core concept of anxiety disorder 1.experience of anxiety, worry, and apprehension frequently, more...
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Core Concept of Anxiety Disorder
Core Concept of Anxiety Disorder
1.Experience of anxiety, worry , and apprehension frequently, more intensely, and with longer period of time comparing with normal subjects.
2.Frequent development of avoidance, ritual acts, or repetitive thoughts.
1.Experience of anxiety, worry , and apprehension frequently, more intensely, and with longer period of time comparing with normal subjects.
2.Frequent development of avoidance, ritual acts, or repetitive thoughts.
• Phobias
• Panic Disorder ( with or without Agoraphobia )
• Generalized Anxiety Disorder
• Obsessive – Compulsive Disorder
• Post – Traumatic Stress Disorder
• Acute Stress Disorder
• Phobias
• Panic Disorder ( with or without Agoraphobia )
• Generalized Anxiety Disorder
• Obsessive – Compulsive Disorder
• Post – Traumatic Stress Disorder
• Acute Stress Disorder
Anxiety DisordersAnxiety Disorders
General CriteriaGeneral Criteria
1. Not due to the effect of a substance or a known non psychiatric medical disorder (excluding specific phobia and PTSD ).
2. Not better accounted for by another psychiatric disorder.
3. Produces significant impairment of social or occupational functioning or causes marked distress.
1. Not due to the effect of a substance or a known non psychiatric medical disorder (excluding specific phobia and PTSD ).
2. Not better accounted for by another psychiatric disorder.
3. Produces significant impairment of social or occupational functioning or causes marked distress.
O bsess ive C o m puls ive D iso rders P ho bias
P anic D iso rder G enera lized A nxie ty D iso rders
P o st-T raum attic S tress D iso rder A cute S tress D iso rder
Anxiety Disorders
O bsess ive C o m puls ive D iso rders P ho bias
P anic D iso rder G enera lized A nxie ty D iso rders
P o st-T raum attic S tress D iso rder A cute S tress D iso rder
Anxiety Disorders
Anxiety DisordersAnxiety Disorders
DefinitionsDefinitions
1.1. Phobia : A persistent and irrational fear of an Phobia : A persistent and irrational fear of an objectobject or or situationsituation that leads to attempts to avoid it. that leads to attempts to avoid it.
2.2. Obsession : recurrent and persistent anxiety-provoking Obsession : recurrent and persistent anxiety-provoking thoughts, impulses, or images recognized at some time thoughts, impulses, or images recognized at some time intrusive and inappropriate.e as intrusive and intrusive and inappropriate.e as intrusive and inappropriate.inappropriate.
3.3. Compulsions:Repetitive behaviors or mental acts that a Compulsions:Repetitive behaviors or mental acts that a person feels driven to perform to prevent distress or person feels driven to perform to prevent distress or some dreaded event; Although behaviors are not some dreaded event; Although behaviors are not realistically related with the events they are designed to realistically related with the events they are designed to prevent or they are clearly excessiveprevent or they are clearly excessive
1.1. Phobia : A persistent and irrational fear of an Phobia : A persistent and irrational fear of an objectobject or or situationsituation that leads to attempts to avoid it. that leads to attempts to avoid it.
2.2. Obsession : recurrent and persistent anxiety-provoking Obsession : recurrent and persistent anxiety-provoking thoughts, impulses, or images recognized at some time thoughts, impulses, or images recognized at some time intrusive and inappropriate.e as intrusive and intrusive and inappropriate.e as intrusive and inappropriate.inappropriate.
3.3. Compulsions:Repetitive behaviors or mental acts that a Compulsions:Repetitive behaviors or mental acts that a person feels driven to perform to prevent distress or person feels driven to perform to prevent distress or some dreaded event; Although behaviors are not some dreaded event; Although behaviors are not realistically related with the events they are designed to realistically related with the events they are designed to prevent or they are clearly excessiveprevent or they are clearly excessive
Psychodynamic Themes in Phobias
1. Principle defense mechanisms include: displacement, projection, and avoidance.
2. Environmental stressors, including humiliation and criticism from an older sibling, parental fights, or loss and separation from parents, interact with a genetic-constitutional diathesis.
3. A characteristic pattern of internal object relations is externalized in social situations in the case of social phobia.
4. Anticipation of humiliation, criticism, and ridicule is projected onto individuals in the environment.
5. Shame and embarrassment are the principal affect states.
6. Family members may encourage phobic behavior and serve as obstacles to any treatment plan.
7. Self-exposure to the feared situation is a basic principle of all treatment
Psychodynamic Themes in Phobias
1. Principle defense mechanisms include: displacement, projection, and avoidance.
2. Environmental stressors, including humiliation and criticism from an older sibling, parental fights, or loss and separation from parents, interact with a genetic-constitutional diathesis.
3. A characteristic pattern of internal object relations is externalized in social situations in the case of social phobia.
4. Anticipation of humiliation, criticism, and ridicule is projected onto individuals in the environment.
5. Shame and embarrassment are the principal affect states.
6. Family members may encourage phobic behavior and serve as obstacles to any treatment plan.
7. Self-exposure to the feared situation is a basic principle of all treatment
Panic DisorderPanic Disorder
Criteria For Panic AttackCriteria For Panic AttackA panic attack is a syndrom that is not in itself a specific diagnosis.
The esential feature of a panic attack is the occurrence of a discrete period of intense fear or discomfort, usually lasting for several minutes , and accompanied by at least four of the following symptoms,which develop abruptly and reach a peak of intensity within 10 minutes.
1. Palpitations,pounding,or accelerated heart rate2. Sweating3. Trembling or shaking4. Sensations of shortness of breath or smothering5. Feeling choking6. Chest pain or discomfort7. Nausea or abdominal distress8. Feeling dizzy,unsteady,lightheaded,or faint9. Derealization ( feeling of unreality ) or depersonalization ( being
detached from oneself )10. Fear of loosing control or going crazy11. Fear of dying12. Paresthesias(numbness or tingling sensations)13. Chills or hot flushes
There are two general categories of panic attacks:a) Unexpected(uncued)panic attacks occur without any obvious
external trigger(Panic disorder)b) Situationally bound(cued) panic attacks occur immediately after
exposure to a situational trigger or in anticipation of such an exposure.(Social phobia,Specific phobia,PTSD)
A panic attack is a syndrom that is not in itself a specific diagnosis. The esential feature of a panic attack is the occurrence of a discrete period of intense fear or discomfort, usually lasting for several minutes , and accompanied by at least four of the following symptoms,which develop abruptly and reach a peak of intensity within 10 minutes.
1. Palpitations,pounding,or accelerated heart rate2. Sweating3. Trembling or shaking4. Sensations of shortness of breath or smothering5. Feeling choking6. Chest pain or discomfort7. Nausea or abdominal distress8. Feeling dizzy,unsteady,lightheaded,or faint9. Derealization ( feeling of unreality ) or depersonalization ( being
detached from oneself )10. Fear of loosing control or going crazy11. Fear of dying12. Paresthesias(numbness or tingling sensations)13. Chills or hot flushes
There are two general categories of panic attacks:a) Unexpected(uncued)panic attacks occur without any obvious
external trigger(Panic disorder)b) Situationally bound(cued) panic attacks occur immediately after
exposure to a situational trigger or in anticipation of such an exposure.(Social phobia,Specific phobia,PTSD)
Panic Disorder(with or without Agoraphobia)
Panic Disorder(with or without Agoraphobia)
• Experience of recurrent, unexpected panic attacks that are followed by at least a mount of worry about having additional attacks, concern about the implications of attacks, or a change in behavior related to attacks.
• Experience of recurrent, unexpected panic attacks that are followed by at least a mount of worry about having additional attacks, concern about the implications of attacks, or a change in behavior related to attacks.
Organic Differential Diagnosis Of Panic Disorder
Organic Differential Diagnosis Of Panic Disorder
Cardiovascular diseasesAnemiaAnginaCongestive heart failureHyperactive beta-adrenergic
stateMitral valve prolapseMyocardial infarctionParadoxical atrial tachycardia
Pulmonary diseaseAsthmaHyperventilation
Pulmonary embolus
Neurological diseaseCerebrovascular diseaseEpilepsyHuntington’s diseaseInfectionMeniere’s diseaseMigraineMultiple sclerosisTransient ischemic attackTumorWilson’s disease
Cardiovascular diseasesAnemiaAnginaCongestive heart failureHyperactive beta-adrenergic
stateMitral valve prolapseMyocardial infarctionParadoxical atrial tachycardia
Pulmonary diseaseAsthmaHyperventilation
Pulmonary embolus
Neurological diseaseCerebrovascular diseaseEpilepsyHuntington’s diseaseInfectionMeniere’s diseaseMigraineMultiple sclerosisTransient ischemic attackTumorWilson’s disease
Endocrine diseaseAddison’s diseaseCarcinoid syndromCushing’s syndromDiabetesHyperthyroidismHypoglycemiaHypoparathyroidismMenopausal disordersPheochromocytomaPremenstrual syndrom
Drug intoxicationAmphetamineAmyl nitriteAnticholinergicsCocaineHallucinogensMarijuanaNicotine
Theophyline Drug withdrawal
AlcoholAntihypertensivesOpiates and opioidsSedative-hypnotics
Endocrine diseaseAddison’s diseaseCarcinoid syndromCushing’s syndromDiabetesHyperthyroidismHypoglycemiaHypoparathyroidismMenopausal disordersPheochromocytomaPremenstrual syndrom
Drug intoxicationAmphetamineAmyl nitriteAnticholinergicsCocaineHallucinogensMarijuanaNicotine
Theophyline Drug withdrawal
AlcoholAntihypertensivesOpiates and opioidsSedative-hypnotics
PhobiasPhobias
Specific phobia: Excessive and unreasonable fear of exposure to a specific object or situation (provoked anxiety and even panic attack)
Social phobia: Fear of one or more social or performance situations and fear of scrutiny by others and being humiliated or embarrassed
Agoraphobia : Anxiety about being in places or situations from which escape might be difficult or help may not be available in the event of having panic attack or panic-like symptoms Being outside home alone Being in a crowd or standing in a line Being on a bridge Traveling in a bus, train, or automobile
Specific phobia: Excessive and unreasonable fear of exposure to a specific object or situation (provoked anxiety and even panic attack)
Social phobia: Fear of one or more social or performance situations and fear of scrutiny by others and being humiliated or embarrassed
Agoraphobia : Anxiety about being in places or situations from which escape might be difficult or help may not be available in the event of having panic attack or panic-like symptoms Being outside home alone Being in a crowd or standing in a line Being on a bridge Traveling in a bus, train, or automobile
Kinds Of PhobiaKinds Of Phobia
Generalized Anxiety Disorder
Generalized Anxiety Disorder
Generalized Anxiety Disorder
Generalized Anxiety Disorder
Excessive anxiety and worry that they can not control a number of events or activities(everyday’s life).
Lasting more Six months.
Anxiety not confined to the features of another axis I disorder.
Excessive anxiety and worry that they can not control a number of events or activities(everyday’s life).
Lasting more Six months.
Anxiety not confined to the features of another axis I disorder.
Symptoms Of Generalized Anxiety Disorder
Symptoms Of Generalized Anxiety Disorder
1.Physical Gastrointestinal
• Dry mouth• Difficulty in swallowing• Epigastric discomfort• Excessive wind• Frequent or loose motions Respiratory• Constriction in the chest• Difficulty inhaling• Overbreathing Cardiovascular• Palpitations• Discomfort in chest• Awareness of missed beats Genitourinary• Frequent or urgent micturition• Failure of erection• Menstrual discomfort• Amenorrhea Neuromuscular system• Tremor• Pricking sensation• Tinnitus• Dizziness• Headache• Aching muscles
1.Physical Gastrointestinal
• Dry mouth• Difficulty in swallowing• Epigastric discomfort• Excessive wind• Frequent or loose motions Respiratory• Constriction in the chest• Difficulty inhaling• Overbreathing Cardiovascular• Palpitations• Discomfort in chest• Awareness of missed beats Genitourinary• Frequent or urgent micturition• Failure of erection• Menstrual discomfort• Amenorrhea Neuromuscular system• Tremor• Pricking sensation• Tinnitus• Dizziness• Headache• Aching muscles
2.Psychological Fearful anticipation Irritability Sensitivity to noise Restlessness Poor concentration Worrying thoughts
3.Sleep disturbance Insomnia Night terror
4.Other symptoms Depression Tiredness Obsessions Depersonalisation
2.Psychological Fearful anticipation Irritability Sensitivity to noise Restlessness Poor concentration Worrying thoughts
3.Sleep disturbance Insomnia Night terror
4.Other symptoms Depression Tiredness Obsessions Depersonalisation
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder
Obsessive-CompulsiveDisorder
Obsessive-CompulsiveDisorder
• Obsessions or compulsions recognized at some point as excessive and unreasonable behavior.
• Not simply excessive worries about real life problems.
• The person attempt to ignore or suppress such thoughts,impulses, or images, or to neutralize them with some other thought or action.
• Takes significant amount of time or interfere with usual activities.
• If another axis I disorder is present , compulsions not restricted to the themes of that disorder.
• Obsessions or compulsions recognized at some point as excessive and unreasonable behavior.
• Not simply excessive worries about real life problems.
• The person attempt to ignore or suppress such thoughts,impulses, or images, or to neutralize them with some other thought or action.
• Takes significant amount of time or interfere with usual activities.
• If another axis I disorder is present , compulsions not restricted to the themes of that disorder.
Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder
Acute Stress Disorder
Acute Stress Disorder
Post-Traumatic Stress Disorder(PTSD(
Acute Stress Disorder(ASD)
Post-Traumatic Stress Disorder(PTSD(
Acute Stress Disorder(ASD)• Exposure to a traumatic event in which they or others
were threatened with death or serious injury.
• During the event they responded with fear, helplessness or horror.
• Since the event they have had the following symptoms for more than a month(for PTSD) and two days to four weeks(for ASD).
• Exposure to a traumatic event in which they or others were threatened with death or serious injury.
• During the event they responded with fear, helplessness or horror.
• Since the event they have had the following symptoms for more than a month(for PTSD) and two days to four weeks(for ASD).
1. Re experience of trauma :in the form of thoughts, images, dreams, feelings related to the trauma and psychological and physiological distress at exposure to cues symbolize or resembles aspects of the event.
2. Avoidance of stimuli that arouse recollection of trauma:thoughts, feelings, conversations, activities, places or people.
3. Arousal :Difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness.
4. Numbing:Diminished interest or participation in significant activities,Feeling of detachment or estrangement from others,Restricted range of affect.
5. Dissociative symptoms(Only for ASD):Reduction in awareness ones surrounding,Derealization,Depersonalisation,Dissociative amnesia
1. Re experience of trauma :in the form of thoughts, images, dreams, feelings related to the trauma and psychological and physiological distress at exposure to cues symbolize or resembles aspects of the event.
2. Avoidance of stimuli that arouse recollection of trauma:thoughts, feelings, conversations, activities, places or people.
3. Arousal :Difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness.
4. Numbing:Diminished interest or participation in significant activities,Feeling of detachment or estrangement from others,Restricted range of affect.
5. Dissociative symptoms(Only for ASD):Reduction in awareness ones surrounding,Derealization,Depersonalisation,Dissociative amnesia
Common Questions In
Making Diagnosis
Common Questions In
Making Diagnosis
Common Questions In Making DiagnosisCommon Questions In Making Diagnosis
Could the patient’s symptoms be produced by drugs or a non psychiatric medical illness?*Orderliness of symptoms*Persistence of symptoms after adequate treatment of illness or
cessation of substance Is the onset of the patient’s anxiety linked to a specific
situational trigger(cue) or is it unexpected?*Unexpected(Panic disorder)
If the patient’s anxiety is cued,what types of external situational triggers precipitate it?*Specific object or situation(specific phobia)*Social or performance situations(social phobia)*Traumatic event or reminders of a traumatic event(PTSD or ASD)
Does the patient experience long-term anxiety that is neither unexpected nor situationally triggered?*Recurrent, intrusive and distressing thoughts, impulses or
images or repetitive behaviors or mental acts to reduce the anxiety(OCD)
*Excessive anxiety associated with everyday events and activities(GAD)
Could the patient’s symptoms be produced by drugs or a non psychiatric medical illness?*Orderliness of symptoms*Persistence of symptoms after adequate treatment of illness or
cessation of substance Is the onset of the patient’s anxiety linked to a specific
situational trigger(cue) or is it unexpected?*Unexpected(Panic disorder)
If the patient’s anxiety is cued,what types of external situational triggers precipitate it?*Specific object or situation(specific phobia)*Social or performance situations(social phobia)*Traumatic event or reminders of a traumatic event(PTSD or ASD)
Does the patient experience long-term anxiety that is neither unexpected nor situationally triggered?*Recurrent, intrusive and distressing thoughts, impulses or
images or repetitive behaviors or mental acts to reduce the anxiety(OCD)
*Excessive anxiety associated with everyday events and activities(GAD)