Anxiety Disorders By Dr seddighHUMS

Anxiety DisordersNormal & pathologic anxiety DSM IV Panic Disorder with AgoraphobiaSocial Phobia & Specific PhobiaObsessive Compulsive DisorderGeneralized Anxiety Disorder PTSD ( Acute Stress Disorder)

Phobias( specific & social) Intense, irrational fear that may focus on:category of objects event or situation social setting

Subtypes of Specific PhobiaAnimal typeNatural environment type Blood-Injection-Injury type

Situational type

Other type

Facts about Specific PhobiaPrevalence: Sp 11 %So 3-13 %Gender:F>M 2:1BII F=MAge of Onset: Natural environment type &Blood-Injection-Injury type 5-9 y/oSituational type 20 y/o

Development of PhobiasClassical conditioning model e.g., dog = CS, bite = UCSproblems: no memory of a traumatic experiencetrauma not produce phobia

Specific PhobiaFear Marked, persistent excessive unreasonable B. Exposure ----- anxity responceC. recognizes : excessive or unreasonableD. avoided E. distress functioning F. Not mental disorder

Some Unusual PhobiasAilurophobia - fear of catsAlgobphobia - fear of painAnthropophobia - fear of menMonophobia - fear of being alonePyrophobia - fear of fire

Social PhobiaMarked, persistent fear social or performance humiliating or embarrassing.B. Exposure ------- anxiety responseC. recognizes excessive or unreasonableD. avoided E. distress or functioning

Phobias - TreatmentInsight-oriented psychotherapyRelaxationBreathing techniquesCognitive RestructuringExposure TherapyMedication beta blockerMOA Inh,SSRI,BZD,Venlafaxin,Buspiron

Obsessive-Compulsive Disorder (OCD)Obsessions irrational, disturbing thoughts intrude Compulsions repetitive actions alleviate obsessionsChecking and washing most common compulsions neural activity ------ caudate nucleus

Facts about OCDPrevalence: GP 2-3%

Gender: M=F B>G SINGLE>MARRIEDAge 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 images1-Recurrent, persistent intrusive inappropriate 2- about real-life problems3-The person attempts 4- recognizes ------his or her own mind

Typical ObsessionsDoubts turn off ? lock the door? hurt someone hurt or killed criminal dirty or contaminated

Obsessive-Compulsive DisorderCompulsions as defined by 1 and 2Repetitive behaviors or mental acts response to an obsession rules rigidly2- reducing distress or preventing

Typical CompulsionsCheckingCleaning/washing number in a rowDoing and then undoing things symmetryMental acts such as praying, counting, etc.

Obsessive-Compulsive DisorderB. recognized ---- excessive or unreasonableC. distress or functioning due to the D. not restricted Axis I disorderE. not GMC or substance

OCD - TreatmentCognitive Behavioral TherapiesExposure and Response Prevention (ERP)

MedicationsSSRIClomipramine

Panic DisorderPanic attack & Panic Dx Agoraphobia often develops as a result

Panic DisorderPrevalence: P.A 3-5.6P.D 1.5-5A 0.6 -6Gender: 2-3 F =MAge of onset: 25 y/oComorbidity

Etiology (CNS , PNS & AUTONOUM)

Panic Attack (not a diagnosis)Discrete period intense fear or discomfort, in which 4 or more reach a peak within 10 minutesPalpitationsSweatingTrembling/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 21. Recurrent, unexpected panic attacks2. At least one 1 months 1 followinga. additional attacksb. implications consequencesc. change in behavior B. Presence of agoraphobiaC. not GMC or substanceD. not mental disorder

Panic Disorder without AgoraphobiaA. Both 1 and 21. Recurrent, unexpected panic attacks2. At least one 1 months 1 followinga. additional attacksb. implications consequencesc. change in behavior B. Absence of agoraphobiaC. not GMC or substanceD. not mental disorder

Panic Disorder - TreatmentMedicationSSRI, TCA, BZDBupropion,venlafaxine,nefazodonePsychotherapyRelaxationBreathing techniques Behavioral therapyCognitive Restructuring

Posttraumatic Stress Disorder (PTSD)Follows traumatic event or events such as war, rape, or assaultSymptoms include:nightmaresflashbackssleeplessnesseasily startleddepressionirritability

Generalized Anxiety Disorder (GAD) More or less constant worry about many issues The worry seriously interferes with functioning Physical symptoms Headaches Stomachaches muscle tension Irritability

Facts about GADPrevalence: 5%Gender:F:MOut 2:1In 1:1Age of Onset: unknown

Generalized Anxiety Disorder (GAD)Excessive anxiety and worry 6 months, number of events difficult to control 3 following symptoms Restlessness easily fatigued concentrating IrritabilityMuscle tensionSleep Disturbance

GAD - TreatmentMedicationBenzodiazepines,SSRI,Buspirone

Cognitive TherapyRelaxationBreathing Techniques

Cognitive DisordersDR SEDDIGH8.9.88

DefinitionCognitive disorders = central feature

impairment of

memory, attention, perception, and thinking.

A. DSM History called organic disorders

DSM-IV cognitive

B. AssessmentMental Status Exam:

5 major components:Appearance and behaviorMood and affectThoughtPerceptionSensorium and Intellect

Sensorium = consciousness and awareness of surroundings

Cognitive Disorders Types of Cognitive Disorders

A. DeliriumFeaturesKey feature consciousnessAssociated features Clouded sensorium no clear awareness of surroundings attention memory speechPerceptual disturbances

A. Delirium (cont.)Statistics and course onset ------ course life-long superimposed

2. Statistics and course (cont.) certain people:ElderlyMedically ill (e.g., cancer; AIDS)Dementia

A. Delirium (cont.)CausesDrugs: intoxication, withdrawal, poisonDelirium tremens MedicationsInfectionHead injury brain trauma

A. Delirium (cont.)Treatment precipitating problem

Prevention

B. DementiaFeaturesKey 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.)Statistics and courseIncidence prevalence rate, 65-74:1.29%75-84:3.83%85+:10.14%

2. Statistics and course (cont.) males and femalesOnset type

over age

B. Dementia (cont.) Alzheimers DiseaseDSM-IV Criteria multiple cognitive deficits both:Memory impairmentOne (or more) of the following:AphasiaApraxiaAgnosiaDisturbance in executive functioning

DSM-IV criteria (cont.)B. impairment C. Gradual onset

- Rule out

3. Alzheimers (cont.)Onset usually in 60s or 70s (presenile dementia)Definitive diagnosis

Gross atrophy Neurofibrillary tanglesSenile plaques

B. Dementia (cont.)Causes of dementiaDirect cause Plaques and tangles Blocked artery Genetic factors linked to some dementiasMultiple genes Single dominant gene

boxers dementia

4. Causes (cont.)Vascular dementia diet ---- genetic Psychosocial factors education level Social resources and family support

B. Dementia (cont.)Treatment of dementiaLimited drugs Psychological treatmentsMemory walletMemory skills trainingTeach 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 functioningDelirium short-lived; treat precipitating factor (e.g., substance withdrawal) or preventDementia gradual, continual decline (e.g., Alzheimers)Dementia treatments are limited; help with memory skills

*****The caudate nucleus is located in the basal ganglia and is associated with initiation of learned, habitual motor activities

Using drugs that increase Serotonin reduces the activity of the caudate nucleus and leads to a reduction in the obsessions and compulsions - people who recover from OCD using behavioral and cognitive therapies also show a reduction in actiivity in the caudate nucleus**Q: What are cognitive disorders? (problem with memory, attention, etc.)Q: Why are cognitive disorders relevant to abnormal psychology? (affect behavior and personality)*- All mental disorders involve some dysfunction in the brain, so organic isnt very descriptive*Signs of disorder through observation, motor activity, speech and attitudeFeelings and emotional toneStream of thought (productive and continuous), form of thought (coherent or loose), and contentLook for hallucinations, depersonalization, or derealizationOrientation x3: time, place, person; levels of consciousness awake coma *All cog disorders share basic feature of primary dysfunction being in cognitive functions including memory, attention, perception, and thinking. All involve a change from previous functioning levels.*DTs can be fatal**- Alzheimers onset is usually in late adulthood; vascular dementia is caused by blocked artery and could happen at any time*Aphasia language disturbance (trouble comprehending language and/or trouble producing language)Apraxia cant carry out motor activities despite intact motor function (e.g., cant draw a clock when commanded but can do it)Agnosia failure to recognize or identify objects despite intact sensory function*-tangles of strand-like filaments- plaques: build up of gummy protein deposits*Memory wallet can include pictures and names of loves ones, friends to help social interactionsMemory skills training using index cards; keeping a notebook to help rememberTeach to use road signs, cues around living area to help avoid getting lost if wander away