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Back From Behavior To Mollecular Expression: RONNY TRI WIRASTO, M.D, Psychiatrist
Back From Behavior To Mollecular Expression: RONNY TRI WIRASTO, M.D, Psychiatrist
MOLLECULAR EXPRESSION
5-GGGCCTACTGTGGCTACTCA-3
Anxiety Vulnerability
5-GGCCCTTTTTCCAGGTCTG-3
Biology : GABA and serotonin
Diathesis Stress Model
Individuals inherit tendencies to express certain traits or
behaviors, which are then expressed or activated under
conditions of stress.
Psychodynamic Model
mental mechanisms
emphasis on childhood experiences
emphasis on unconscious motives
Id, Ego, Superego
Anxiety is a signal that the ego’s controls are at risk of being
overcome by the id or the superego.
Diarrhea
Dizziness, lightheadedness
Hyperhydrosis
Hyperreflexia
Palpitations
Pupillary mydriasis
Restlessness
Syncope
Tachycardia
Tingling in the
extremities
Tremors
Upset stomach
Urinary Frequency
Differential Diagnosis for Anxiety
Disorders
•Cardiovascular/Respiratory •Gastrointestinal
Disorders • Colitis
• Arrhythmias • Irritable Bowel Syndrome
• COPD • Peptic ulcers
• Hypertension • Ulcerative colitis
• Angina • Miscellaneous
• Myocardial Infarction • Epilepsy
• Endocrine system • Migraine
• Hyperthyroidism • Pain
• Hypothyroidism • Pernicious anemia
• Hypoglycemia • Porphyria
Types Of Anxiety
Generalized Anxiety Disorder
Social Anxiety
Post Traumatic Stress Disorder
Obsessive Compulsive Disorder
Phobic Disorders
Panic Disorder with or without agoraphobia
Atypical Anxiety Disorder
GENERALIZED ANXIETY DISORDER
Chronic and excessive worry more days than not
occurring for at least 6 months and involving many
aspects of the person’s life
Persistent exhibition of signs of severe anxiety: motor
tension, apprehensive expectation, autonomic
hyperactivity
Impatience, irritability, unable to concentrate, fatigue,
sleep disturbance
Diagnostic Criteria for GAD
Motor Tension Autonomic Vigilance or Scanning
Hyperactivity
Trembling Shortness of breath Feeling keyed up or on
Edge
Muscle tension Palpitations or Startling easy
tachycardia
Restlessness Sweating or cold clammy Difficulty concentrating
hands
Easily fatigued Dry mouth Trouble falling asleep or
staying asleep
Dizziness or Irritability
lightheadedness
Nausea, diarrhea, or GI
distress
Hot or cold flashes
Frequent urination
Pharmacotherapy Options for GAD
Drugs of Choice
SSRIs
TCAs
Buspirone
MAOIs
Effexor
PHOBIC DISORDERS
Persistent irrational fear attached to an object or
situation that does not pose a significant threat
Anticipatory anxiety – avoidance of situation
Agoraphobia
Simple/Specific Phobias
Social Phobias
SPESIFIC PHOBIA
• Acrophobia • Fear of heights
• Agoraphobia • Fear of open places
• Ailorophobia • Fear of cats
• Hydrophobia • Fear of water
• Claustrophobia • Fear of closed spaces
• Cynophobia • Fear of dogs
• Myosophobia • Fear of dirt and germs
• Pyrophobia • Fear of fire
• Xenophobia • Fear of strangers
• Zoophobia • Fear of animals
Treatment Options for Specific
Phobias
Behavior therapy
Insight-oriented psychotherapy
Hypnosis
Family therapy
Exposure therapy
Pharmacotherapy
Social Phobia
Defined as a persistent fear of one or more situations. The
person fears they may act in a way or do something that will
be humiliating or embarrassing in public. Avoidance behavior
interferes with life.
*paroxetine hidrochloride
PANIC ATTACKS
Discrete period of intense apprehension or terror
without any real accompanying danger accompanied
by at least 4 of the following symptoms:
Palpitations, sweating, trembling, shortness of breath,
feeling of choking, chest pain, abdominal distress,
dizziness, depersonalization, fear of losing control, fear
of dying, paresthesias (numbness), chills or hot flashes
PANIC DISORDER
Recurrent unexpected panic attacks that cause
presistent worry about recurrences of complication
from attacks or behavioral change in response to
attack for at least one month
Sympathomimetic Responses for Panic
Disorder
• Dyspnea •Depersonalization or
• Dizziness/faintness derealization
• Palpitations • Parathesias
• Trembling or shaking • Hot/cold flashes
• Sweating • Chest pain
• Choking • Fear of dying
• Nausea or abdominal • Fear of going crazy or
distress doing something
uncontrolled
Treatment for Panic Disorder
Cognitive behavioral Therapy (effective in resolving
80% of cases)
Pharmacotherapy
Paxil (FDA-approved)
Zoloft (FDA-approved)
Imipramine
Desipramine
Alprazolam (hi dose)
Diazepam
Clonazepam
Phelzine (may take up to 6 weeks to work)
Should start antidepressant and prn BZD at the same time Watch for stimulating
effects from antidepressants
Taper BZD after 1-2 weeks
Current treatment options should not employ BZDs
OBSESSIVE COMPULSIVE DISORDER (OCD)
Experience of recurrent obsessions or
compulsions that are time consuming or cause
significant distress or impairment
Obsessions
Recurrent intrusive and persistent thoughts, ideas,
images, or impulses
Compulsions
Ritualistic behaviors person is compelled to
perform
Reduce anxiety
Delay to perform ritual results in increasing tension
Nonpsychiatric Clinical Specialists Likely to See Patients
with Obsessive-Compulsive Disorder
Dermatologist
Family Practitioner
Oncologist, infectious disease internist
Neurosurgeon
Obstetrician
Pediatrician
Pediatric cardiologist
Dentist
Symptoms of OCD
Obsessions Compulsions
• Contamination • Checking
• Pathological doubt • Counting
• Somatic • Washing
• Need for symmetry • Need to ask or confess
• Aggressive • Symmetry and precision
• Sexual • Hoarding
• Multiple obsessions • Multiple comparisons
• Other
Treatment for OCD
Behavior Therapy
Psychotherapy
Pharmacotherapy
SSRIs
Prozac
Luvox
Paxil
Zoloft
POST-TRAUMATIC DISTRESS DISORDER (PTSD)
Development of characteristic symptoms after
exposure to severe of extraordinary stressor
Three cardinal features:
Hyperarousal, recurrent nightmares, and
flashbacks
Sign/Symptom :
Denial, re-experience of event, perceptual
distortions, feelings of disorganization when
thinking about the event, memory impairment,
overgeneralization of other sensory inputs,
exaggerated startle reaction, somatic symptoms,
altered states of consciousness, recurrent
nightmares
Acute PTSD may last up to three months
Chronic PTSD persists longer than three months
PTSD is often accompanied by other psychiatric
disorders including, depression, substance abuse, and
personality disorders
Additional Symptoms of PTSD
Alienating yourself to prevent stressful situations
Avoiding people and places that remind you of the trauma
Panicking in social situations you cannot escape
Hiding your feelings of anxiety and fear
Smiling or laughing so others think you’re happy
Withdrawing from relationships with loved ones
Struggling to fall asleep … and stay asleep
Reliving the trauma in dreams and flashbacks
Suffering in your performance at work
Drinking or abusing drugs to mask your problems
Avoiding plans for a future you doubt you’ll see
Thinking about suicide
Feeling like you’re facing all of this alone
Treatment of PTSD
Patients receiving adequate treatment have an median
recovery time of 36 months, as compared with 64
months in patients who are untreated.
Psychotherapy
Behavioral Therapy
Pharmacotherapy
*courtesy BBC