Respected viewers i am just trying to explain the Anxiety discorded. plz any questions related to my presentation tyring to contact me as on email.

1. Anxiety disorders.
MR.KULTHEVIKRANT
MENTALHEALTHNURSING

2. What is Anxiety?
Anxiety is a normal response to danger.
Normal emotion/mood
Enhances performance
Useful in 3 ways: fight, flight, freeze
Closely coupled with somatic, autonomic
and psychological components
Abnormal, when out of proportion or
outlasts the threat

3. Components Of Normal
Anxiety
Psychological arousal:
 fearful anticipation
 irritability
 sensitivity to noise
 restlessness
 poor concentration
 worrying thoughts

4. Autonomic arousal:
• Gastro-intestinal
• Respiratory
• Cardiovascular
• Genitourinary
Somatic symptoms:
• Muscle tension
• Hyperventilation
• Sleep disturbance

5. Definition Of Anxiety Disorders
Abnormal states in which the most
striking features are mental and
physical symptoms of anxiety,
occurring in the absence of organic
brain disease or another psychiatric
disorder.

6. Types Of Disorders
Generalized anxiety disorders
anxiety continuous
Phobic anxiety disorders
anxiety intermittent, situational
Panic disorder
anxiety intermittent, unrelated to
situation
Obsessive-compulsive disorder

7. Etiology Of Anxiety Disorders
stress Diasthesis model:
Appear to be caused by stressors acting
on a personality predisposed by a
combination of genetic factors and
environmental influences in childhood.

8. Stressful life events
Genetic causes
Psychoanalytical theories
Cognitive – behavioural theory
Neurobiological mechanisms

9. G.A.D.
Lifetime prevalence: 5 – 9 %
M : F ratio 2 : 1
Key features:
• Worry and apprehension
• Muscle tension
• Autonomic overactivity
• Psychological arousal
• Sleep disturbances
All the above are persistent and pervasive
Not dependent on any circumstances

10. Clinical signs
Strained face
Furrowed forehead
Tense posture
Restless and trembling
Pale skin
Sweating
Tearful

11. Diagnosis
Presence of symptoms for most days
of the week for at least several weeks
at a time and usually for several
months
Presence of symptoms for at least 6
months duration

12. Differential diagnosis
Depressive disorder
Schizophrenia
Dementia
Substance misuse (withdrawal states)
Physical illness : thyroid dist.

13. Prognosis
 Longer the duration, poorer the prognosis
 Frequent depressive episodes on follow – up
 Co-morbidity: substance misuse, avoidance of
situations (social and agoraphobia); will have
poorer prognosis.

14. Treatment
Counselling – effective mainly in early
stages
Relaxation training – effective in less
severe disorders
CBT – 50% reduction in anxiety
symptoms, low drop-out rates

15. Medication – used to reduce anxiety
quickly and make patient amenable
to undergo CBT
• Benzodiazepines
• Beta blockers
• Anti-depressants

16. Phobic anxiety disorders
 Anxiety symptoms only in particular
situations associated with avoidance of
those situations and having anticipatory
anxiety
 3 syndromes:
• Specific phobia
• Social phobia
• Agoraphobia

17. Specific phobia
Men 4%
Women 13%
Age of onset:
animals: 7 yrs
blood: 9 yrs
dental: 12 yrs

18. Clinical features
Inappropriately anxious in the
presence of one or more objects or
situations
Whole range of symptoms can be
experienced
Anticipatory anxiety
Escape or avoidance from feared
situation

19. Types of specific phobia
 Animals
 Aspects of natural environment : Height
 Blood, injections, injuries: different autonomic
response; tachycardia f/b vasovagal response
helped by tensing muscles
 Situations: flying
 Dental and medical situations: phobia of illness
 Phobia of choking

20. Treatment
 Medications:
Benzodiazepines (risk of dependance)
Only short course recommended
 Behaviour therapy:
Exposure response prevention. Intensity of
symptoms and social disability reduced

21. Social Phobia
 Inappropriate anxiety is experienced in situations in
which the person is observed and could be criticized
 One year prevalence:
Male: 7%
Female: 9%

22. Clinical features
 Avoid social situations
 Avoid making conversations
 Sit in least conspicuous places
 Blushing and trembling frequent
 Even thought of such situations anxiety
provoking
 Preoccupied by ideas that will be observed
critically (but knows that this ideas are
baseless)

23. Clinical features
 Onset : 17 – 30 yrs
 Ist episode in public places without apparent
reason
 Episodes gradually increase in severity and
later on associated with avoidance
 Special mention:
Phobia of excretion
Phobia of vomiting

24. Co-morbidity
Depressive disorder
Suicide attempts
Alcohol and
substance misuse
common

25. Differntial diagnosis
 Avoidant personality disorder (no specific onset, lifelong
shyness)
 Social inadequacy
 Other anxiety disorders,depression and schizophrenia

26. Course and prognosis
 Average 20 yrs duration
 Persists inspite of treatment
 DSH only if co-morbid depression and alcohol misuse

27. Treatment
 Medications: Benzodiazepines (short term only),
beta blockers and antidepressants
 CBT: most effective when combined with exposure
therapy. Also given in group format
 Relaxation training: ineffective alone, but effective
when combined with exposure (applied relaxation)
 Dynamic psychotherapy

28. Agoraphobia
Anxiety when patients are away from
home, in crowds or in situations that
they cannot leave easily
Life time prevalence: 6 to 10 %

29. Clinical features
 Situational anxiety: Characterized by panic
attacks and anxious cognitions about
fainting and loss of control
 Avoidance of situations which provoke
anxiety
 3 common themes:
distance from home
crowding
confinement

30. Clinical features
Anxiety reduced if accompanied by
companion, pet dog or child
Anticipatory anxiety
Other symptoms: commonly
depressive, depersonalization and
obsessive thoughts

31. Onset and course
Early or middle 20’s
First episode typically while waiting for
public transport or shopping
Extreme anxiety (with palpitations and
fainting) with quick recovery on
reaching home or hospital
As condition progresses – increased
dependance on spouse or others

32. Treatment
Exposure treatment with anxiety
management gives better long term
results
CBT : more effective in long term
Medications

33. Panic disorder
Sudden attacks of anxiety in which
physical symptoms predominate and
are accompanied by fear of a serious
consequence such as heart attack
Life time prevalence : 5.6%

34. Clinical features
 Autonomic arousal
 Somatic symptoms of anxiety
 Psychological arousal
 Fear of dying or going crazy

35. Vicious cycle
breathes
even more
vigorously
Paradoxical feeling
of breathlessness
Dizziness,
headache,
numbness,
Precordial discomfort
Decreased CO2 conc.
In blood
Hyperventilation

36. Treatment
 Supportive measures
 Attention to causative personal or social
problems
 Medication
 Cognitive therapy

37. Obsessive compulsive disorder
Life time prevalence: 2 – 3 %
More common in females
70 % have both obsessions and
compulsions

38. Aetiology
 Genetic: 5 to 7 % of parents of patients have
OC symptoms
 Evidence of a brain disorder (associated with
other neurological disorders and as suggested
by brain imaging studies)
 Abnormal serotonergic function

39. Aetiology
 Early experience: imitative learning
(unproven)
 Psychoanalytical theories: repression and
reaction formation
 Learning theory: rituals are equivalent to
avoidance responses
 Cognitive theory: intrusive thoughts are
normal but patient lacks ability to control
them

40. Clinical features
Obsessional thoughts:
words, ideas or beliefs recognized as own
intrusive do not make sense Usually
unpleasant
Attempts to resist

41. Clinical features
Obsessional ruminations:
internal debates
arguments for and against
on simple everyday actions
endless reviewing
e.g. Turning of gas knob

42. Clinical features
 Obsessional impulses:
Urges to perform acts of violent or
embarrassing kind
 Obsessional slowness:
Slowness out of proportion to other
symptoms

43. Clinical features
Obsessional rituals:
Include mental activity like counting and
repeated senseless behaviours
Preceded by explanatory obsessional
thoughts
Rituals are illogical and there are attempts
to avoid

44. Clinical features
 Obsessional Phobias:
Avoidance of certain situations
 Anxiety: rituals either lessen or increase the
anxiety
 Depression: reactive or co-existing
endogenous

45. Prognosis
 2/3 rd improve partially by one year
 Good prognostic indicators:
Precipitating event
Good social and occupational adjustment
Episodic symptoms
Shorter duration
Onset in adulthood
Stable pre morbid personality

46. Treatment
 Counselling:
Explanation of symptoms
Reassurance
Supportive interviews
Family sessions
 Medication

47. Treatment
 CBT:
Response prevention combined with
exposure to environmental cues
2/3rd of patients improve substantially
 Cognitive therapy:
Techniques of suppression and distraction
May be combined with exposure

48. Treatment
 Dynamic psychotherapy
Not effective
 Neurosurgery:
Good immediate results
long term effects uncertain
Only for most chronic cass who resist
treatment for atleast one year

49. Thank You