AnxietyHasan Arafat

Introduction• Anxiety: abnormal fear out of proportion to any external stimulus• Symptoms interfere with daily life and functioning• Caused by a combination of genetic, environmental, biologic and

psychiatric factors• Associated with neurotransmitter imbalance• More common in women• More common in high socioeconomic groups

Panic Attacks• Discrete periods of heightened anxiety and fear that occur in patients

with panic disorders• Usually peaks within 10 minutes and lasts less than 25 minutes• Can be provoked by triggers or come spontaneously• Panic attack criteria PANICS: Palpitations, Abdominal distress,

Numbness/Nausea, Intense fear of death, Choking/Chills/Chest pain, Sweating/Shaking/Shortness of breath.

Panic Disorder• Spontaneous, recurrent panic attacks with no obvious precipitant• 2 panic attacks/ week• Last 20-30 min• Anticipatory anxiety in between episodes• DSM-IV Diagnostic Criteria

1 month of: Anticipatory anxietyWorry about the consequences of attacksSignificant change in behavior

Symptoms not due to any other condition With/without agoraphobia (must specify)

Agoraphobia• Agora (Ἀγορά): large public space• Agoraphobia: fear of being alone in public places• Characterized by avoidance of being in places from which escape or

help might be difficult• Can present alone or as panic disorder with agoraphobia• Treating the panic disorder treats the agoraphobia too• Agoraphobia alone is hard to be treated

Specific Phobia and Social Phobia• Irrational fear of certain objects or situations• Specific phobia: exaggerated fear o a certain object or situation• Social phobia: fear of social situations in which embarrassment can

occur (AKA: social anxiety disorder)• DSM-IV Diagnostic Criteria

Excessive, persistent fear brought on by a specific situation or object Exposure brings about immediate anxiety response Patient recognizes that fear is excessive Age <18, symptoms >6 months

Obsessive-Compulsive DisorderObsession• Recurrent and intrusive

thought, feeling or idea • Egodystonic

Compulsion• A conscious, repetitive

behavior linked to an obsession

• Functions to relieve anxiety caused by the obsession when performed

Obsessive Compulsive Disorder

Obsessive-Compulsive Disorder

Common Patterns• Obsession of Contamination• Obsession of Doubt• Obsession of Symmetry• Intrusive Thoughts• Somatic Obsessions

Post-Traumatic Stress Disorder• A response to a catastrophic (life-threatening) life experience in which

the patient re-experiences the trauma, avoids reminders of the event and experiences emotional numbing or hyperarousal.• DSM-IV Diagnostic Criteria

Patient experienced a traumatic event (war, rape, natural disaster) The event was potentially harmful Persistent re-experiencing of event Numbing of responsiveness Persistent arousal Symptoms >1 month

Acute Stress Disorder• The patient experiences a traumatic event but anxiety symptoms last

for a short time• Similar to PTSD• The difference is that it maximally lasts for 1 month

Generalized Anxiety Disorder• Persistent, excessive hyperarousal and anxiety about general daily life• Experience somatic symptoms, therefore, they seek help from a non-

psychiatrist first• DSM Diagnostic Criteria

Excessive worry about daily activities At least 6 months of symptoms 3 or more of the following must bepresent: restlessness, fatigue, difficulty concentrating, irritability and sleep disturbances