ANXIETY

By DR. INAM RASOOL

MBBS, MCPS, FCPS

Associate Professor & Head of Psychiatry, Baqai Medical University.

ANXIETY
A state of apprehension and tension, characterized by excessive worries, unknown fears and somatic features.

ANXIETY

FEAR:

an emotional reaction to threat, present in reality. an emotional reaction to imaginary threats present in future irrational fear

ANXIETY:

PHOBIA:

ANXIETY

Adaptive

Non adaptive

ANXIETY

A reaction to stress A symptom of a syndrome A disease state

FEATURES OF ANXIETY
PSYCHOLOGICAL Excessive worries Apprehension Unknown fears Poor concentration Excessive forgetfulness Easy irritability Increased sensitivity to noise Tearfulness Restlessness and at times agitation.

FEATURES OF ANXIETY
SOMATIC GASTROINTESTINAL: dryness of mouth, difficulty in swallowing, epigastric discomfort, excessive wind, at times diarrhea. RESPIRATORY: rapid shallow breathing, feeling of difficulty in inhalation, CARDIOVASCULAR: increased heart rate, increased pulse, and pericardial discomfort GENITOURINARY: increased frequency of urination, loss of libido, menstrual disturbance NEUROMUSCULAR: headache, pain in neck and shoulders.

FEATURES OF ANXIETY
OTHER FEATURES Sleep disturbance Excessive sweating, cold and clammy hand and feet, Giddiness Nausea Significant distress or social and /or occupational impairment

TYPES OF ANXIETY DISORDERS

Generalized AD (GAD) Preval 2.5-6.5% Features of anxiety Persistent Not specific to the situation No avoidance No anticipatory anxiety Phobic AD Anxiety occur in special situation or from specific objects Avoidance from the phobic situation/ object Anticipatory anxiety Panic attacks Attacks of severe anxiety can occur any where and at any time No avoidance Anticipatory anxiety More common in women

TYPES OF PHOBIC ANXIETY DISORDERS:

SIMPLE PHOBIA SOCIAL PHOBIA AGORA PHOBIA

Generally begin in childhood Phobia from simple objects or situations Avoidance from the phobic object or situation Anticipatory anxiety

Late adolescence Phobic symptoms occur in situations in which person is observed or could be criticized. Anticipatory anxiety Blushing and tremors

Early adult life Away from home in crowded places or can not leave easily Decrease in presence of a friend or relative Avoidance of going out

Anxiety disorder due to a general medical condition

Presence of clinically significant anxiety of sufficient severity to justify a diagnosis of anxiety disorder, that is judged to be due to the direct physiological effect of a general medical condition. Evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition

General medical conditions which may cause anxiety symptoms

Endocrine conditions hyper- and hypothyroidism, pheochromocytoma, hypoglycemia, hyperadrenocorticism Cardiovascular conditions congestive heart failure, pulmonary embolism, arrhythmia Respiratory conditions ` chronic obstructive pulmonary disease, pneumonia, hyperventilation Metabolic conditions vitamin B 12 deficiency, porphyria Neurological conditions neoplasms, vestibular dysfunction, encephalitis

General medical conditions which may cause anxiety symptoms

Toxicity from drugs: e.g. theophylline, beta-agonists, sympathomimetics, thyroxine, amphetamines, and caffeine Withdrawal from depressants: e.g. benzodiazepines and alcohol Side effects of medications: e.g. corticosteroids & antihypertensives

DIAGNOSIS OF ANXIETY DISORDERS

History of onset, nature & severity of symptoms Complete physical and mental state exam. Lab. And radiological investigations if history or physical exam suggest Use of self reporting questionnaire Use of other instruments e.g. Hamilton Anxiety scale to record severity.

TREATMENT OF ANXIETY
Drug treatment Buspirone Antidepressants Benzodiazepines Beta-Blockers
Psychological Counseling Behavioral treatment Relaxation techniques

Thank You