Anxiety and related

disorders:
Normal anxiety:
Anxiety is a normal human response to certain
situations.
Pathological anxiety
• Three factors may suggest that anxiety is
pathological:
1. Degree :- if the anxiety is far greater than most
people experience.
2. Situation :– if the precipitant would not normally
be anxiety provoking, for example insects or leaving
the house.
3. Consequences :– if the anxiety has negative
consequences or is disabling in some way and
perhaps affecting an individual’s functioning, in their
interpersonal relationships:
(i) At work;
(ii) In the home.

. Symptoms of anxiety
• The symptoms of anxiety are almost the same in all the
anxiety disorders.

•  
1. Mood fearfulness, apprehension
 
2. Thoughts *unrealistic appraisal or evaluation of
danger/illness to self or others.
* Lack of belief in ability to cope with stress.
 
3.Increased arousal * Difficulty sleeping
* Restlessness and irritability
*Noise sensitivity
*Increased startle response
• 4.Somatic symptoms
(i) hyperventilation: *Faintness, Paresthesia,
*Carpopedal spasm
(ii)muscular tension:
*Tremor, chest tightness:
*Fatigue, pain, stiffness,
(iii) autonomic overactivity:
*Tachycardia,
*Palpitation, dry mouth, diarrhea,
*Urinary frequency, sweating
 5.Behaviour
* Reduced purposeful activity
* Restless purposeless activity
* Avoidance of situations which exacerbate anxiety
Diagnosis of Anxiety disorders
Diagnostic flow chart
*Disorders related to anxiety; According to DSM5 are
classified under trauma and stressor- related disorders: -
 1- acute stress reaction; is no longer included in
ICD11 classification as a mental disorder and instead is now
classified as a reaction to trauma (factor influencing health).
2- adjustment disorder:
It is a psychological reaction to a significant
change in life circumstances rather than to a specific
stressful event. It is mild in severity and rarely requires
psychiatric treatment.
3- Post-Traumatic Stress Disorder (PTSD)
• The patient is complaining of symptoms of anxiety
specifically related to a particularly stressful event.
• PTSD is characterized by the following triad:
1. Re-experiencing symptoms (intrusive thoughts/memories,
nightmares or flashbacks),
2. Hypervigilance (difficulty sleeping, enhanced startle reflex,
autonomic overactivity, irritability and reduced concentration)
3. Avoidance behavior (reduced emotional responsiveness, lack
of pleasure, restlessness, avoiding situations reminding the
patient the event, increased fantasy life).
• Depression and \or alcohol/substance misuse should be
excluded.
• The onset is delayed, in cases of PTSD and excludes an
acute stress reaction.
• Adjustment disorder is a psychological reaction to a
significant change in life circumstances rather being
due to a specific stressful event. It is mild in severity and
rarely requires psychiatric treatment.
 • Depressive disorder may show some anxiety symptoms but
the low mood and associated depressive symptoms
( SIGECAPS) are prominent.

*Generalized anxiety disorder

• Generalized anxiety disorder is characterized by free floating
or constant symptoms of anxiety.
*Organic anxiety disorder: In cases of ((hyperthyroidism,
CNS/extracranial neoplasia, subarachnoid hemorrhage, seizure disorders, hypo
glycaemia, drug intoxication/withdrawal, phaeochromocytoma, hypercalcemia)

*Panic disorder
The anxiety symptoms are not related specifically to a
significant trauma, it occurs at random and it is episodic.
*Phobias
Agoraphobia: symptoms related to crowds, open places
Social phobia: symptoms occurs in social gathering, e.g.
talking in front of others (class room) eating in
restaurants…..
Specific phobias: phobia of animals, specific stimuli,
heights, closed places e.g. lifts
In the previous classifications ICD 10 and DSM iv
OCD was classified under anxiety group because
anxiety is usually a feature of this disorder, but now is
classified under Obsessive- Compulsive and
related disorders
Beside OCD this group include e.g., body dysmorphic
disorder, Hoarding disorder, Trichotillomania
 Obsessive Convulsive Disorder:
Obsessions:
Obsessions are repetitive, intrusive and stereotyped
thoughts, images or impulses.
The patient knows they are irrational or silly and tries to
resist them, but they are recognized as the patient’s own.
Compulsions:
are voluntary actions which the patient performs in order
to reduce the build up of anxiety and tension caused by the
obsession.
• There may be a family history of OCD or other anxiety
disorders.
• The history should always exclude a depressive episode,
which may sometimes present with obsessions and
compulsions.
• Schizophrenia should be considered for two reasons:
• obsessional symptoms are common in the early
stages of schizophrenia,
• before a person has developed frank psychosis;
repetitive intrusive thoughts may suggest thought insertion
(first rank symptom of schizophrenia), so it is important to
ensure that the patient recognizes the thought as their
own.
• Someone with anankastic(obsessive) personality disorder
is excessively cautious and unwilling to take risks, and is
preoccupied with rules and details. (Ego syntonic while
OCD patients are ego dystonic).
 • People with anankastic personality disorder may develop
OCD and are at an increased risk of developing
depressive episodes.

TREATMENT OF ANXIETY DISORDERS

There are many pharmacological and psychological treatments for
anxiety. Some are diagnostically non-specific, and may be used in any
disorder in which anxiety is a feature. Some are used specifically for a
particular diagnosis.
 Antidepressants are effective anxiolytics. They are most likely to
be effective in acute mental illnesses, particularly panic disorder.
 Long-standing generalized anxiety is likely to respond less well to
pharmacological treatment and tends to follow a waxing and
waning course.
 Psychological treatment of anxiety disorders necessarily requires
exposure of the patient to their anxiety, in a graduated and
supportive way, allowing them to habituate to it

Non-specific and diagnosis-specific psychological treatments of anxiety

Non-specific psychological  Supportive psychotherapy
treatments of anxiety  Relaxation training
 Problem-solving therapy
 Anxiety management
Diagnosis-specific Phobic anxiety disorders;
psychological treatments of  Graded exposure
anxiety Obsessive–compulsive disorder:
 Exposure and response prevention
 Thought stopping