anxiety disorders اختلالات اضطرابی by dr seddigh hums
TRANSCRIPT
Anxiety Disorders
اضطرابی اختالالت
By Dr seddigh
HUMS
Anxiety DisordersNormal & pathologic anxiety
اضطراب فوایداساس بر
DSM IV
Panic Disorder with Agoraphobia
Social Phobia & Specific Phobia
Obsessive Compulsive Disorder
Generalized Anxiety Disorder
PTSD ( Acute Stress Disorder)
Phobias( specific & social)
Intense, irrational fear that may focus on:
category of objects اشیاevent or situation موقعیتها
social setting اجتماعی مسایل
Subtypes of Specific PhobiaAnimal type
شایعترینNatural environment type
طوفان ، بلندیBlood-Injection-Injury type
Situational type
Other type
مرگ ، بیماری
Facts about Specific PhobiaPrevalence:
Sp 11 %
So 3-13 %
Gender:
F>M 2:1
BII F=M
Age of Onset:
Natural environment type &Blood-Injection-Injury type 5-9 y/o
Situational type 20 y/o
Development of Phobias
Classical conditioning modelکالسیک شدن شرطی مدل
e.g., dog = CS, bite = UCS
problems: • no memory of a traumatic experience• trauma not produce phobia
Specific PhobiaA. Fear Marked, persistent excessive unreasonable B. Exposure ----- anxity responceC. recognizes : excessive or unreasonableD. avoided E. distress functioning F. Not mental disorder
Some Unusual Phobias
Ailurophobia - fear of cats
Algobphobia - fear of pain
Anthropophobia - fear of men
Monophobia - fear of being alone
Pyrophobia - fear of fire
Social Phobia
A. Marked, persistent fear
social or performance
humiliating or embarrassing.
B. Exposure ------- anxiety response
C. recognizes excessive or unreasonable
D. avoided
E. distress or functioning
Phobias - TreatmentInsight-oriented psychotherapy
Relaxation
Breathing techniques
Cognitive Restructuring
Exposure Therapy
Medication
beta blocker
MOA Inh,SSRI,BZD,Venlafaxin,Buspiron
Obsessive-Compulsive Disorder (OCD)
Obsessions irrational, disturbing thoughts intrude
Compulsions repetitive actions alleviate obsessions
Checking and washing most common compulsions neural activity ------ caudate nucleus
Facts about OCDPrevalence:
GP 2-3%
Gender: M=F B>G SINGLE>MARRIED
Age of Onset: 20 Y/OM 19 F 22COMORBIDITY:
Obsessive-Compulsive DisorderA. Either obsessions or compulsions:
Obsessions as defined by 1, 2, 3, and 4 thoughts, impulses, or images
1-Recurrent,
persistent
intrusive
inappropriate
2- about real-life problems
3-The person attempts
4- recognizes ------his or her own mind
Typical Obsessions
Doubts turn off ? lock the door? hurt someone
hurt or killed
criminal
dirty or contaminated
Obsessive-Compulsive Disorder
Compulsions as defined by 1 and 21. Repetitive behaviors
or mental acts
response to an obsession
rules rigidly
2- reducing distress
or preventing
Typical Compulsions
Checking
Cleaning/washing
number in a row
Doing and then undoing things
symmetry
Mental acts such as praying, counting, etc.
Obsessive-Compulsive Disorder
B. recognized ---- excessive or unreasonable
C. distress or functioning due to the
D. not restricted Axis I disorder
E. not GMC or substance
OCD - TreatmentCognitive Behavioral Therapies
“Exposure and Response Prevention” (ERP)
Medications
SSRI
Clomipramine
Panic Disorder
Panic attack & Panic Dx
Agoraphobia often develops as a result
Panic DisorderPrevalence:
P.A 3-5.6P.D 1.5-5A 0.6 -6
Gender: 2-3 F = MAge of onset: 25 y/o
Comorbidity
Etiology (CNS , PNS & AUTONOUM)
Panic Attack (not a diagnosis)A. Discrete period B. intense fear or discomfort,C. in which 4 or more D. reach a peak within 10 minutes
PalpitationsSweatingTrembling/achingSensations of shortness of breath or smotheringFeeling of chokingChest pain/discomfortNausea/abdominal distressFeeling dizzy/unsteady/lightheaded/faintDerealization/depersonalizationFear of losing control/going crazyFear of dyingParesthesias (numbness or tingling sensation)Chills/hot flushes
Panic Disorder with AgoraphobiaA. Both 1 and 2
1. Recurrent, unexpected panic attacks
2. At least one 1 months
1 followinga. additional attacks
b. implications consequences
c. change in behavior
B. Presence of agoraphobia
C. not GMC or substance
D. not mental disorder
Panic Disorder without Agoraphobia
A. Both 1 and 21. Recurrent, unexpected panic attacks
2. At least one 1 months
1 followinga. additional attacks
b. implications consequences
c. change in behavior
B. Absence of agoraphobia
C. not GMC or substance
D. not mental disorder
Panic Disorder - Treatment
Medication
SSRI, TCA, BZD
Bupropion,venlafaxine,nefazodone
Psychotherapy
Relaxation
Breathing techniques
Behavioral therapy
Cognitive Restructuring
Posttraumatic Stress Disorder (PTSD)
Follows traumatic event or events such as war, rape, or assault
Symptoms include:nightmares
flashbacks
sleeplessness
easily startled
depression
irritability
Generalized Anxiety Disorder (GAD) منتشر اضطراب اختالل
More or less constant worry about many issues موقعیتها اکثر در مداوم نگرانی
The worry seriously interferes with functioning جدی عملکرد اختاللPhysical symptoms جسمی عالئم
Headaches سردرد
Stomachaches معده ناراحتیmuscle tension تنشعضالنی Irritability پذیری تحریک
Facts about GADPrevalence:
5%
Gender: F:M
Out 2:1
In 1:1
Age of Onset:
unknown
Generalized Anxiety Disorder (GAD)
A. Excessive anxiety and worry 6 months, number of events
B. difficult to control
C. 3 following symptoms 1. Restlessness
2. easily fatigued
3. concentrating
4. Irritability
5. Muscle tension
6. Sleep Disturbance
GAD - Treatment
Medication
Benzodiazepines,SSRI,Buspirone
Cognitive Therapy
Relaxation
Breathing Techniques
Cognitive Disorders
DR SEDDIGH
8.9.88
Definition
Cognitive disorders = central feature
impairment of
memory, attention, perception, and thinking.
A. DSM History
called
“organic disorders”
DSM-IV
“cognitive”
B. Assessment
Mental Status Exam:
5 major components:
1. Appearance and behavior
2. Mood and affect
3. Thought
4. Perception
5. Sensorium and Intellect
• Sensorium = consciousness and awareness of surroundings
Cognitive Disorders
Types of Cognitive Disorders
A. Delirium
1. Features• Key feature
consciousness• Associated features
• Clouded sensorium – no clear awareness of surroundings
• attention• memory• speech• Perceptual disturbances
A. Delirium (cont.)
2. Statistics and course• onset ------ course
life-long
• superimposed
2. Statistics and course (cont.)
certain people:Elderly
Medically ill (e.g., cancer; AIDS)
Dementia
A. Delirium (cont.)
3. Causes• Drugs: intoxication, withdrawal, poison
• Delirium tremens
• Medications• Infection• Head injury• brain trauma
A. Delirium (cont.)
4. Treatment• precipitating problem
• Prevention
B. Dementia
1. Features• Key feature
impairment of multiple cognitive abilities • novel problems • First signs:
personality change and memory loss
Differential Diagnosis: Top Ten (commonly used mnemonic device: AVDEMENTIA)
1. Alzheimer Disease (pure ~40%, + mixed~70%)2. Vascular Disease, MID (5-20%)3. Drugs, Depression, Delirium4. Ethanol (5-15%)5. Medical / Metabolic Systems6. Endocrine (thyroid, diabetes), Ears, Eyes, Environ.7. Neurologic (other primary degenerations, etc.)8. Tumor, Toxin, Trauma9. Infection, Idiopathic, Immunologic10. Amnesia, Autoimmune, Apnea
B. Dementia (cont.)
2. Statistics and course• Incidence • prevalence rate,
• 65-74: 1.29%
• 75-84: 3.83%
• 85+: 10.14%
2. Statistics and course (cont.)
males and females
Onset type
over age
B. Dementia (cont.)
Alzheimer’s DiseaseDSM-IV Criteria
A. multiple cognitive deficits
both:1) Memory impairment
2) One (or more) of the following:a) Aphasia
b) Apraxia
c) Agnosia
d) Disturbance in executive functioning
DSM-IV criteria (cont.)
B. impairment
C. Gradual onset
- Rule out
3. Alzheimer’s (cont.)
Onset usually in 60’s or 70’s (presenile dementia)
Definitive diagnosis
1. Gross atrophy
2. Neurofibrillary tangles
3. Senile plaques
B. Dementia (cont.)
4. Causes of dementia• Direct cause
• Plaques and tangles
• Blocked artery
• Genetic factors linked to some dementias• Multiple genes
• Single dominant gene
• boxer’s dementia
4. Causes (cont.)
Vascular dementia
diet ---- genetic
Psychosocial factors education level
Social resources and family support
B. Dementia (cont.)
5. Treatment of dementia• Limited – drugs • Psychological treatments
• Memory wallet
• Memory skills training
• Teach to use navigational cues to avoid getting lost
SummaryCognitive disorders involve an impairment of memory, attention, perception, and thinking that represents a change from previous functioning
Delirium – short-lived; treat precipitating factor (e.g., substance withdrawal) or prevent
Dementia – gradual, continual decline (e.g., Alzheimer’s)
Dementia treatments are limited; help with memory skills
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