomach discomfort, and restlessness, indicated by an inability to sit or stand still for long. - women affected nearly twice as frequently as men. - Anxiety disorders often are chronic and resistant to treatment
- 5. Fear vs anxiety FearAnxiety Fear is a similar alerting signal, Anxiety is an alerting signal; it warns of impending danger and enables a person to take measures to deal with a threat a response to a known, external, definite, or nonconflictual threat; anxiety is a response to a threat that is unknown, internal, vague, or conflictual.
- 7. Stress vs anxiety •The nature of the event and on the person’s resources, psychological defenses, and coping mechanisms • All involve the ego, a collective abstraction for the process by which a person perceives,thinks, and acts on external events or internal drives • A person whose ego is functioning properly is in adaptive balance with both external and internal worlds; if the ego is not functioning properly and the resulting imbalance continues sufficiently long, the person experiences chronic anxiety
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- 10. Contributions of Psychological Sciences Theanxiety disorders make up one of the most common groups of psychiatric disorders Women (30.5 percent lifetime prevalence) are more likely to have an anxiety disorder than are men(19.2 percent lifetime prevalence). The prevalence of anxiety disorders decreases with higher socioeconomic status. epidemiology Contributions of Biological Sciences
- 11. Psychoanalytic Theories> Freud ultimately redefined anxiety as a signal of the presence of danger in the unconscious. Behavioral Theories > this theory postulate that anxiety is a conditioned response to a specific environmental stimulus. Existential Theories> Existential theories of anxiety provide models for generalized anxiety, in which no specifically identifiable stimulus exists for a chronically anxious feeling. The central concept of existential theory is that persons experience feelings of living in a purposeless universe 11 Contribution of Psychological Science
- 12. Autonomic NervousSystem >. Stimulation of the autonomic nervous system causes certain symptoms—cardiovascular(tachycardia), muscular(headache), gastrointestinal (diarrhea), and respiratory (tachypnea). Neurotransmitters> he three major neurotransmitters associated with anxiety on the bases of animal studies and responses to drug treatment are norepinephrine, serotonin, and gabba -aminobutyric acid (GABA) 12 Contribution of Biological Science
- 13. Classification of anxietydisorder 13
- 14. Place your screenshothere 14 Anxiety can be conceptualized as a normal and adaptive response to threat that prepares the organism for flight or fight. Persons who seem to be anxious about almost everything, however, are likely to be classified as having generalized anxiety disorder. Generalised anxietydisorder
- 15. 15 Phobic –anxiety disorder ༝Specific phobia ༝ Social phobia ༝ Agarophobia with panic disorder/without panic disorder
- 16. ⬡ A personwith a specific phobia is inappropriately anxious in the presence of a particular object or situation ⬡ In the presence of that object or situation, the person experiences the symptoms of anxiety ⬡ Specific phobias can be characterized further by adding the name of the stimulus (e.g. spider phobia). ⬡ In DSM-5, five general types of specific phobia are recognized, which are concerned with: ● animals ● aspects of the natural environment ● blood, injection, medical care, and injury ● situations (for example, aeroplanes, lifts, enclosed spaces). ● other provoking agents (for example, fears of choking or vomiting). Specific phobia
- 18. ⬡ In thisdisorder, inappropriate anxiety is experienced in social situations, in which the person feels observed by others and could be criticized by them. ⬡ attempt to avoid such situations. If they cannot avoid them, they try not to engage in them fully ⬡ Even the prospect of encountering the situation may cause considerable anxiety, which is often misconstrued as shyness. ⬡ Social phobia can be distinguished from shyness by the levels of personal distress and associated social and occupational impairment (Stein and Stein, 2008). Social phobia
- 19. ⬡ Agarophobic patientsare anxious when they are away from home, in crowds, or in situations that they cannot leave easily. They avoid these situations, feel anxious when anticipating them, and experience other symptoms. ⬡ The anxiety symptoms that are experienced by agoraphobic patients in the phobic situations are similar to those of other anxiety disorders ⬡ although two features are particularly important: >panic attacks, whether in response to environmental stimuli or arising spontaneously >anxious cognitions about fainting and loss of control Agarophobia!
- 20. 20 Panic disorder ༝ Thecentral feature is the occurrence of panic attacks. these are sudden attacks of anxiety in which physical symptoms predominate, and they are accompanied by fear of a serious medical consequence such as a heart attack ༝ The important features of panic attacks are that: ༝ ● anxiety builds up quickly ༝ ● the symptoms are severe ༝ ● the person fears a catastrophic outcome.
- 21. • Shorter oxfordTextbook of Psychiatry • Kaplan Sadock’s Concise Textbook of clinical Psychiatry • Kaplan and sadock’s Synopsis of Phychiatry • DSM-5 references
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- 23. Diagnostic Criteria forAnxiety Disorders MOKHAM SINGH 012016090444
- 24. • Diagnosing GeneralAnxiety Disorder requires a broad differential and caution to identify confounding variables and comorbid conditions • Screening tools can help with diagnosis as well and monitoring responses to therapy • Early diagnosis is key to preventing the condition from negatively impacting the patient's quality of life and disrupting important activities of daily living.
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- 26. Consultation • Medications • Alcoholconsumption • Coffee consumption • Hormones
- 27. Conditions with similar symptoms • Heartattack • Angina • Mitral valve prolapse • Tachycardia • Asthma • Hyperthyroidism • Adrenal gland tumors • Menopause • Side effects of certain drugs, such as drugs for high blood pressure, diabetes, and thyroid disorders • Withdrawal from certain drugs, such as those used to treat anxiety and sleep disorders • Substance abuse or withdrawal
- 28. Test to Diagnose • ZungSelf-Rating Anxiety Scale • Hamilton Anxiety Scale (HAM-A) • Beck Anxiety Inventory (BAI) • Social Phobia Inventory (SPIN) • Penn State Worry Questionnaire • Generalized Anxiety Disorder Scale • Yale-Brown Obsessive-Compulsive Scale (YBOCS)
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- 34. MONITORING TOOLS FORGENERAL ANXIETY DISORDERS • GAD-7
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- 36. • Total scorefor the 7 items ranges from 0 to 21. • Scores of 5, 10, and 15 represent cutoffs for mild, moderate, and severe anxiety, respectively. • Although designed primarily as a screening and severity measure for GAD, the GAD-7 also has moderately good operating characteristics for panic disorder, social anxiety disorder, and posttraumatic stress disorder. • When screening for anxiety disorders, a recommended cutoff for further evaluation is a score of 10 or greater
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- 39. Assessment and management ◦ Completehistory taking ◦ Full physical examinations ◦ Any role for hospitalization? ◦ Investigations: to role out substance abuse or any medical disorders
- 40. Assessment and management •There are differences in the features and treatment of the various types of anxiety disorder, there are also many common features. • Treatments are tested on patients who meet formal diagnostic criteria, but many patients seek help before their symptoms meet these criteria, and it is usually appropriate to start treatment immediately based on clinical judgement.
- 41. General treatment planfor anxiety disorders
- 42. Psychoeducation ◦ Anxiety disordersare maintained by fears about the nature and consequences of their symptoms. ◦ An explanation of the condition should be tailored to the concerns of the individual patient, but it is usually necessary to explain how fears that symptoms are caused by physical illness can cause vicious circles of anxiety. ◦ Providing written information is important, as anxious people often suffer from poor concentration.
- 43. Advice about self-help methods. ◦Patients with anxiety disorders can help themselves in simple ways, ◦ time management, ◦ activity scheduling, ◦ taking time off to relax, ◦ reducing caffeine intake.
- 44. Hyperventilation • Patients shouldpractise slow, controlled breathing, at first under supervision and then at home • A tape recording can be used to help the patient time their breathing appropriately. • Such a tape can be made by the primary care team or obtained from a department of clinical psychology. • It is important to identify and treat the underlying anxiety disorder.
- 45. Cognitive behavioral therapy ◦ Providedby a clinical psychologist or a specially trained psychiatric nurse, who may be based within primary or secondary care, and should be weekly sessions of 1 hour to a total of 16–20 hours delivered within 4 months. ◦ This may be quicker to access as a group treatment
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- 47. Antidepressants • Have beenproven to be effective at reducing anxiety even in patients who do not have co-morbid depression. • The main advantage of anti depressant is that they do not produce dependence, and therefore can be used long term. • An SSRI should be the first-line medication. • Tricyclic antidepressants are recommended for some anxiety .However, they are more toxic in overdose and have a less good side-effect profile than SSRIs.
- 48. Antidepressants • If thereis no improvement after 12 weeks, another SSRI should be tried. • Medication is usually continued for at least 6 months after the symptoms improve, and often longer. • Patients who relapse can resume their medication or be referred for cognitive behaviour therapy. • For GAD specifically, there is some evidence that paroxetine may be the best SSRI to use. • Venlafaxine is also licensed for use in GAD, but should not be a first-line medication, and should be started by a specialist.
- 49. Limit the useof anxiolytics. • Anxiolytic drugs (such as benzodiazepines) can bring rapid relief from anxiety at times of crisis and are frequently used to cover the 2–3 weeks it takes for an antidepressant to work. • While it is easy to prescribe them, this should not be done routinely but kept for more severe disorders or cases in which immediate relief is essential. • Anxiolytics should not be prescribed for more than about 3 weeks because of the risk of dependency
- 50. Buspirone ◦ Buspirone isa non-benzodiazepine anxiolytic which can be used for short-term relief in GAD. ◦ It is less likely to cause dependence than a benzodiazepine, but does take up to 4 weeks to work
- 51. General treatment planfor anxiety disorders
- 53. Risk assessment A riskassessment should be carried out , focusing specifically upon risk of self-harm, exploitation, self-neglect, and driving. • The nature of the risk; • The probability of the risk in the short and longer term; • Whether there are any factors that increase the risk; • Whether there are any factors that decrease the risk; • Whether there are any interventions that may reduce the risk.
- 55. Case study Mike isa 20 year-old who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. Mike has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college. You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him – he assumes they will find him “dumb,” “boring,” or a “loser.”
- 56. Case study When heloses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the “stupid” things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drive him to engage in these avoidance behaviors.
- 57. Case study SOCIAL ANXIETYDISORDER
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