Anxiety Disorders

By: Dr Taher Abdelraheem

Professor of Psychiatry
Sohag University
.Anxiety disorders are among the
most prevalent psychiatric
conditions.

.Recent studies suggest that

chronic anxiety disorder may
increase the rate of
cardiovascular-related
mortality.
Currently, the treatments
available for anxiety
disorders are among the
most effective in
psychiatric medicine.

Specific phopia & social phopia;Diagnosis

 Anxiety
Diffuse unpleasant, vague sense of
apprehension,

often accompanied by autonomic

symptoms such as

Headache, sweating palpitation,

tightness in the chest, stomach
Anxiety dis.

discomfort, and restlessness.

 Fear and Anxiety

Anxiety is an alerting signal of

impending danger (unknown,
internal, vague, or conflictual).

Fear is a response to a known,

external and definite threat.
Anxiety dis.
 Manifestations of Anxiety
(A) Peripheral

1-Palpitation, pupillary dilatation.

2-Hyperreflexia, hypertension.

3-Diarrhea, dizziness.

4-Hyperhydrosis (cold sweats) palms,

soles and axilla.
Anxiety dis.---> Manifestations
5-Restlessness.

6-Syncope.

7-Tingling in extremities.

8-Tremors.

9-Upset stomach, urinary frequency

Specific phopia & social phopia;Diagnosis

 (B) Central:

1 -Distortions of thinking, perception

and learning.

2-Selective attention to certain

things and overlook others.
Anxiety dis.---> Manifestations
 Anxiety Disorders

Epidemiology

-One in four persons have at

least one anxiety disorder

Anxiety disorders
-Women (30.5% lifetime
prevalence).

-Men (19.2% lifetime

prevalence).

Specific phopia & social phopia;Diagnosis

Causes of Anxiety

Anxiety disorders
I-Psychological Causes:

1-Psychoanalytical Theories:
psychic conflict between
unconscious sexual or aggressive
wishes and external reality.

2-Behavioral theories: Persons may

learn and imitate the anxiety
responses of their parents.
Anxiety disorders; Causes
II-Biological Causes

*1-Autonomic Nervous System:

↑ ↑ Sympathetic tone.

Anxiety disorders; Causes

A-Serotonin:

antidepressants have therapeutic effects

Serotonergic
in anxiety disorders

B-GABA:

ttt. of generalized anxiety and

Benzodiazepines→
panic disorder.
Anxiety disorders; Causes
 3-Genetic Studies

a-Almost half of all patients with panic disorder

have at least one affected relative.

b-Higher frequency of the illness in first

degree relatives of affected patients.

Anxiety disorders; Causes

 Classification

Anxiety disorders
 DSM-IV-TR Anxiety Disorders

1-Panic disorder with agoraphobia.

2-Panic disorder without agoraphobia.

3-Agoraphobia
Anxiety disorders
4-Specific phobia.

5-Social phobia.

6-Obsessive-compulsive
disorder.
Specific phopia & social phopia;Diagnosis
.Posttraumatic stress disorder-7

.Acute stress disorder-8

.Generalized anxiety disorder-9

Specific phopia & social phopia;Diagnosis

Panic disorder

 Characterized by the spontaneous, unexpected occurance of panic

attacks.

 Panic attack is discerete pereiods of intense fear.

Panic Disorder and A goraphobia

Agoraphobia

(Greek words, agor = fear and phobos =

marketplace) the fear of being alone in public
places.

escape might be difficult or help may not be

available

Panic disorder is often

accompained by agoraphobia
Panic Disorder and A goraphobia
 Epidemiology

Panic Disorder and A goraphobia

 Panic disorder
 1-Lifetime prevalence rates→ 1.5 to 5%.

 2-Sex: - Women are 2 to 3 times more likely to be

affected than men.

 3-Age: - The mean age of presentation is about 25

years.

 4-Social factors:
Panic Disorder and A goraphobia; Epidemiology - Recent history of divorce or
separation.
 Co morbidity

A-10-15% major depressive disorder

B-Other Anxiety disorders.

Panic Disorder and A goraphobia

 Diagnosis
Panic Disorder and A goraphobia
Panic Attacks

intense fear (4) symptoms

developed abruptly and reached a
peak within 10 minutes:

1-Palpitations.

2-Sweating.
Panic Disorder and A goraphobia; Diagnosis
3-Trembling or chaking.

4-Sensations of shortness of breath.

5- Feeling of choking.

6-Chest pain or discomfort.

Specific phopia & social phopia;Diagnosis

7-Nausea or abdominal discomfort.

 8-Feeling dizzy, unsteady light headed or faint

 9-Derealization (feeling of unreality) or depersonalization (being detached from

oneself).

Specific phopia & social phopia;Diagnosis

10-Feeling of losing control or
going crazy.

11- Fear of dying .

12-Paraesthesia (numbness or
tingling sensations).

13-Chills
Specific phopia & social phopia;Diagnosis
or hot flushes
 Differential Diagnosis

Panic Disorder and A goraphobia; diagnosis

 Differential Diagnosis of Panic
Disorder
Medical Disorders

I-Cardiovascular diseases:

1-Angina.

2-Myocardial infarction.

3-Congestive heart failure.

Panic Disorder and A goraphobia; diagnosis; DD
 4-Mitral valve prolapse.

5-Hypertension.

6-Anemia.
Specific phopia & social phopia;Diagnosis
 II-Pulmonary diseases:

1-Asthma.

2-Pulmonary embolism

Specific phopia & social phopia;Diagnosis

 III-Neurological diseases:

1-Epilepsy.

2-Transient ischemic attack.

3-Brain tumor.

4-Infection.
Specific phopia & social phopia;Diagnosis
IV-Endocrine diseases:

1-Hyperthyroidism.

2-Hypoglycemia.

3-Pheochromocytoma.

4-Cushing’s syndrome.
Specific phopia & social phopia;Diagnosis
 V-Drug intoxication:

1-Amphetamine.

2-Anticholinergics.

3-Cocaine.
Panic Disorder and A goraphobia; diagnosis; DD
4-Hallucinogens.

5-Mrijuana.

6-Nicotine.

7-Theophylline
Specific phopia & social phopia;Diagnosis
 VI-Drug withdrwal:

1-Alcohol.

2-Opiates.

3-Sedative-hypnotics.
Specific phopia & social phopia;Diagnosis
 VII-Other conditions:

1-Electrolyte disturbances.

2-Heavy metal poisning.

3-Uremia.
Specific phopia & social phopia;Diagnosis
 Course

1-In general is a chronic disorder.

2-Excessive intake of caffeine or
nicotine may exacerbate the
symptoms.
3-Alcohol and other substance
dependence occur in about 20 to
40%.
Panic Disorder and A goraphobia; Course & prognosis
 Treatment
Panic Disorder and A goraphobia
The 2 most effective treatments

A-Pharmacotherapy

B-Cognitive-Behavioral Therapy

Panic Disorder and A goraphobia; Treatment

 Pharmacotherapy

 I-SSRIs (Selective serotonin reuptake inhibitors)

 II-Benzodiazpine:

 III-Tricyclic and Tetracyclic Drugs

Panic Disorder and A goraphobia; Treatment

Specific Phobia

and

Social Phobia
Specific phobia is a strong,
persisting fear of an object or
situations.
Social phobia (social anxiety
disorder) is a strong persisting fear
of situations in which
embarrassment can occur
[speaking in public, urinating in a
public rest room (shy bladder),
and speaking to a date].
Specific phopia & social phopia
 Diagnosis
Specific phopia & social phopia;Diagnosis
 DSM-IV-TR Diagnostic Criteria for
Specific Phobia

A-Marked and persistent fear of a

specific object or situation (flying,
heights, animals, receiving an
injection, seeing blood).
B-Exposure to the phobic stimulus almost
provokes an immediate anxiety
response, which may take the form a
situationally bound or predisposed
panic attack.
Specific phopia & social phopia; Diagnosis
C-The person recognize that
the fear is excessive.
D-The phobic situation(s) is
avoided.
E-The avoidance interfere
significantly with person's
occupational functioning or
social activities.
.

Specific phopia & social phopia;Diagnosis

 DSM-IV-TR Diagnostic
Criteria for Social Phobia
A-A marked and persistent fear of
one or more social or
performance situations in which
the person is exposed to
unfamiliar people or to possible
scrutiny by others.
B-Exposure to the feared social
situations almost provokes
anxiety.
Specific phopia & social phopia;Diagnosis

.
C-The person recognizes that the
fear is excessive or unreasonable.
D-The feared social or performance
situations are avoided.
E-The avoidance of social or
performance social situation (s)
interferes significantly with the
person's occupational (academic)
functioning or social activities

Specific phopia & social phopia;Diagnosis

T H A N K
Y O U.
Specific phopia & social phopia;Diagnosis