Understanding Anxiety Disorders: Symptoms, Types, and Treatments

1. Anxiety Disorders

2. Panic Attack • Brief episode where pt. feel intense dread accompanied by a variety of physical and other symptoms that begin suddenly and peak rapidly (usually 10 minutes) • Physical/mental sensations • Chest pain, chills or hot flashes, choking sensation, derealization/depersonalization, dizziness, fear of losing control, tachycardia, numbness, sweating, shortness of breath, trembling.

3. Panic Disorder • Repeated Panic Attacks • Worry/dread at having additional attacks • With/without Agoraphobia

4. Posttraumatic StressDisorder • Symptoms following exposure to extreme trauma present for at least one month. • Experiencing or witnessing an event that involves actual or threatened death or serious injury to self or another • Elicits a reaction of intense fear, helplessness, or horror • After trauma there is persistent reexperiencing of the trauma, persistent avoidance of stimuli associated with trauma, and persistent symptoms of increased arousal

5. Acute Distress Disorder • Similar to PTSD, except Sx must have onset within 4 weeks of the trauma and must last for at least 2 days but no longer than 4 weeks • 3 or more dissociative Sxs (e.g.. sense of numbing or emotional detachment, derealization, dissociative amnesia) • Must exhibit persistent reexperiencing of the trauma. • Marked avoidance of stimuli that cause recollection the trauma • Sxs of marked anxiety or increased arousal.

6. Phobia • Specific Phobia-patients fear specific objects or situation, such as animals, storms, heights, blood, airplanes, being closed in or any situation that may lead to vomiting, choking or developing an illness. • Social Phobia-These patient imagine themselves embarrassed when they speak, write, or eat in public, use a public urinal; during exposure-immediate panic attacks.

7. Generalized Anxiety Disorder • Excessive anxiety and worry about multiple events or activities. • The anxiety and worry are relatively constant for at least 6 months, and the person finds them difficult to control. • Must entail 3 of following: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance • Disproportionate to feared events or their potential impact • Worrier or GAD? Measures-State Trait Inventory; How else?

8. Substance-InducedAnxiety Disorder • The development of anxiety, OC Sxs, or panic attacks are present within one month of Substance Intoxication or Withdrawal or are due to medication use. • Associated with caffeine, cannabis, cocaine, hallucinogen, inhalant, and PCP intoxication and withdrawal from alcohol, cocaine, or a sedative, hypnotic or anxiolytic • Medications and toxins (e.g. gasoline, paint, insecticides, and CO can produce anxiety symptoms.)

9. Obsessive-Compulsive Disorder • Characterized by recurrent obsessions or compulsions that are severe enough to cause significant distress, to be time-consuming (take more than one hour per day), or to markedly interfere with the person’s usual routine, occupational or academic functioning, social activities and relationships. • Person must be aware, at some time during the course of the disorder, that his/her obsessions and compulsions are excessive or unreasonable

10. Biology & Anxiety • Peripheral Nervous System • Somatic • Sensory Systems • Skeletal Motor System • Autonomic • Sympathetic-arousal & energy expenditure • Parasympathetic-conservation of energy

11. ANS & Anxiety Disorders • Although primarily involuntary, it has been found to be brought under voluntary control • Pts. With Anxiety D/O’s demonstrate delayed response to repeated stimuli and excessive response to moderate stimuli • Predisposition or Learning?????

12. Panic (M/F%) 2/5 Agoroph. W/O 3.5/7 Social Phobia 11/15 Simple Phobia 7/16 Gen. ADO 4/7 OCD 2/3 Any Phobia 10/18 Any ADO 19/31 1.3 vs. 3.2 1.7 vs. 3.8 6.6 vs. 9.1 4.4 vs. 13.2 2.0 vs. 4.3 1.4 vs. 1.9 6.2 vs. 12.8 11.8 vs. 22.6 Anxiety D/O EpidemiologyLifetime % 12-Month %

13. Neurotransmitters • Norepinephrine, Serotonin & GABA • Act in brainstem (noradrenergic neurons); limbic system(anticipatory anxiety) and prefrontal cortex • PFC associated with the possible generation of phobic avoidance

14. Norepinerhrine • Pts. have poorly regulated noradrenergic systems leading to occasional energy bursts • Stimulation leads to fear response • Beta-adrenergic agonists (Isuprel) or Alpha2-adrenergic antagonist (Yohimbine) lead to severe panic attacks • Alpha2-adrenergic agonist (Clonidine/Catapres) & B-ATN (Propanolol/Inderal) reduce anxiety

15. Serotonin • Many SE type receptors-more selective • Clomipramine (Anafranil)-OCD • Buspirone (Buspar) 5HT agonist with projections from brainstem, cortex, limbic system and hypothalamus

16. GABA (Aminobutyric Acid) • Most common inhibitory NT in CNS • Benzodiazepines increase the activity of GABA at the receptor • Low potency most treatment for GAD • High potency GABA’s (e.g. Xanex) have been effective in treatment of PDO

17. Anxiolytic MedicationsWhat to Rx? • SSRIs: Paroxetine (Paxil) • other alternatives? • Benzodiazepines • Alprazolam (Xanex) Lorazepam (Ativan) & Clonzaepam (Klonopin) • Advantages and disadvantages? • Tricyclics: Clomipramine & Imipramine (Tofranil) • Alternatives, advantages & disadvantages

18. Psychotherapy and ADOs • Controversies? • In vivo exposure with response prevention (flooding) –Agoraphobia • SDT or Participant modeling-Specific Phobias (observation/graded participation) • CBT, PMR, Social skills training & Assertiveness Training • Medication vs. Psychotherapy?

19. Realistic Anxiety?