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Anxiety Disordes.

Discussion in 'Psychiatry' started by Mena Moner, Oct 20, 2017.

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  1. Mena Moner

    Mena Moner Active member

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    (Generalized Anxiety)

    It is a subjective feeling of fear or apprehension usually accompanied by autonomic system hyperactivity & physical discomfort.

    NB: Anxiety is a normal emotion which in a moderate degree can be a helpful force by increasing effort & alertness. It is also protective function in the face of danger. It becomes pathological when symptoms are out of proportion to external circumstances or if persist long after a threatening situation. Also normal anxiety is less severe & of longer duration than pathological anxiety. Lastly normal anxiety improve performance but pathological anxiety decrease it.

    Types & Differential diagnosis:

    - Normal Anxiety it is a universal feeling, see above.

    - Anxiety neurosis.

    - Anxiety symptoms secondary to other psychiatric diseases
    e.g. depression, hysteria, schizophrenia, mania.

    - Anxiety secondary to medical diseases:
    e.g. thyrotoxicosis, pheochromcytoma, cerebral atherosclerosis, mitral valve prolapse, hypoglycemia, angina, bronchial asthma, alcohol & drug withdrawal.

    Etiology:

    1- Heredity: increase rate among twins.

    2- Learnt response: child learn to be anxious in situations which they experience as threatening.

    3- Physiological basis: increase level of catecholamines

    4- Psychological basis: A continuous conflict which pushes the individual beyond the last limit of adaptation.

    5- Personality: obsessive personality are more liable.

    Clinical picture of anxiety disorders:

    A- Psychological symptoms:

    - Unexplained fears apprehension, irritability.

    - Insomnia, night mares.

    B- Somatic manifestations:

    CVS: Tachycardia. Lt mammary pain, systolic hypertension.

    GIT: Nausea, Vomiting, indigestion, diarrhea, anorexia.

    Chest: Sighing, tightness, hyperventilation resulting sometimes in tetany & numbness (Hyperventilation syndrome)

    Urogenital: Frequency, dysmenorrhea, impotence, premature ejaculation.

    Nervous System: Headache, tremors, hyperreflexia.

    Muscles: Pains due to muscular spasm.

    Skin: Rashes, urticaria, & neurodermatitis

    C- Cognitive manifestations:

    - Lack of concentration

    - Lack of remembering & recall

    - Decreased ability to learn

    D- Psychosomatic illness:

    - Bronchial asthma, CHD, ulcerative colitis, peptic ulcer.

    - Psychosomatic illness usually occur with chronic generalized anxiety.

    Classification of Anxiety Disorders:

    1. Generalized Anxiety: (chronic persistent anxiety).

    2. Panic Disorders (acute anxiety):

    - Recurrent attacks of severe anxiety which are sudden & unpredictable

    - They are not related to a particular situations

    - They may lead to secondary agoraphobia i.e. fear of being in open spaces, outside the home a loner in a crowd.

    Diagnostic C/P for panic disorder
    (At Least 4 of the following features must be present during the attack)


    - Shortness of breath

    - Tachycardia

    - Shaking

    - Abdominal distress

    - Paresthesias

    - Chest pain

    - Fear of dying


    3. Terror status: (acute anxiety):

    Immobility characterizes this anxiety condition. Also there are tachycardia, sweating, palpation & trembling.

    Investigations of anxiety disorders:

    1- No specific test for anxiety.

    2- Non-specific EEG changes.

    3- Echocardiogram show mitral valve prolapse in good percent of patients.

    4- T3, T4, VMA, blood sugar, ECG: to exclude medical condition.

    Treatment of anxiety:

    1. Psychotherapy:

    This to vntilate all his conflicts & through suggestion, reassurance & guidance getting him to overcome his anxiety, group psychotherapy may be used.

    2. Environmental & social manipulations:

    to remove the patient from the disturbing factors.

    3. Slow breathing to reduce physical symptoms of anxiety:

    - Breath in for 4 seconds & out for 4 sec. & pause for 4 sec before breathing in again.

    - Practice 20 min morning or night (5-10 min is better than nothing)

    - Use before & during situations that make you anxious.

    - Regularly check & slow down breathing throughout the day.

    4. Drugs:

    I) Generalized anxiety

    Benzadiazepines

    - Diazepam 2-10 mg / 8 hr but should be reduced & tailed off after 3 weeks or dependence may occur.

    Non benzodiazepines:

    - Buspisone (Buspar) 5-10 mg bid.

    - Antidepressants e.g. amitriptyline 10-100 mg at night.

    - SSRIs

    - Inderal 10-30 mg / day controls out manifestations.

    II) Panic disorders

    Tricyclic anti-depressant
    e.g. clomipramine (Anafranil 25 mg tab) 100-150 mg/D

    Selective seratonine reuptake inhibitors (SSRIs)

    - Prozac 20 mg/D

    - Cipram 20 mg/D

    - Lustural 50 mg/D

    Benzodiazepines

    - Alprazolam (Xanax®) 0.25-0.5 mg/d

    Non bezoodiazepines buspar

    Beta-blockers
     

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