Anxiety and Mood Disorders

Sunday, May 24, 2020 8:32 PM

Introduction Anxiety Disorder

Two Classification Systems Mental Disorders How Clinical significant anxiety is separated from normal feeling of anxiety and fear?
• Diagnostic and Statistical Manual of Mental Disorders (DSM -5 2013) • It should cause distress
• International Classification of Diseases (ICD) • Impairment in functioning

Depressive Disorders

Major Depressive Disorder

Three systems of Anxiety

What people
Clinically Significant How body think
Distress reacts to before/during/
anxiety after feelin
anxiety

Impairment of functioning
Includes
Or

Or irritable mood Anhedonia

in children and
adolescents

Symptoms of MDD
What they do when anxious

• Specific Phobia
Specific Phobia: Fear related to a very specific subject

Symptoms of Specific Phobia

• Extreme fear in response to a stimuli whenever confronted with it
• More than + or - 5% in a month or • Situation is avoided or endured with severe anxiety
• • Faliure to gain expected weight • Out of proportion fear
• Fear, anxiety or avoidance experienced for six months or longer
• Must cause clinically significant distress or interference
• Not explained by other mental illnesses

• Insomnia or mostly Hypersomnia Statistics

• Because of tiredness
•
• Could be an escape mechanism
• Escapism could lead to suicidal thoughts

• Twice in female than in male

• Agitation = fidgety when depressed
• • Retardation= slow when depressed (mostly)

• Loss of Energy compared to previous level of functioning

•

• Excessive or Inappropriate amount of guilt everyday

•
• Could be delusional

• • Person's experience or described by others

• • Could be planned or unplanned

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• • Could be planned or unplanned

• The symptoms should not be due to substance use or other medical condition
• They could also due to a loss (Death, Financial ruin or end of a relationship) or a grief

Persistent Depressive Disorder (Dysthymia)

Social Anxiety Disorder (Social Phobia)
• Chronic lower version of MDD
• Diagnosis: Depressed mode, most of the day for at least two years (Children and adolescents its more than one year)
Avoidance of social event where someone might be judged or scrutinized by others.
Symptoms
Symptoms
Poor Appetite or Overeating • Extreme anxiety in response to situation
• Such situations are avoided or endured with anxiety
Insomnia or Hypersomnia
• Present at least for six months
Fatigue • Out of proportion fear to danger
Low Self-esteem • Distress or impairment of functioning
• Not explained by other mental illnesses or substance
Poor Concentration or Indecisiveness
Sense of hopelessness Statistics
• In western countries, 12 month prevalence is 7% (roughly same for children, adults and adolescents)
• More common among female
Statistics for Depressive Disorders (US Data)
• In adults, 12 month prevalence of MDD is 6-7%
• Prevalence in 18-29 years old people is 3X that in older than 60
• Females are 1.5X - 3X more likely
• 12 month prevalence of PDD is 0.5%
• Many adults developed the condition at adolescence or early adulthood (particularly true for PDD)
• Having MDD and PDD together is called Double Depression

Course of Depressive Disorders

•

Peak in
Western
Countries Generalized Anxiety Disorder (GAD)
Excessive worrying

Symptoms
• Uncontrollable worry
• Six months or longer
• Three out of six physiological symptoms
Course for MDD ○ Muscle tention
○ Restlessness
• MDD could start at any point of life • Distress and Impairment
• PDD has an early onset • Not explained by other illnesses and substances
• Remission (Period of two or more months with no symptoms or no more than two symptoms in mild level) is rarely • Hypervigilance: world is always full in dangers and need to look out
experienced by some people who have PDD. Others can go for number of years without a major depressive episode (MDE)
• Spontaneous Recovery is possible with some people over time (2 in 5 will spontaneous recover in three months of onset Statistics
and 4 in 5 in 12 months of onset in MDD.)
• Lower rates of Recovery in MDD leads to
• Symptom Severity
• Personality Disorders
• Psychotic Features
• Followings may increase the risk of another episode
• Severity of proceeding episode
Females are twice likely
• Being younger at onset
• More prior episodes
• When a person with PDD faces MDD, when MDD is recovered PDD might prevail

Causes for Depressive Disorders

• Biological Factors
• Neurotransmitters
○ Serotonin
○ Dopamine
○ Noradrenaline
• Genetic Factors
• First degree relatives of a patient are more likely to develop DDs (odds are two to four times than normal people)
• PDD has even higher genetic influences
• Genetic influence is overall 40%
• Environmental Factors Panic Disorder
• Childhood experiences (Trauma, Abuse, Neglect)
• MDs are unlikely to occur without stressful life events
Recurrent unexpected panic attacks (an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes)
• Not everyone who goes through stressful life events will develop MDs either
Symptoms of a panic attack
Diathesis-stress Model

• Genetics, physiological or psychological vulnerability combined with a stressful life event.

Cognitive Behavioural Model of Depression

Due to failure to
engage in previously
enjoyed activities
4 or more out
of the
• Due to negatives thoughts with respect to the World, Self and Future
symptoms is
• Depressed people express a Pessimistic Explanatory Style
called a panic

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 Due to failure to
engage in previously
enjoyed activities
4 or more out
of the
• Due to negatives thoughts with respect to the World, Self and Future
symptoms is
• Depressed people express a Pessimistic Explanatory Style
called a panic
attack

Symptoms of Panic Disorder

Treatments for Depressive Disorders
• Antidepressants (commonly Selective Serotonin Uptake Inhibitors -SSRIs)
• Last resort: Electroconvulsive Therapy (ECT)
• Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT)
About having
CBT another attack or
1. Behavioural Activation (Pleasant Events Scheduling) consequences of
○ Search for previously enjoyed activities and set homework tasks on them another attack
○ Physical Exercises In a month
○ Aim is to have a positive reinforcement on the patient and redevelop joy in engaging in them.
One or both
2. Cognitive Restructuring
○ Help the client to catch the thoughts of negative reinforcements Related to the
○ Evaluating evidences for and against the accuracy of the thoughts attack

Statistics
• 2%-3% prevalence among adolescents and adults
• Not commonly seen among children
• Female are twice as males

Relaxation Techniques during a panic attack

1. Deep breathing
2. Progressive muscle relaxation
3. Creative Visualization
4. Exercising

Comorbidity
More than one diagnosis

Comorbidity with Panic Disorder

• Depressive Disorders (10-65%)
• Other Anxiety Disorder
• Substance Use Disorder

Causes of Anxiety Disorders

1. Genetics
○ First order relatives
2. Biological
○ Innate personality (Temperament) rather than learned (shyness, fear of unfamiliar situations, withdrawal)
3. Environmental
○ Exposure to traumatic events
○ Accumulation of stressful life events
○ Parenting Behaviour (Modeling, overprotection)

Diathesis-stress Model

• Genetics, physiological or psychological vulnerability combined with a stressful life event.

Cognitive Behavioural model

Of developing fear

Experience stimuli generalization

Learning from instructions

When a role model shows fear (a parent)

Treatments for Anxiety Disorders

• CBT is more productive for GAD than Social Anxiety Disorder
• Some individuals are not recovered by CBT
• Some regain symptoms after a while during CBT
• Medications are also used

CBT
1. Psychoeducation
○ Educating about anxiety
2. Cognitive Restructuring
○ ABC Model
○ Scientific Approach

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 ○ Scientific Approach
3. Exposure
○ Habituation: Continuously exposing to anxiety giving stimuli. Could be imaginal or in-vivo (real life experience)
○ Relaxation is not advised to use

Case Study

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