Anxiety Disorders New Insights. Dr.R.V.S.N.Sarma., M.D., M.Sc., Consultant Physician visit : www.drsarma.in. ANXIETY. What is anxiety ?. It is a mood-state with Marked Negative effects Bodily symptoms of tension Apprehensions about future
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Dr.R.V.S.N.Sarma., M.D., M.Sc.,
visit : www.drsarma.in
situations limited to particular situations
as a normal response, as part of one’s
solved, but are not acted on
solved (at least not by the individual), but
can be coped with
and probably will never exist
genetics, other biological factors
physiology, infection, injury, trauma
temperament, life experiences
upbringing, family, school, peers,
society in general, Doctors in particular
stress - chronic or acute
disorders is essential
2. Panic Disorder (PD)
with Agoraphobia (AG)
3. PD sans Agoraphobia
4. Specific Phobia (SP)
5. Social Phobia (SoP)
6. Obsessive Compulsive
7. Post traumatic Stress
8. Acute Stress Disorder
9. SAD, CAD (ASD)
Anxiety disorder (SIAD)
11. Anxiety disorder due
some medical illness
Dual Diagnosis Disorders
Kessler et al. Arch Gen Psychiatry. 1995;52:1048.
Kessler et al. Arch Gen Psychiatry. 1994;51:8.
Are women more ‘Nutty’ ?
Restlessness or feeling keyed up or on edge,
Being easily fatigued,
Difficulty concentrating or mind going blank,
Pathological anxiety, which is
Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events. The person finds it difficult to control the anxiety and worry and has associated three (or more) of the above six symptoms
Worry that is
3 out of 6 other associated physical symptoms
difficult (or embarrassing) or help might not be
available in the event of having a panic attack or
situations where a person is exposed to unfamiliar
situations or people or possible scrutiny by others.
Marked and persistent fear that is excessive or unreasonable,
cued by the presence or anticipation of a specific object or
situation (e.g., flying, heights, animals, receiving an injection,
Exposure to the phobic stimulus almost invariably provokes an
immediate anxiety response, which may take the form of a
The person recognizes that his/her fear is excessive or
unreasonable. The phobic situation is avoided or else is
endured with intense anxiety or distress
Better-halfophobia fear of wife
Trembling or shaking
Shortness of breath
Feeling of choking
Chest pain or discomfort
Nausea or abd. distress
8. Feeling dizzy, fainty
9. Derealization (feelings of unreality)
10. Fear of going crazy
11. Fear of dying
13. Chills or hot flushes
A discrete period of intense fear or discomfort in which 4 (or more) of the above 13 symptoms develop abruptly and reach a peak within 10 minutes
Mrs. B c/o a long h/o episodes of anxiety, SOB, racing heart, sweating, CP, and fears that she is having a MI and will die. These last 30 minutes and are unexpected. She c/o anxiety while in malls and traveling alone to new places for fear of having another attack. Despite a negative w/u, she still worries about having a MI during an attack.
associated with at least four physical and/or
cognitive symptoms cognitive symptoms
attacks or the consequences of an attack (losing
control, having a heart attack, “going crazy”).
that are experienced during the disturbance, as intrusive
and inappropriate, and cause marked anxiety or distress.
excessive worries about real life problems.
impulses, or images are a product of his or her own mind
checking) or mental acts (e.g., praying, counting, repeating
event and has responded with intense fear,
hopelessness or horror.
than 4 weeks after it was experienced and lasted
more than one month.
in several ways, e.g., by intrusive recollections,
dreams, illusions, hallucinations, or flashbacks.
months after the event occurs it is called acute
months, it is considered chronic and long term
those cases where the symptoms do not occur
immediately after the experience, but, rather,
months or years later
Mr. A witnessed a friend die in a MVA six weeks ago and c/o frequent nightmares of the accident, poor sleep, fears of driving, anxiety around highways, anhedonia and decreased affection highways, towards his girlfriend. His girlfriend also notes that he has been very irritable and startles easily since the accident.
Substances that cause
Current Management Strategies
These are PC based in a CD-Rom
or phone based or Web-based
with young people.
5 Modules - analysis and results
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