Anxiety disorders.ppt

1、Anxiety disorders,Mental Health Center Sichuan University Huang Yi,Definition of anxiety disorders,Abnormal states Striking features anxiety Mental symptoms Physical symptoms Not caused by organic brain disease or psychiatric disorder,Anxiety and fear,Both involve sympathetic arousal but Fear: speci

2、fic object Anxiety: sense that something unpleasant will happen,Fear and anxiety serve an useful function- preparing us for danger Anxiety disorder- fear and anxiety result in dysfunction and distress,Features of anxiety,Worry and apprehension Autonomic hyperactivity Motor tension Persistent Difficu

3、lt to control Prolonged,Classification,Generalized anxiety disorders Phobic anxiety disorders Panic disorder Obsessive compulsive disorder Post-traumatic stress disorder,Generalized anxiety disorders,Persistent Not restricted to or strongly predominating in any particular circumstances,Clinical pict

4、ure(1),Anxiety Other psychological symptoms Irritability Poor concentration Sensitivity of noise Other motor symptoms Autonomic symptoms,Clinical picture(2),Autonomic symptoms Gastro-intestinal Respiratory Cardiovascular Genitourinary Nervous system,Clinical picture(3),Sleep disturbance Difficulty i

5、n falling asleep Night terrors Wake unrefreshed Other symptoms Tiredness Depressive symptoms depersonalization,Diagnosis,Symptoms Symptoms persistent for six months Comorbidity,Differential diagnosis,Depressive disorder Severity Order in which they appeared Schizophrenic Senile and presenile dementi

6、a Substance abuse Physical illnesses(thyrotoxicosis, hypoglycemia),Epidemiology,One-year prevalence rates 2.5-6.4% 2% women 4.3% men,Etiology,Be caused by stressors acting on a personality predisposed by a combination of genetic factors and environmental influences on childhood.,Risk factors,Stressf

7、ul events involving threat Genetic causes (41% VS. 4%) Personality,Psychoanalytic theories,Central symptoms of all kinds of neurosis Result of defences Principle cause intrapyschic conflicts Ego overwhelmed by Realistic anxiety Neurotic anxiety Moral anxiety Vulnerable ego weakened by development fa

8、ilure in childhood,Psychological responses stressful events,Conditioning theories Inherited predisposition to autonomic hyperactivity Initial fear responses become generalized by conditioning to neutral stimuli Cognitive theories Tendency to worry unproductively Focus on potentially threatening circ

9、umstances,Treatment(1),Counselling Explanation for the nature of the disorder and reassurance Help to deal with and adjust to social events Cognitive behavioral treatment Relaxation training Anxiety management training,Treatment(2),Drug treatment Benzodiazepines Beta-adrenergic antagonists Tricyclic

10、 antidepressants Monoamine oxidase inhibitors,Phobic anxiety disorders,Anxiety symptoms Symptoms occur only in particular circumstances Avoidance Anticipatory anxiety Situations, objects,natural phenomena,Classification,Simple phobia Social phobia agrophobia,Simple phobia,Inappropriately anxious Par

11、ticular objects, situations Phobia of dental treatment Phobia of flying Phobia of illness,Prevalence,Adults lifetime prevalence Men: 4% Women: 13%,Etiology,Continuation of childhood phobias Modest genetic vulnerability combined with phobia-specific stressful events Psychoanalytic theory -displacemen

12、t,Differential diagnosis,Depressive disorder Obsessional disorders,Treatment & prognosis,Behavioral therapyexposure Originate in childhood continue for many years Start in adult life have better prognosis,Social phobia,Anxiety symptoms blushing,trembling In situations in which the person is observed

13、 and could be criticized Avoidance Anticipatory anxiety Ideabeing observed critically,Clinical picture,Comorbidityalcohol abuse Limited social phobia speaking, writing, playing Phobias of excretion Phobias of vomiting,Epidemiology,One-year prevalence Men: 7% Women: 9%,Prognosis,Without treatment, la

14、sts for many years, Beings in the ages of 17-30 Deliberate self-harm,Differential diagnosis,Generalized anxiety disorder Depressive disorder Schizophrenia Avoidant personality disorder Social inadequacy-type of a behavior,Etiology,Genetic factors Non-specific environmental factors Cognitive factor f

15、ear of negative evaluation,Treatment,Psychological treatment Social skills training Relaxation training Exposure Drug treatment,Agoraphobia-clinic picture(1),Anxiety symptoms Circumstances Away from home In crowds In situations what they can not leave easily Avoidance,clinic picture(2),Two groups of

16、 anxiety symptoms Panic attacks Anxious cognitions about fainting and loss of control Other symptomsdepression, depersonalization, obsessional thoughts,clinic picture(3),Anticipatory anxiety Other symptoms Depression Depersonalization Comorbid with Prolapse of the mitral valves,Differential diagnosi

17、s,Panic disorder Social phobia Generalized anxiety disorder Depressive disorder Paranoid delusions,Epidemiology,One-year prevalence Agoraphobia without panic disorder Men: 1.7% Women: 3.8% The lifetime prevalence : 6%-10%,Etiology,Unreasonably afraid of minor physical symptomsmisinterpreted Biologic

18、al predisposition- inhibitory mechanism defected Unconscious mental conflicts Learning , conditioning, personality,Treatment (1),Behavior therapy - exposure Anxiolytic drugs Antidepressant drugs- imipramine, clomipramine Monoamine oxidase inhibitors,Panic disorder,Occurrence of panic attacks Sudden

19、attacks of anxiety Physical symptoms predominate Fear of a serious consequence,Symptoms,Palpitations and accelerated heart rate Chest discomfort or pain ,Choking Sweating Dizziness,trembling, shaking, flushes Depersonalization or derealization Fear of dying Fears of going crazy or doing something uncontrolled,Clinical pictures,Panic attacks occur unexpectedly Four attacks in four weeks or one attack followed by four weeks of fear Hyperventilation,Epidemiology,One-year prevalence Men: 13/1000 Women: 32/1000 Subclinic attack: 6 months prevalenc