Anxiety Disorders and OCD

1. Anxiety Disorders and OCD Rui Feng Sir Run Run Shao Hospital

2. the definition of “anxiety”： Apprehension, tension, or uneasiness that stems from the anticipation of danger, which may be internal or external...The manifestations of anxiety and fear are the same and include motor tension, autonomic hyperactivity, apprehensive expectation, and vigilance and scanning. • three separate dimensions: - Verbal reports of subjective experiences - Behavioral responses - Physiological responses

3. Psychological arousal • Fearful anticipation • Irritability • Sensitivity to noise • Restlessness • Poor concentration • Worrying thoughts • Muscle tension • Tremor • Headache • Aching muscles Hyperventilation • Dizziness • Tingling in the extremities • Feeling of breathlessness Sleep disturbance • Insomnia • Night terror Autonomic arousal • Gastrointestinal Dry mouth Difficulty in swallowing Epigastric discomfort Excessive wind Frequent or loose motions • Respiratory Constriction in the chest Difficulty inhaling • Cardiovascular Palpitations Discomfort in the chest Awareness of missed heartbeats • Genitourinary Frequent or urgent micturition Failure of erection Menstrual discomfort Amenorrhoea

4. Distinction between Normal and Abnormal anxiety • Normal anxiety • Abnormal anxiety

5. Distinction between Anxiety and other disorders: • Schizophrenia • Mood Disorders

6. Anxiety Disorders Features:

7. Generalized Anxiety Disorder • General characteristics

8. CLINICAL PICTURE • Worry and apprehension • Psychological arousal • Autonomic over-activities • Muscle tension • Hyperventilation • Sleep disturbances • Others

9. Epidemiology

10. Aetiology • Stressful events • Genetic causes • Early experience • Cognitive-behavioural theories • Personality • Neurobiological mechanisms

11. Prognosis • The prognosis beyond 3 years is less certain though in a study of medical patients with anxiety disorder, two-thirds improved substantially or recovered within 6 years .

12. CASE STUDY • I wish I could tell you what's the matter. Sometimes I feel like something terrible has just happened when actually nothing has happened at all. Other times, I'm expecting the sky to fall down any minute. The fact is that I am tense and jumpy almost all the time. Sometimes my heart beats so fast, I'm sure it's a heart attack. Little things can set it off. The other day I thought a supermarket clerk had overcharged me a few cents on an item. She showed me that I was wrong, but that didn't end it. I worried the rest of the day. I kept going over the incident in my mind, feeling terribly embarrassed at having raised the possibility that the clerk had committed an error. The tension was so great, I wasn't sure I'd be able to go to work in the afternoon.

13. Case study • Kristen is a 38 year-old divorced mother of two teenagers. She has had a successful, well-paying career for the past several years in upper-level management. Even though she has worked for the same, thriving company for over 6 years, she’s found herself worrying constantly about losing her job and being unable to provide for her children. This worry has been troubling her for the past 8 months. Despite her best efforts, she hasn’t been able to shake the negative thoughts. • Ever since the worry started, Kristen has found herself feeling restless, tired, and tense. She often paces in her office when she’s there alone. She’s had several embarrassing moments in meetings where she has lost track of what she was trying to say. When she goes to bed at night, it’s as if her brain won’t shut off. She finds herself mentally rehearsing all the worse-case scenarios regarding losing her job, including ending up homeless.

14. Medication • Buspirone • Beta adrenergic antagonists • benzodiazepines • tricyclic and specific serotonin release inhibitors

15. Phobia Disorders • Definition a persistent, irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the dreaded object, activity or situation The circumstances provoking anxiety can be grouped into situations(for example, crowded places), “objects”(a term that includes living things such as spiders), and natural phenomena(for example, thunder).

16. Phobia Disorders • Phobias • Specific phobias • Social phobia • Agoraphobia

17. specific phobia • 1. animals • 2. aspects of the natural environment • 3. blood, injection, and injury • 4. situations and other provoking agents.

18. Specific Phobias

19. Treatment • The main treatment is the exposure form of behavior therapy.

20. Case study • I can't tell you why I'm afraid of rats. They fill me with terror. Even if I just see the word "rat" my heart starts pounding. I worry about rats in restaurants I go to, in my kitchen cupboard, and anywhere I hear a noise that sounds like a small animal scratching or running.

21. Social Phobia • General characteristics Fear of being in social situations in which one will be embarrassed or humiliated

22. Aetiology • Genetic factors • Conditioning • Cognitive factors • Neural mechanisms

23. Case study • "I sometimes don't go to class because I think the professor might call on me. My fear doesn't have anything to do with being unprepared if he asks me a question because I'm almost always well prepared. My grades on exams are always near the top of the class. What I keep thinking about is that the professor and all the students will see how red my face gets whenever I have to say something in a group".

24. Agoraphobia • "the fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of a panic attack"

25. Differential diagnosis • Social phobia • Generalized anxiety disorder

26. treatment • Exposure treatment was the first of the behavioural treatments for agoraphobia. • Medication can be offered as a first treatment espe­cially when panic attacks arc frequent and/or severe. medication is usually combined with repeated practice in re-entering situations that are feared and avoided.

27. Panic Disorder

28. Panic Attacks: discrete periods of intense fear or discomfort

29. Case Study 1: • It happened without any warning, a sudden wave of terror. My heart was pounding like mad, I couldn't catch my breath, and the ground underfoot seemed unstable. I was sure it was a heart attack. It was the worst experience of my life.

30. Case Study 2: A 35-year-old mathematician gave a history of episodic palpitations and faintness over the previous 15 years. There had been periods of remission of up to 5 years, but in the past year the symptoms had increased and in the last few days the patient had stopped working because of the distress. His chief complaints were that at any time and without warning, he might suddenly feel he was about to faint and fall down, or tremble and experience palpitations, and if standing would cringe and clutch at the nearest wall or chair. If he was driving a car at the time he would pull up at the curbside and wait for the feelings to pass off before he resumed his journey. He was becoming afraid of walking alone in the street or of driving his car for fear that the episodes would be triggered by it and was loath to travel by public transport. Although he felt safer when accompanied, this did not abolish his symptoms. The attacks could come on at any time of day or night.

31. Obsessive-Compulsive Disorder • Obsessions- repetitive unwanted ideas that the person recognizes are irrational Most common: • Aggressive impulses • contamination • Doubt • sex • concern over health • need for symmetry

32. Obsessive-Compulsive Disorder • Compulsions- repetitive, often ritualized behavior whose behavior serves to diminish anxiety caused by obsessions

33. Some typical compulsions • Checking Rituals: • Cleaning Rituals:

34. Case Study • A newly married young computer programmer spent many long hours ruminating over whether she had or had not murdered a solitary old lady whom she had visited regularly. This troublesome thought intruded repeatedly, seriously impaired her concentration, and provoked considerable discomfort and guilt. Repeated enquiries, including several visits to the local police station, failed to satisfy her that the woman had in fact died of natural causes some days after the woman had last seen her. This single tormenting obsessional rumination...had plagued her for years.

35. Case Study • A 38-year-old mother of one child was obsessed by a fear of contamination for over 20 years. Her concern with the possibility of being infected by germs resulted in washing and cleaning rituals that invaded all aspects of her life. Her child was restrained in one room, which was kept entirely germ free. She opened and closed all doors with her feet in order to avoid contaminating her hands.

36. Case Study • Before I come home from work I spend half my time wondering whether a burglar has broken into the apartment. As soon as I get home I check every room, under the bed, and in the closets. Before going to sleep I probably check the lock on the front door fifty times. I feel better after each check, but then my concern wells up and I have to go check again

37. Thank you for your attention!

38. Conclusions • We have reviewed some of the disorders classified as Anxiety Disorders. Undoubtedly, you have experienced some of these symptoms to one degree or another at some time in your life. Such experiences are not abnormal. Anxiety becomes abnormal when it becomes excessive, irrational, and chronic. The anxiety experienced by people suffering from these disorders is intrusive and disruptive to their everyday lives.