ANXIETY DISORDERS Dr David Schaefer. History Normal anxiety: - evolutionary - alerting signal -...
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Transcript of ANXIETY DISORDERS Dr David Schaefer. History Normal anxiety: - evolutionary - alerting signal -...
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ANXIETY DISORDERS
Dr David Schaefer
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History
Normal anxiety: - evolutionary - alerting signal - interpersonal
Pathological: - most common
- selective attention - Yerkes Dobson
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Classification
Generalised anxiety disorder Panic disorder Agorophobia Specific phobia Social phobia OCD PTSD Substance induced anxiety disorder
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Panic Attack Discrete period of intense fear/discomfort Starts suddenly, peaks at 10 mins Palpitations Sweating Trembling/shaking SOB/choaking Chest pain Nausea Dizzy/fainting Derealization/detached Fear losing control ,dying Paraesthsia, chills
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Panic Disorder
Recurrent unexpected panic attacks Worry about additional panic attacks Worry about consequences Behavioural change
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Treatment Panic Disorder
Emergency- Benzos First line- SSRI (delayed effect) 2nd line- MAOI
- Mirtazepine
- TCA- imipramine, clomip
- Venlafaxine
- Epilim
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Panic Disorder-Therapy
Psychoeducation Cognitive- ‘false alarm’ Relaxation- muscular, imagery Breathing
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Obsessive Compulsive Disorder
Obsessions- recurrent intrusive thoughts, impulses, images. Recognise thoughts are their own
Compulsions- repetitive behaviours/mental acts in response to obsession or rule. Include:
- handwashing, ordering, checking,praying, repeating words, counting
Compulsion aimed at reducing stress/preventing event
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Treatment OCD
SSRI or Clomipramine Add Neuroleptic Citalopram and Clomipramine Mirtazepine and SSRI
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Therapy OCD
Exposure CBT
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Obsessive Compulsive Related Disorders OCD Body Dysmorphic Disorder Hoarding Disorder (new to DSM V) Trichotillomania Excoriation (skin picking) Substance induced Obsessional jealousy
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PTSD
Exposure to traumatic event Reexperienced: Recurrent recollections Dreams FlashbacksAvoidanceEmotional numbing/detachmentHyperarousal- sleep, irritability,startle reflex
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Treament PTSD
SSRI Add neuroleptic Mirtazepine Venlafaxine ? CMZ, clonidine, lamictin, Epilim ? Benzos
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Therapy PTSD
Cognitive- world unsafe Exposure therapy- conditioned fear response
Eye Movement Desensitisation and Reprocessing
Behavioural- breathing, progressive muscular relaxation
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Specific Phobia
Marked fear specific object/situation Exposure provokes anxietyb response Avoidance Realises fear unreasonable
Treatment- exposure therapy
- ?B-blockers
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Social Anxiety Disorder Fear of social/performance situations Fears humiliation/embarrassment Exposure causes anxiety Avoidance Anxious anticipation Blushing
Treatment- emergency- Benzos -1st line- SSRI - B-blocker- performance - Buspirone - Venlafaxine - Epilim
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Therapy SAD
CBT- mind reading Exposure therapy
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Generalised Anxiety Disorder
Excessive anxiety and worry Unable to control worry Symptoms- restlesness - fatigue - poor concentration - irritability - muscular tension - insomnia- Common- prevalence 5-8%- women>men- Many seek help other specialities
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Treatment GAD
Benzos?- sort-term 2-4 weeks Stessum SSRI- start low dose Mirtazepine Venlafaxine B-blockers ?neuroleptics
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Therapy GAD
Psycho-education CBT Exercise Relaxation
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Summary
Common Disorders Often Missed High comorbidity Often missed Treatment medication and therapy