Anxiety

disorders
 Definition

Anxiety is a pathological state

characterized by a feeling of dread
accompanied by somatic signs that
indicate a hyperactive autonomic
nervous system. It is differentiated from
fear, which is a response to a known
and reasonable cause.
Clinical subtypes

1.Panic disorder
2.Generalized anxiety disorder.
3.Specific phobia.
4.Social anxiety disorder (Social
phobia).
5. Separation anxiety disorder.
6. Selective mutism.
7. Agoraphobia.
8. Substance-induced anxiety disorder
and Anxiety disorder due to
general medical condition.
DIAGNOSIS
1- Panic disorder

I- Recurrent unexpected panic attacks,

followed by one month or more of persistent
concern about having additional attacks, and
significant change in behavior.
II- Diagnostic criteria of panic attack:

a- Intense fear or discomfort, in which

four or more of the following symptoms
developed abruptly and reached a peak
within 10 minutes:

1- palpitation,
2- sweating,
3- trembling,
4- tachypnea,
5- feeling of choking,
6- chest pain,
7- nausea,
8- dizziness,
9- derealization (feelings of unreality),
10- depersonalization (being detached
from oneself),
11- fear of going crazy,
12- fear of dying,
13- numbness,
14- hot flushes.
b- Not substance-induced or
not due to general medical
condition.
 2- Generalized anxiety disorder

(a) excessive worry for 6 months or

more about a number of activities.

(b) The worry is associated with three

or more of:
Restlessness, easily fatigued, difficulty
concentrating, irritability, muscle
tension and sleep disturbance.
 (c) Significant impairment in social ,
occupational functions.

(d) Not substance-induced or not due to

general medical condition.
3- Specific phobia

(a) Excessive, unreasonable and

persistent fear cued by the presence of a
specific object, e.g.,

- Animal type
- Natural environmental type (e.g., heights,
storms)
- Blood-injection-injury type
- Situational type (e.g., airplanes, elevators)
(b) The person recognizes that the
fear is excessive or unreasonable.

(c) The person avoids the feared

situation.
 4- Social anxiety disorder
(Social phobia)

1- Excessive, unreasonable and

persistent fear of social situations.
2- Exposure to the feared social
situations provokes anxiety.
3- The person recognizes that his
fear is excessive and unreasonable.
4- The person avoids the feared
situations.
 5-Separation Anxiety Disorder

a) Excessive fear concerning separation

from those to whom the individual is
attached.
1. excessive distress when experiencing
separation.
2. Excessive worry of losing them by illness
or death.
3. Reluctance to go out away from home or
sleep alone.
4. Physical complaints when separated.
b) Duration is 4 weeks in children and
adolescence and 6 months or more in
adults.

c) significant disotress in social ,

academic and occupational functioning.
6- Selective Mutism

a) failure to speak in specific social

situations (e,g., school) despite speaking in
other situations.
b) The disturbance interferes with education
or social communication.
c) Duration at least is 1 month.
d) Not due to lack of knowledge os spoken
language required in the social situation.
 7- Agoraphobia

a) Marked fear about 2 or more of: using

public transportation, being in open places
like marketplaces, being in enclosed places
like cinemas, standing in line, and being
outside of the home alone.

b) Avoidance of these places because

escape may be difficult or need a companion.
c) Exposure to these situations provokes fear
which is out of proportion.

d) The duration is more than 6 months.

e) Significant impairment in social, academic

and occupational functioning.
AETIOLOGY
A- biological
1- Excessive autonomic reaction with
increased sympathetic tone, results in
increased release of catecholamines.

2- Increased norepinephrine metabolites

(3-methoxy 4-hydroxyphenyl glycol).

3- Hyperactivity in locus ceruleus (centre

of adrenergic neurones).

4- Decreased gama-aminobutyric acid

causes CNS hyperactivity.
 B- Learning theory

Anxiety is produced by frustration or stress.

Once experienced, anxiety becomes a
conditioned response to other, less severe,
frustrating or stressful situation.

Social learning theory: may be learned

through identification and imitation of anxiety
patterns in parents.
TREATMENT
A- Pharmacotherapy

1- Benzodiazepines:
Indications : good short-term treatment for
GAD, PTSD, panic disorder and agoraphobia.
Adverse effects : drowsiness, cognitive
impairment and dependence.

2- Buspirone:
Indication : GAD.
Adverse effects : headache and dizziness.
 3- Serotonin specific reuptake inhibitors
(SSRI) :
Indications : GAD, OCD, PTSD, and
depression comorbid on anxiety.
Adverse effects : nausea, decreased appetite,
sleep disturbances.
B- psychosocial therapy

a- Behavior therapy; to reinforce the desired

behaviors and minimize the undesired
behaviors.

b- Group therapy; focusing on supporting and

developing social skills.
Case no. 1
A 35-year- old man visits a psychiatrist because he is
overwhelmingly anxious about a speech he has to
make.
The man states that he was recently promoted to a
position within his company that requires him to
speak in front of an audience of approximately
100 people.
He says that the first such speech is coming up in 2
weeks and that worrying about it keeps him from
sleeping.
He knows that his fear is out of proportion, but he is
unable to control it.
He explains that he has always had trouble with
public speaking because he fears that he might
“do something stupid” or otherwise embarrass
himself.
He has avoided public speaking in the past as much
as possible or has spoken in public only before an
audience of less than 10.
He knows that his fear is out of proportion, but he is
unable to control it.
Because he knows that he must make the presentation
coming up in 2 weeks or he will not be able to keep
his new job, he has visited the psychiatrist hoping to
find a solution to the problem.

• What is the most likely diagnosis?

• What are the treatment options open to the patient?
Thank you