CHAPTER 6

ANXIETY DISORDERS
 Anxiety Disorders
Classification of Anxiety Disorders

Separation Anxiety Disorder

Selective Mutism

Generalized Anxiety Disorder

Panic Disorder

Social Anxiety Disorder

Specific Phobia

Obsessive-Compulsive Disorder

Acute Stress/Post traumatic stress disorder

Substance induced/ Anxiety due to GMC
 Generalized Anxiety Disorder (GAD)
Clinical Features
• Excessive anxiety/worry on most days for >6 months of
several events/activities.
• Difficulties in controlling the worry.

At least 3 of the following:

– Blank Mind/Difficulty concentrating
– Energy low/Easily fatigued
– Sleep disturbance
– Restlessness
– Irritability
– Muscle Tension (headaches, tremor…)
 Treatments
Psychological Treatment
• Evidence supporting Cognitive Behavioral
therapy (CBT)
– Benefits comparable to antidepressants.
• Supportive therapy
– Reassurance and comfort
Pharmacologic Treatment:
First line:
• SSRI’s: Paroxetine, citalopram, Sertraline
Second Line:
• Benzodiazepines:
– lorazepam, diazepam, and bromazepam
 Usually given for 2-6 weeks with 1-2 weeks of tapering.
 Risk of dependence is high
 Panic Disorder
Clinical Features of Panic: 4's

4 symptoms of panic

Recurrent attacks
 About 4 or more in 4 weeks

4 weeks of fear of another attack

Worry about consequence of the attack

Panic symptoms include: Headache, heart burn,
tremor, palpitation, increased HR and nausea.
Fear of dying and fear of going crazy.
 Treatment
Psychological
• Cognitive Behavior Therapy (CBT)
– Exposure
– Relaxation training
Pharmacotherapy
First line
• Any SSRI: Fluoxetine, Paroxetine and Sertraline
Second Line:
• TCA: Clomipramine, Imipramine
• Benzodiazepines: Clonazepam
 Social Anxiety Disorder

• Excessive fears of humiliation or embarrassment in

social settings
• Example: speaking in public places; speaking in a
conference.
• Generalized social phobia - chronic and disabling
condition characterized by a phobic avoidance of most
social situations
 Treatments
Psychological Treatment:
CBT:
• An established treatment.
• Associated with significant improvement.
• Major components: education, cognitive restructuring
and exposure. Often also has social skills training and
relaxation procedures.
Pharmacological treatment
• First Line:
– SSRI: Paroxetine, Sertraline, Fluvoxamine
– Venlafaxine
• Second Line:
• Citalopram
• Benzodiazepines: Clonazepam, alprazolam or
Bromazepam
– Efficacy reported similar to SSRI or CBT
 Specific Phobia


Excessive fear of specific
things or situations

Example: Excessive fear of
Animals, heights, needles,
cat…
 Obsessive Compulsive Disorder (OCD)

Obsessions (intrusive thoughts) OR

Compulsions (Actions to relieve intrusive thoughts)
 Washing (particularly hand washing) and
Checking most common

Prevalence 2%; M=F
Different from Obsessive Compulsive
Personality Disorder in that OCPD is
 Non-bizarre
 Non-responsive to medication

Clomipramine is the best treatment for OCD

Can be treated also with high-dose SSRIs

May need 12-16 weeks to see meaningful benefit
 Acute Stress Disorder

In the last month, experienced
life-threatening / serious risk
event

Felt Fearful

During event had 3 or more
dissociative symptoms

Subsequently
 Re-experiencing,
avoidance, increased
arousal

Duration of symptoms 2 days to
4 weeks
 Post Traumatic Stress Disorder (PTSD)
• Experienced event that involved actual death or threatened death
or serious injury, AND
• Response involved intense fear, PLUS

Intrusive Recollection (1)
 Memories, dreams, flashbacks, distress at reminders, physical
reactivity to reminders

Hyper-arousal (2)
 Sleep, irritable, concentration, hyper-vigilance

Avoidance / Numbing (3)
 Avoid thoughts, Avoid activities, cannot recall event details,
decreased interest, restricted affect, sense of foreshortened future

Duration (4)
 4 weeks or more
THANK YOU!