Anxiety Disorders-I

Vishal Dhiman Assoc. Professor of Psychiatry

AIIMS, Rishikesh

Concept?

• unpleasant emotional state• A feeling of impending doom or danger• Manifestations:• psychic tension or apprehension• somatic symptoms of tension • sympathetic over activity

• Can be normal or abnormal• Anxiety verses Fear

Symptoms

• Physiological/Physical• Palpitations, tremors, tightness of chest and choking

sensation, difficulty breathing, hyperventilation, sweating, dizziness, pupillary dilatation, light-headedness, tingling, urinary frequency, increased GI motility, motor activity (restlessness), insomnia

• Psychological• Apprehension (diffuse, vague, unpleasant), fearfulness,

nervousness, irritability, inability to relax, feeling of impending doom/disaster, hypervigilance, hyperarousal, poor conc., inability to think clearly, derealization, depersonalization

Epidemiology

• One of the commonest psychiatric illnesses • 10-15 % in general practic• GAD: 1.4-17.9• Panic: 1.5-5• Agoraphobia: 0.6-6• Social phobia: 3-13• Social phobia: 3-13

• May be • Generalized• Episodic• Situations or object specific• Part of stress

Causes

1. Psychiatric illness2. Substance or drug use3. Drug induced4. Other medical illnesses

Types

• Generalized anxiety disorder (GAD)• Panic disorder• Phobic Anxiety Disorder• Obsessive-compulsive disorder (OCD)• Acute Stress Disorder• Post Traumatic stress disorder(PTSD)• Anxiety disorder due to a medical condition• Substance induced anxiety disorder

Etiology

• Psychoanalytic theory• Behavioral theory• Existential theory• Biological theory

1. Generalized Anxiety Disorder (GAD)

• Anxiety symptoms for at least 6 months• Free Floating Anxiety• Chronic disorder• May last for lifetime

GAD…

Differential diagnosis:• Medical conditions giving rise to generalized anxiety• Substance dependence (intoxication or withdrawal)• Depression• Dysthymia• Schizophrenia• OCD• Phobias• Panic disorders

2. Panic Disorder• Very common in general practice• Onset usually early 20s• Spontaneously occurring episodes of acute anxiety• Overwhelming• Recurrent• Confused with angina, respiratory distress, etc.• Anticipatory anxiety

Panic Disorder…

Differential diagnosis:• Mitral valve prolapse• Hypoglycemia• Pheochromocytoma• Drug of abuse • Medications (like anticholinergics)• Another Psychiatric illness (like depression, phobia)

3. Phobic Anxiety Disorder

• Severe anxiety to some well defined non-dangerous objects or situations• Secondary avoidance• Irrational• Reassurance failure

4. Substance Induced Anxiety Disorder

• Analgesics• Bronchodilators• Anticholinergics• Insulin• thyroid preparations• oral contraceptives• Antihistamanics• Steroids• Antiparkinsonians• Antihypertensives• Anticonvulsants• Alcohol• Amphetamines• caffeine, etc.

Intoxication & Withdrawal State

Management of Anxiety Disorders

Pharmacological• Antidepressants

• SSRIs• TCAs• SNRIs• RIMA

• Benzodiazepines• Beta blockers• Buspirone

Non Pharmacological• Psycho education• Cognitive behaviour therapy

(CBT)• Behaviour therapy• Supportive Psychotherapy• Relaxation, yoga meditation,

biofeedback, etc

Other Methods

• Relaxation • yoga • meditation • biofeedback

Course and Prognosis

• Variable• recurrences common• Earlier the diagnosis, better is the prognosis• Good response to Rx• Non pharmacological approaches efficacious

Thank you!

vishal.psyc@aiimsrishikesh.edu.in