A NX IET Y 01 02 03

DISORDERS PANIC
DISORDER
AGORAPHOBIA SPECIFIC
PHOBIA
E C H AV E Z |
ELLORIN

04 05 06
SOCIAL GENERALIZED OTHER ANXIETY
ANXIETY ANXIETY DISORDERS
SOCIAL
PHOBIA

Itself is what the end-user

derives value from also.
BACKGROUND
BACKGROUN Distinct differentiation of social anxiety disorder from specific
D
phobia, which is the intense and persistent fear of an object or
DIAGNOSIS
AND
FEATURES situation.
DSM-5
CRITERIA
◉ Prevalence : Lifetime - 3 to 13%
COURSE AND 6-month - 2 to 3 %
PROGNOSIS
◉ Predominance: FEMALES > Males
TREATMENT

SOCIAL PHOBIA
BACKGROUND
BACKGROUN ◉ Neurochemical Theory (Adrenergic)
D
✔ β-adrenergic receptor has led to the development of an adrenergic
DIAGNOSIS
AND theory for these phobias.
FEATURES
DSM-5 ✔ Patients with performance phobias may release more
CRITERIA
norepinephrine or epinephrine, both centrally and peripherally, than
COURSE AND
PROGNOSIS do non-phobic persons, or such patients may be sensitive to a normal
level of adrenergic stimulation.
TREATMENT
✔ The observation that MAOIs may be more effective than TCAs in
the treatment of generalized social anxiety disorder.

SOCIAL PHOBIA
BACKGROUND

DIAGNOSIS ◉ At least some degree of social anxiety or

AND FEATURES
self-consciousness is common in the general
DSM-5
CRITERIA population
COURSE AND ◉ Anxiety only becomes social anxiety disorder when
PROGNOSIS
the anxiety either prevents an individual from
TREATMENT participating in desired activities or causes marked
distress during such activities.

SOCIAL PHOBIA
BACKGROUND

DIAGNOSIS
AND
FEATURES
DSM – 5
CRITERIA

COURSE AND
PROGNOSIS

TREATMENT
BACKGROUND

DIAGNOSIS
AND ◉ Onset: Late childhood or Early adolescence.
FEATURES
DSM-5 Common
CRITERIA
as young as 5 years of age and as old as
COURSE AND 35 years.
PROGNOSIS
◉ Typically chronic, although patients whose
TREATMENT
symptoms do remit tend to stay well.

SOCIAL PHOBIA
 ◉ Both psychotherapy and pharmacotherapy are useful
BACKGROUND
◉ Effective drugs for the treatment of social anxiety disorder include:
DIAGNOSIS (1)SSRIs
AND
FEATURES Most clinicians consider SSRIs the first-line treatment choice for
DSM-5 patients with more generalized forms of social anxiety disorder
CRITERIA
(2) Benzodiazepines
COURSE AND
PROGNOSIS Alprazolam (Xanax) and Clonazepam (Klonopin) are also
efficacious
TREATMENT (3) Venlafaxine
(4) Buspirone
Shown additive effects when used to augment treatment with
SSRIs
SOCIAL PHOBIA
GENERALIZED
ANXIETY

Itself is what the end-user

derives value from also.
BACKGROUND
BACKGROUN Generalized anxiety disorder is defined as excessive anxiety and
D
worry about several events or activities for most days during at least
DIAGNOSIS
AND
FEATURES a 6-month period.
DSM-5
CRITERIA
◉ Prevalence : Lifetime – close to 5%
COURSE AND 1-year - 3 to 8 %
PROGNOSIS
◉ Predominance: FEMALES > Males (2:1)
TREATMENT

GENERALIZED ANXIETY
BACKGROUND
BACKGROUN ◉ Biochemical Theory (Adrenergic)
D
✔ β-adrenergic receptor has led to the development of an adrenergic
DIAGNOSIS
AND theory for these phobias.
FEATURES
DSM-5 ✔ Patients with performance phobias may release more
CRITERIA
norepinephrine or epinephrine, both centrally and peripherally, than
COURSE AND
PROGNOSIS do non-phobic persons, or such patients may be sensitive to a normal
level of adrenergic stimulation.
TREATMENT
✔ The observation that MAOIs may be more effective than TCAs in
the treatment of generalized social anxiety disorder.

GENERALIZED ANXIETY
BACKGROUND

DIAGNOSIS ◉ Characterized by a pattern of frequent, persistent worry

AND FEATURES and anxiety that is out of proportion to the Benzodiazipine

DSM-5 ◉ impact of the event or circumstance that is the focus of the

CRITERIA
worry.
COURSE AND
PROGNOSIS ◉ Distinction between generalized anxiety disorder and normal
anxiety is emphasized by the use of the word “excessive” in
TREATMENT the criteria and by the specification that the symptoms cause
significant impairment or distress

GENERALIZED ANXIETY
BACKGROUND

DIAGNOSIS
AND
FEATURES
DSM – 5
CRITERIA

COURSE AND
PROGNOSIS

TREATMENT
BACKGROUND

◉ Onset: Age difficult to specify. Usually come to a

DIAGNOSIS
AND clinician’s
FEATURES
DSM-5 attention in their 20s, although the first contact
CRITERIA
with
COURSE AND a clinician can occur at virtually any age
PROGNOSIS
◉ Only one-third of patients who have generalized anxiety
TREATMENT disorder seek psychiatric treatment.
◉ Chronic condition that may be lifelong

GENERALIZED ANXIETY
BACKGROUND
◉ Combines psychotherapeutic, pharmacotherapeutic, and supportive
DIAGNOSIS
approaches.
AND
FEATURES ◉ Cognitive approaches
DSM-5
CRITERIA Address patients’ hypothesized cognitive distortions directly.
Psychodynamic therapy proceeds with the assumption that anxiety
COURSE AND
PROGNOSIS can increase with effective treatment. The goal of the dynamic
approach may be to increase the patient’s anxiety tolerance
TREATMENT ◉ Behavioral approaches
Address somatic symptoms directly. The major techniques used are
relaxation and biofeedback.

GENERALIZED ANXIETY
BACKGROUND

DIAGNOSIS ◉ Pharmacotherapy
AND
FEATURES decision to prescribe an anxiolytic to patients with generalized
DSM-5
CRITERIA anxiety disorder should rarely be made on the first visit.

COURSE AND ☞ 6- to 12-month treatment

PROGNOSIS
• 12% - relapse during the 1st month
TREATMENT • 60-80 % - of relapse within the course of 1 year

GENERALIZED ANXIETY
BACKGROUND ◉ Drugs Used:

DIAGNOSIS
(1)Benzodiazepines
AND
FEATURES ✔ Drug of choice with the selection of long acting drugs taken when
DSM-5 feeling anxious
CRITERIA
✔ About 25 to 30 percent of all patients fail to respond, and
COURSE AND
PROGNOSIS tolerance and dependence & experience
✔ Impaired alertness
TREATMENT ✔ Treatment for most anxiety conditions lasts for 2 to 6 weeks
followed by 1 or 2 weeks of tapering drug

GENERALIZED ANXIETY
BACKGROUND ◉ Drugs Used:
DIAGNOSIS (2) Buspirone
AND
FEATURES ✔ Agonist and is most likely effective in 60 to 80 % of
DSM-5
CRITERIA patients with generalized anxiety disorder.

COURSE AND ✔ More effective in reducing the cognitive than somatic

PROGNOSIS
symptoms.

TREATMENT ✔ Patients who have previously had treatment with

benzodiazepines are not likely to respond to treatment with
Buspirone.

GENERALIZED ANXIETY
BACKGROUND ◉ Drugs Used:
(3) Venlafaxine
DIAGNOSIS
AND ✔ Effective for insomnia, poor concentration, restlessness,
FEATURES
DSM-5 irritability, and excessive muscle tension associated with
CRITERIA generalized anxiety disorder
COURSE AND ✔ Venlafaxine is a nonselective inhibitor of the reuptake of three
PROGNOSIS
biogenic amines—serotonin;

TREATMENT (4) SSRIs

✔ SSRIs may be effective, especially for patients with comorbid
depression
✔ Transient anxiety & agitated states
GENERALIZED ANXIETY
OTHER
A NX IE T Y ATTRIBUTABLE TO ANOTHER MEDICAL CONDITION

DISORDERS MIXED ANXIETY-DEPRESSIVE

SUBSTANCE-INDUCED
BACKGROUND
BACKGROUN
D ◉ Symptoms can include panic attacks, generalized anxiety, and
DIAGNOSIS other signs of distress. In all cases, the signs and symptoms will
AND
FEATURES
be due to the direct physiological effects of the medical
DSM-5
CRITERIA
condition.
COURSE AND
PROGNOSIS ☞ Pheochromocytoma produces epinephrine, which can
cause
TREATMENT
paroxysmal episodes of anxiety symptoms.
☞ Hypoglycemia can also mimic the symptoms of an anxiety
disorder. ANXIETY DISORDER ATTRIBUTABLE
TO ANOTHER MEDICAL CONDITION
BACKGROUND ◉ Requires the presence of symptoms of an anxiety disorder
caused by one or more medical illnesses
DIAGNOSIS
AND FEATURES ◉ Characterized by symptoms of generalized anxiety or panic
attacks
DSM-5
CRITERIA
◉ Increased level of suspicion for the diagnosis when chronic
COURSE AND or paroxysmal anxiety is associated with a physical disease
PROGNOSIS
known to cause such symptoms in some patients
TREATMENT
☞ Paroxysmal bouts of hypertension in an anxious
patient may indicate that a workup for a
pheochromocytoma is appropriate.
ANXIETY DISORDER ATTRIBUTABLE
TO ANOTHER MEDICAL CONDITION
BACKGROUND ◉ DIFFERENTIAL DIAGNOSIS
To ascertain the degree to which a general medical
DIAGNOSIS condition is causative for the anxiety, the clinician should
AND FEATURES
evaluate:
DSM-5
CRITERIA ✔ the timeline between the medical condition and the
anxiety symptoms
COURSE AND
PROGNOSIS
✔ age of onset (primary anxiety disorders usually have
TREATMENT their
onset before age 35 years),
✔ patient’s family history of both anxiety disorders
ANXIETY DISORDER ATTRIBUTABLE
✔ relevant general medical conditions (e.g.,
TO ANOTHER MEDICAL CONDITION
hyperthyroidism)
BACKGROUND
◉ LABORATORY FINDINGS
DIAGNOSIS ✔ Tests should be selected to rule in specific diagnoses
AND FEATURES
suggested by the patient’s somatic symptoms (if present).
DSM-5
CRITERIA ✔ Brain imaging may be useful in ruling out demyelinating
disorder, tumor, stroke, or hydrocephalus and is
COURSE AND
PROGNOSIS especially important if the anxious individual reports
neurological symptoms
TREATMENT

ANXIETY DISORDER ATTRIBUTABLE

TO ANOTHER MEDICAL CONDITION
BACKGROUND

DSM 5 DIAGNOSTIC CRITERIA FOR ANXIETY DUE TO ANOTHER MEDICAL CONDITION

DIAGNOSIS
AND
FEATURES
DSM – 5
CRITERIA

COURSE AND
PROGNOSIS

TREATMENT
 DISORDERS ASSOCIATED WITH ANXIETY

BACKGROUND

DIAGNOSIS
AND
FEATURES
DSM – 5
CRITERIA

COURSE AND
PROGNOSIS

TREATMENT
BACKGROUND
Can be identical to those of the primary anxiety disorders.
DIAGNOSIS A syndrome similar to panic disorder is the most common clinical
AND picture, and a syndrome similar to a phobia is the least common.
FEATURES
DSM-5
CRITERIA
◉ Panic Attacks

COURSE AND
☞ Patients who have cardiomyopathy may have the highest
incidence of panic disorder secondary to a general
PROGNOSIS
medical condition
TREATMENT
☞ Increased noradrenergic tone in these patients may be
the provoking stimulus for the panic attacks.

ANXIETY DISORDER ATTRIBUTABLE

TO ANOTHER MEDICAL CONDITION
 ◉ Generalized Anxiety
BACKGROUND
☞ High prevalence of generalized anxiety disorder
DIAGNOSIS symptoms has been reported in patients with Sjögren’s
AND
FEATURES syndrome, Graves’ disease (hyperthyroidism), in which
DSM-5
CRITERIA as many as two-thirds of all patients meet the criteria for
generalized anxiety disorder.
COURSE AND
PROGNOSIS ◉ Phobias

TREATMENT
☞ Phobias appear to be uncommon, although one study
reported a 17 percent prevalence of symptoms of social
phobia in patients with Parkinson’s disease

ANXIETY DISORDER ATTRIBUTABLE

TO ANOTHER MEDICAL CONDITION
BACKGROUND
◉ Unremitting experience of anxiety can be disabling and can
DIAGNOSIS interfere with every aspect of life, including social,
AND occupational, and psychological functioning
FEATURES
DSM-5
CRITERIA
◉ A sudden increase in anxiety level may prompt an affected
person to seek medical or psychiatric help more quickly than
COURSE AND when the onset is insidious
PROGNOSIS
◉ Treatment or the removal of the primary medical cause of
TREATMENT the anxiety usually initiates a clear course of improvement
in the anxiety disorder symptoms

ANXIETY DISORDER ATTRIBUTABLE

TO ANOTHER MEDICAL CONDITION
BACKGROUND

DIAGNOSIS
AND
FEATURES
DSM-5
CRITERIA ◉ Primary treatment for anxiety disorder due to a
COURSE AND general medical condition is to treat the
PROGNOSIS
underlying medical condition.
TREATMENT

ANXIETY DISORDER ATTRIBUTABLE

TO ANOTHER MEDICAL CONDITION
OTHER
A NX IE T Y ATTRIBUTABLE TO ANOTHER MEDICAL CONDITION

DISORDERS MIXED ANXIETY-DEPRESSIVE

SUBSTANCE-INDUCED
BACKGROUND
BACKGROUN Patients with both anxiety and depressive symptoms who do not meet
D
the diagnostic criteria for either an anxiety disorder or a mood disorder.
DIAGNOSIS
AND Combination results in significant functional impairment for the affected
FEATURES
COURSE AND person
PROGNOSIS
◉ 2/3 of all patients with depressive symptoms
TREATMENT ------ have prominent anxiety symptoms, and one-third may meet
the
diagnostic criteria for panic disorder.
◉ 20 to 90 % of all patients with panic disorder
------ have episodes of major depressive disorder.
MIXED ANXIETY-DEPRESSIVE
BACKGROUND

DIAGNOSIS ◉ The diagnostic criteria for mixed anxiety-depressive

AND FEATURES disorder require the:

COURSE AND ✔ Presence of sub-syndromal symptoms of both anxiety

PROGNOSIS
and depression
TREATMENT ✔ Presence of some autonomic symptoms, such as
tremor, palpitations, dry mouth, and the sensation of a
churning stomach

MIXED ANXIETY-DEPRESSIVE
BACKGROUND ◉ Presentation at Onset
DIAGNOSIS On the basis of clinical data to date, patients seem to be
AND
FEATURES equally likely to have prominent anxiety symptoms,
COURSE AND prominent depressive symptoms, or an equal mixture of the
PROGNOSIS two symptoms at onset

TREATMENT ◉ During the course of the illness, anxiety or depressive

symptoms may alternate in their predominance
◉ The prognosis is not known

MIXED ANXIETY-DEPRESSIVE
BACKGROUND

DIAGNOSIS ◉ Treatment based on the symptoms present, their severity, and

AND
FEATURES the clinician’s own level of experience with various treatment
COURSE AND modalities.
PROGNOSIS
◉ Psychotherapy
TREATMENT ✔ Time-limited approaches ----- (1) Cognitive therapy
(2) Behavior modification
✔ Less-structured approach ----- Insight-oriented psychotherapy

MIXED ANXIETY-DEPRESSIVE
 ◉ Pharmacotherapy
BACKGROUND
----- Can include antianxiety drugs, antidepressant drugs, or both
DIAGNOSIS (1) Anxiolytic drugs ----- Triazolobenzodiazepines as Alprazolam (Xanax)
AND
FEATURES May be indicated because of their effectiveness in treating depression
COURSE AND associated with anxiety.
PROGNOSIS
(2) Antidepressants
----- Buspirone (BuSpar)
TREATMENT
Serotonergic antidepressants may be most effective in
treating mixed anxiety-depres
----- Venlafaxine (Effexor) - DOC
Treatment of depression as well as generalized anxiety
disorder and is a drug of choice in the combined disorder.

MIXED ANXIETY-DEPRESSIVE
OTHER
A NX IE T Y ATTRIBUTABLE TO ANOTHER MEDICAL CONDITION

DISORDERS MIXED ANXIETY-DEPRESSIVE

SUBSTANCE-INDUCED
BACKGROUND
BACKGROUN
D
DIAGNOSIS
AND
FEATURES
◉ Substance-induced disorder is the direct result of a
DSM-5
CRITERIA toxic substance, including drugs of abuse,
COURSE AND medication, poison, and alcohol, among others.
PROGNOSIS

TREATMENT

SUBSTANCE-INDUCED
BACKGROUND ◉ Requires the presence of prominent anxiety or panic
attacks.
DIAGNOSIS
AND FEATURES ◉ Cognitive deficits are usually reversible when the substance
use is stopped
DSM-5
CRITERIA
◉ Carefully-controlled studies have found that the effects of
COURSE AND alcohol on anxiety are variable and can be significantly
PROGNOSIS
affected by gender, the amount of alcohol ingested, and
TREATMENT cultural attitudes
◉ Personality disorders and malingering must be considered
in the differential diagnosis, particularly in some urban
emergency departments.
SUBSTANCE-INDUCED
 DSM 5 DIAGNOSTIC
DIAGNOSTIC CRITERIA
CRITERIAFOR
FORANXIETY
SUBSTANCE-INDUCED ANXIETY TO ANOTHER MEDICAL CONDITION
DISORDERS ATTRIBUTED
BACKGROUND

DIAGNOSIS
AND
FEATURES
DSM – 5
CRITERIA

COURSE AND
PROGNOSIS

TREATMENT
BACKGROUND
◉ Prognosis depends on the:
DIAGNOSIS
AND
☞ Removal of the causally involved substance
FEATURES
DSM-5 ☞ Long-term ability of the affected person to limit
CRITERIA use of
COURSE AND the substance
PROGNOSIS ◉ Anxiogenic effects of most drugs are REVERSIBLE
TREATMENT
☞ Reconsideration of diagnosis if anxiety is not
reversed
with cessation of drugs
SUBSTANCE-INDUCED
BACKGROUND

DIAGNOSIS
AND
FEATURES ◉ Removal of Involved Substance
DSM-5
CRITERIA
----- If anxiety disorder symptoms continue even after
stopping substance use, treatment of the anxiety
COURSE AND
PROGNOSIS disorder symptoms with appropriate
psychotherapeutic or pharmacotherapeutic
TREATMENT modalities may be appropriate.

SUBSTANCE-INDUCED