ANXIETY DISORDERS SOMATOFORM DISORDERS

NEUROSIS, PSYCHONEUROSIS, GG CEMAS

UPH LECTURE SERIES DR. W.M. ROAN, DPM(Lond). August 19, 2005
July 20, 2013 Anx. disorder, W.M. Roan 1

ANXIETY DISORDERS
INCLUDE
PANIC ATTACK AGORAPHOBIA PANIC DISORDER W./OUT AGORAPHOBIA AGORAPHOBIA W./OUT HISTORY OF PANIC DISORDER SPECIFIC PHOBIA SOCIAL PHOBIA OBSESSIVE-COMPULSIVE DISORDER POST-TRAUMATIC STRESS DISORDER ACUTE STRESS DISORDER GENERALIZED ANXIETY DISORDER ANXIETY DISORDERS DUE TO GENERAL MEDICAL CONDITION SUBSTANCE-INDUCED ANXIETY DISORDER ANXIETY DISORDER NOT OTHERWISE SPECIFIED (NOS)
July 20, 2013 Anx. disorder, W.M. Roan 2

PANIC ATTACK
A DISCRETE PERIOD IN WHICH THERE IS A SUDDEN ONSET OF INTENSE APPREHENSION, FEARFULNESS, OR TERROR, OFTEN ASSOCIATED WITH FEELINGS OF IMPENDING DOOM. OFTEN ACCOMPANIED BY SYMPTOMS OF SHORTNESS OF BREATH, PALPITATION, CHEST PAIN OR DISCOMFORT, CHOKING OR SMOTHERING SENSATIONS, AND FEAR OF GOING CRAZY OR LOSING CONTROL.
July 20, 2013 Anx. disorder, W.M. Roan 3

EXAMPLES OF PANIC ATTACKS

WHEN CAUGHT UP IN TRAFFIC JAMS THOUGHT OF IMPENDING DANGER OR DEATH, OR ILL-OMEN AND SO AVOID CONTINUING A TASK WITH WHICH HE IS ENGAGED HEART PALPITATION INTERPRETED AS A FATAL HEART ATTACK AND SO REPEATED VISITS TO EMERGENCY UNIT FEAR OF TRAVELLING ALONE, SHOULD HAVE COMPANY
July 20, 2013 Anx. disorder, W.M. Roan 4

AGORAPHOBIA
(Agora=market place, phobia=fear)

ANXIETY ABOUT, OR AVOIDANCE OF, PLACES OR SITUATION FROM WHICH ESCAPE MIGHT BE DIFFICULT (OR EMBARRASSING) OR IN WHICH HELP MAY NOT BE AVAILABLE IN THE EVENT OF HAVING A PANIC ATTACK OR PANIC-LIKE SYMPTOMS

July 20, 2013

Anx. disorder, W.M. Roan

EXAMPLES OF AGORAPHOBIA
MILD:
APPREHENSION HAVING SOCIAL GATHERING WITH ca. 20 PEOPLE OR MORE, WITH COMPLAINTS OF NAUSEA, VOMITING, STOMACH ACHES, DIARRHOEA

MODERATE:
DARE NOT TO WALK ALONE ON THE STREET AVOID GOING INTO SHOPPING MALLS OR DEPARTMENT STORES, ESPECIALLY MARKET PLACE FEAR OF WALKING ALONE IN THE CORRIDOR OF BIG BUILDING

SEVERE:
HOUSE-BOUND HOUSE-WIVES, DARE NOT TO LEAVE HOME
July 20, 2013 Anx. disorder, W.M. Roan 6

PANIC DISORDER W./OUT AGORAPHOBIA

RECURRENT UNEXPECTED PANIC ATTACKS ABOUT WHICH THERE IS PERSISTENT CONCERN PANIC DISORDER W./ AGORAPHOBIA IS CHARACTERIZED BY BOTH RECURRENT UNEXPECTED PANIC ATTACKS AND AGORAPHOBIA AGORAPHOBIA W./OUT HISTORY OF PANIC DISORDER, CHARACTERIZED BY PRESENCE OF AGORAPHOBIA AND PANICLIKE SYMPTOM W./OUT A HISTORY OF UNEXPECTED PANIC ATTACKS
July 20, 2013 Anx. disorder, W.M. Roan 7

SPECIFIC PHOBIA
(SIMPLE PHOBIA) CHARACTERIZED BY CLINICALLY SIGNIFICANT ANXIETY PROVOKED BY EXPOSURE TO A SPECIFIC FEARED OBJECT OR SITUATION OFTEN LEADING TO AVOIDANCE BEHAVIOUR.
ANIMAL TYPE (fear of dogs, cats, lizards, cockroaches) NATURAL ENVIRONMENT TYPE (fear of space, prairie) BLOOD-INJECTION TYPE (fear of blood, medical) SITUATIONAL TYPE, (tunnel, flying, enclosed places)
July 20, 2013 Anx. disorder, W.M. Roan 8

SOCIAL PHOBIA
CHARACTERIZED BY CLINICALLY SIGNIFICANT ANXIETY PROVOKED BY EXPOSURE TO CERTAIN TYPES OF SOCIAL OR PERFORMANCE SITUATIONS, OFTEN LEADING TO AVOIDANCE BEHAVIOUR
SUCH AS EATING OUT ALONE IN RESTAURANT LECTURER FEARS OF LECTURING OR PRESENTING IN FRONT OF STUDENTS OR AN AUDIENCE FEAR OF BLUSHING AND NOTED BY OTHERS FEAR OF MEETING WITH SUPERIORS OR HIGH RANKING PERSONS UNEASY ENCOUNTERING PEOPLE
July 20, 2013 Anx. disorder, W.M. Roan 9

OBSESSIVE-COMPULSIVE DISORDER
CHARACTERIZED BY OBSESSIONS (WHICH CAUSE MARKED ANXIETY OR DISTRESS) &/OR BY COMPULSION (WHICH SERVE TO NEUTRALIZE ANXIETY)
INCESSANT COMING OF NUMBERS OR IDEAS, WHEN DRIVING A CAR, DOUBTFUL WHETHER HE HAD HIT A PERSON FREQUENT HAND-WASHING W./OUT REASONS SUCH AS FEAR OF DIRT / BACTERIA. WOMAN WHO FEARS SPLASH OF WASTE WATER FREQUENT CHECKING OF LOCKED DOORS.
July 20, 2013 Anx. disorder, W.M. Roan 10

POST-TRAUMATIC STRESS DISORDER

CHARACTERIZED BY THE REEXPERIENCING OF AN EXTREMELY TRAUMATIC EVENT ACCOMPANIED BY SYMPTOMS OF INCREASED AROUSAL AND BY AVOIDANCE OF STIMULI ASSOCIATED WITH THE TRAUMA
SUCH AS BUS, TRAIN / PLANE CRASH WITH MANY DEATH TOLLS RIOTING, BEING MOLESTED OR RAPED
July 20, 2013 Anx. disorder, W.M. Roan 11

ACUTE STRESS DIORDER

CHARACTERIZED BY SYMPTOMS SIMILAR TO THOSE OF POSTTRAUMATIC STRESS DISORDER THAT OCCUR IMMEDIATELY IN THE AFTERMATH OF AN EXTREMELY TRAUMATIC EVENT
BIG FIRE TERRORISTS GUNS & BOMBS FIRE-ARMED ROBBERIES
July 20, 2013 Anx. disorder, W.M. Roan 12

GENERALIZED ANXIETY DISORDER

CHARACTERIZED BY AT LEAST 6 MONTHS OF PERSISTENT AND EXCESSIVE ANXIETY AND WORRY
Excessive anxiety & worry (apprehensive expectation). Occurring more days than not for at least 6 months about events like work or school performance Difficult to control the worry Restless, feeling keyed up or on edgy Irritability Difficulty concentrating Disturbed sleep Impairment in social, occupational or other functioning
July 20, 2013 Anx. disorder, W.M. Roan 13

ANXIETY DISORDER DUE TO A GENERAL MEDICAL CONDITION

CHARACTERIZED BY PROMINENT SYMPTOMS OF ANXIETY THAT ARE JUDGED TO BE A DIRECT PHYSIOLOGICAL CONSEQUENCE OF A GFENERAL MEDICAL CONDITION
Prominent anxiety, panic, or obsessions & compulsions Physical & lab findings is the direct physiological consequence of gen. med. Conditions Caused distress & impairment in social & occupational & other areas of functioning
July 20, 2013 Anx. disorder, W.M. Roan 14

SUBSTANCE-INDUCED ANXIETY DISORDER

CHARACTERIZED BY PROMINENT SYMPTOMS OF ANXIETY THAT ARE JUDGED TO BE A DIRECT PHYSIOLOGICAL CONSEQUENCES OF A DRUG OF ABUSE, MEDICATION, OR TOXIN EXPOSURE
Prominent anxiety, panic, obsession & compulsions Developed during or within 1 month of substance intoxication or withdrawal Medication use is etiologically related to the disturbance
July 20, 2013 Anx. disorder, W.M. Roan 15

ANXIETY DISORDER
NOT OTHERWISE SPECIFIED (NOS) FOR CODING DISORDERS WITH PROMINENT ANXIETY OR PHOBIC AVOIDANCE THAT DO NOT MEET CRITERIA FOR ANY OF THE SPECIFIC ANXIETY DISORDERS DEFINED IN THIS SECTION (OR ANXIETY SYMPTOMS ABOUT WHICH THERE IS INADEQUATE OR CONTRADICTORY INFORMATION) SEPARATION ANXIETY DISORDER (CHILD) PHOBIC AVOIDANCE TO GENITAL SEXUAL CONTACT
July 20, 2013 Anx. disorder, W.M. Roan 16

CRITERIA FOR PANIC ATTACK

A DISCRETE PERIOD OF INTENSE FEAR OR DISCOMFORT, IN WHICH 4 (OR >) OF THE FOLLOWING SYMPTOMS DEVELOPED ABRUPTLY, AND REACHED A PEAK WITHIN 10 MINUTES:
PALPITATIONS SWEATING TREMBLING OR SHAKING SENSATION OF SHORTNESS OF BREATH / SMOTHERING FEELING OF CHOKING
July 20, 2013 Anx. disorder, W.M. Roan 17

 CHEST PAIN OR DISCOMFORT NAUSEA OR ABDOMINAL DISTRESS FEELING DIZZY, UNSTEADY, LIGHTHEADED, OR FAINT DEREALIZATION (FEELING OF UNREALITY) OR DEPERSONALIZATION (DETACHED FROM ONESELF) FEAR OF LOSING CONTROL OR GOING CRAZY FEAR OF DYING PARESTHESIAS (NUMBNESS OR TINGLING SENSATIONS) CHILLS OR HOT FLASHES
July 20, 2013 Anx. disorder, W.M. Roan 18

SOMATOFORM DISORDERS
PRESENCE OF PHYSICAL SYMPTOMS THAT SUGGEST A GENERAL MEDICAL CONDITION NOT FULLY EXPLAINED BY THAT GEN. MED. CONDITION, NOR THE DIRECT EFFECTS OF A SUBSTANCE OR MENTAL DISORDER (PANIC)
SOMATIZATION DISORDER (HYSTERIA / BRIQUETS SYNDROME) CONVERSION DISORDER PAIN DISORDER HYPOCHONDRIASIS BODY DYSMORPHIC DISORDER
July 20, 2013 Anx. disorder, W.M. Roan 19

SOMATIZATION DISORDER
HISTORY OF MANY PHYSICAL COMPLAINTS BEFORE AGE 30 YRS OCCUR FOR SEVERAL YRS RESULT IN TREATMENT BEING SOUGHT OR SIGNIFICANT IMPAIRMENT IN SOCIAL, OCCUPATIONAL OR OTHER AREAS OF FUNCTIONING
4 PAIN SYMPTOMS e.g. head, abdomen, back, joints, extremities, chest, rectum, during menstruation, sexual intercourse, or urination 2 gastrointestinal symptoms, e.g. nausea, bloating, vomiting (not during pregnancy), diarrhoea, intolerance of several foods
July 20, 2013 Anx. disorder, W.M. Roan 20

 1 sexual symptom e.g. sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy 1 pseudo-neurological symptom e.g. conversion symptom like impaired coordination or balance, paralysis or localized weakness, difficult swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures, dissociative symptoms such as amnesia, or loss of consciousness Those symptoms (B) cannot be fully explained If there is related gen. med. Cond. Physical complaints & resulting social & occupational impairment are in excess of what would be expected. The symptoms are not intentionally produced or feigned
July 20, 2013 Anx. disorder, W.M. Roan 21

CONVERSION DISORDER
1 / > Symptoms or deficits affectidistressng voluntary motor or sensory function that suggest a neurological or other gen. med. Condition. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors. The symptom or deficit is not intentionally produced or feigned. The symptom or deficit cannot be fully explained by a gen. med. Condition, substance effect or as a culturally sanctioned behaviour or experience The symptom & deficit causes distress or impairment in social, occupational or other important areas of functioning
July 20, 2013 Anx. disorder, W.M. Roan 22

PAIN DISORDER
PAIN IN ONE OR MORE ANATOMICAL SITES IS THE PREDOMINANT FOCUS OF THE CLINICAL PRESENTATION & IS OF SUFFICIENT SEVERITY TO WARRANT CLINICAL ATTENTION THE PAIN CAUSES DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL OR OTHER IMPORTANT AREAS OF FUNCTIONING PSYCHOLOGICAL FACTORS ARE JUDGED TO HAVE AN IMPORTANT ROLE IN THE ONSET, SEVERITY, EXACERBATION, OR MAINTENANCE OF THE PAIN THE SYMPTOM OR DEFICIT IS NOT INTENTIONALLY PRODUCED OR FEIGNED (AS IN FACTITIOUS DISORDER OR MALINGERING) THE PAIN IS NOT BETTER ACCOUNTED FOR BY A MOOD, ANXIETY, OR PSYCHOTIC DISORDER AND DOES NOT MEET CRITERIA FOR DYSPAREUNIA
July 20, 2013 Anx. disorder, W.M. Roan 23

HYPOCHONDRIASIS
PREOCCUPATION WITH FEARS OF HAVING, OR THE IDEA THAT ONE HAS, A SERIOUS DISEASE BASED ON THE PERSONS MISINTERPRETATION OF BODILY SYMPTOMS THE PREOCCUPATION PERSISTS DESPITE APPROPRIATE MEDICAL EVALUATION AND ASSURANCE THE BELIEF IN THE ABOVE IS NOT OF DELUSIONALINTENSITY (AS IN DELUSIONAL DISORDER, SOMATIC TYPE) AND IS NOT RESTRICTED TO A CIRCUMSCRIBED CONCERN ABOUT APPEARANCE (AS IN BODY DYSMORPHIC DISORDER) THE PREOCCUPATION CAUSES CLINICALLY SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL & OTHER IMPORTANGT AREAS OF FUNCTIONING THE DURATION OF THE DISTURBANCE IS AT LEAST 6 MONTHS THE PREOCCUPATION IS NOT BETTER ACCOUNTED FOR BY GENERALIZED ANXIETY DISORDER, OCD, PANIC DISORDER, MAJOR DEPRESSIVE EPISODE, SEPARATION ANXIETY, OR ANOTHER SOMATOFORM DISORDER
July 20, 2013 Anx. disorder, W.M. Roan 24

BODY DYSMORPHIC DISORDER

PREOCCUPATION WITH AN IMAGINED DEFECT IN APPEARANCE. IF A SLIGHT PHYSICAL ANOMALY IS PRESENT, THE PERSONS CONCERN IS MARKEDLY EXCESSIVE THE PREOCCUPATION CAUSES CLINICALLY SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR OTHER IMPORTANT AREAS OF FUNCTIONING. THE PREOCCUPATION IS NOT BETTER ACCOUNTED FOR BY ANOTHER MENTAL DISORDER (e.g. dissatisfaction with body shape and size in Anorexia Nervosa
July 20, 2013 Anx. disorder, W.M. Roan 25