Anxiety Disorders | Anatomy2Medicine
Anxiety Disorders

Anxiety Disorders

    • “Anxiety Neurosis” was coined by Sigmund Freud
    • Peripheral manifestations of anxiety
      • Hyperhiderosis
      • Hyper-reflexia
      • Hypertension
      • tachycardia.
      • dryness of mouth
        • diarrhoea.

 

  • Following can provoke anxiety

 

        • Isoproterenol — A beta adrenergic agonist.

 

  • Lysergic acid diethylamide (LSD)

 

        • Flumazenil — A benzodiazepine antagonist
      • Medical conditions that mimic symptoms similar to anxiety disorder,

 

  • Hyperthyroidism
  • Pheochromocytoma
  • Hypoglycemia
  • Vitamin B12 deficiency

 

      • Anxiety is manifested by

 

  • Difficulty in breathing
  • Tingling numbness
  • Palpitations

 

    • Gita, 38 years old, married female was brought to casuality by her relatives, where she complained of choking sensation, chest discomfort, pounding of heart, nausea and giddiness. This all happened two hours ago after her altercation with her alcoholic husband. Cardiology assessment was normal. The

most common diagnosis in this case will be Anxiety disorder

    • Marked fear or avoidance of being the focus of attention, or of situations in which there is fear of behaving in an embarrassing or humiliating way, is characteristic of social phobia.

 

  • Agoraphobia : Classical clinical vignette

 

      • Sailaja 19 years old female, fears of being alone in public places (such as supermarkets, cinema halls), particularly places from which a rapid exit would be difficult. One day she is forced by her mother to bring vegetables from market, and she comes back trembling, sweating. She also complained of difficulty in breathing and feeling of choking. She felt dizzy and fainted. The most appropriate diagnosis in this case would be Agoraphobia
      • Agoraphobia is characterized by marked and consis-
      • tently manifest fear in, or avoidance of, at least two of the following situations:

 

  • Crowds
  • Public places
  • Travelling alone or away from home.

 

      • The general symptoms of anxiety, i.e., autonomic arousal symptoms are also present.
    • Panicogens:
    • Respiratory panic-inducing substances cause respiratory stimulation and a shift in the acid-base balance.
      • Carbon dioxide mixtures (5-35% mixtures)
      • Sodium lactate
      • Bicarbonate
    • Neurochemical Panicogens include:
      • Yohimbine: An az adrenergic receptor antagonist
      • Fenfluramine: A serotonin releasing agent
      • M-Chlorophenylpiperazine (mCPP)—having multiple serotonergic effects
      • Carbolines
      • Flumazenil – A GABAB receptor antagonist
      • Cholecystokinin
      • Caffeine.
    • Panic attack : Classical clinical vignette
    • Pratiba, 28 years old woman, presented with sudden onset episode of restlessness, tremulousness, pounding heart, choking sensation and breathless-ness. She also complained of numbness in her fingers and toes, and fear of dying. Although the attack subsided within 2-3 minutes, she rushed to hospital in a belief that she had experienced a heart

attack. The most probable diagnosis in this case would be Panic attack

 

  • Panic Attacks

 

        • They are episodes of acute anxiety usually of sudden onset and without any apparent precipitating factor lasting for few minutes.
        • Differential diagnosis of mitral valve prolapse to be kept in mind.
        • Drug of choice is antidepressant.
      • Generalized Anxiety Disorder
        • It is characterized by prominent worries, and feelings of apprehension about everyday events and problems of at least 6 months’ duration.
        • Other autonomic arousal symptoms, like, palpitations, sweating, tremors, dry mouth, difficulty in breathing, tingling numbness, restlessness and symptoms of tension may be present.
      • Mitral valve prolapse may present like panic attacks.
      • Thanatophobia. Fear of death.
      • A phobia which typically develops at the age of 8 years, is Thanatophobia
      • Medical disorders that may mimic panic disorder, except:

 

  • Myocardial infarction
  • Carcinoid syndrome
  • Pheochromocytoma
  • Obsessive-compulsive disorder Classical clinical vignette
  • A 19 years old boy, feels that dirt has hung onto him whenever he passes through the dirty street. This repetitive thought causes much distress and anxiety. He knows that there is actually no such thing after he has cleaned once, but he is not satisfied and is compelled to think so. This has led to social withdrawal. He spends much of his time thinking about the dirt and contamination. This has affected his studies also. The most likely diagnosis is Obsessive-compulsive disorder

 

      • Claustrophobia is a fear of Closed spaces

 

  • Morbid fear of high places is called Acrophobia.

 

      • Coprophobia is a morbid disgust at defaecation an faeces.
      • Phobia is a type of Anxiety disorder
      • Most common type of phobia is: Agoraphobia
      • Mrs Shiela has abnormal dislike for dirt and filth. She may be suffering from Rupophobia
      • Ailurophobia is morbid fear of cats.
      • Best treatment for phobia is Behaviour therapy

 

  • Exposure Therapy

 

        • is the most commonly used treat ment for specific phobia,
        • it was pioneered by Joseph Wolpe.
        • In this, therapists desensitize patients by using a series of gradual, self paced exposures to the phobic stimuli. The patients are taught various techniques to deal with anxiety, including relaxation, breathing con trol, and cognative approaches.

 

  • The cognitive approach includes reinforcing the realization that the phobic situation is infact safe.

 

      • drugs used for treatment of anxiety

 

  • Alprazolam
  • Buspirone
  • Propanolol  

 

    • Treatment of choice for obsessive-compulsive disorder is Behaviour therapy
    • In psychoanalytic terms, obsessive-compulsive disorder is fixed at Anal psychosexual phase of development:
    • According to Sigmund Freud,  major psychological defence mechanisms that determine the form and quality of obsessive compulsive symptoms and character traits
      • Isolation
      • Undoing
      • Reaction formation
    • Isolation is a defence mechanism that protects people against anxiety provoking affects and impulses-intimately involved in the production of clinical symptoms.
    • Undoing is a compulsive act performed in an attempt

to prevent or undo the consequences that the patient

irrationally anticipates from frightening obsessional

thoughts or impulse.

    • Reaction formation results in the formation of charac

ter traits and involves manifest patterns of behaviour

and consciously experienced attitudes that are exactly

the opposite of the underlying impulses.

 

      • Most common pattern of obsession is Contamination
      • Most common pattern of compulsion seen, is Checking
      • Poor prognostic factors in obsessive-compulsive disorder
        • Bizarre compulsions
        • Childhood onset
        • Schizotypal personality
        • Yielding to compulsions
        • Need for hospitalization
        • Co-existing major depressive disorder
        • Delusional beliefs
        • Presence of some overvalued ideas (i.e., some acceptance of obsessions and compulsions).
      • Good prognostic factors in OCD
        • Good social and occupational adjustment
        • Presence of precipitating event
        • Episodic nature of symptoms

 

  • Drug of choice for obsessive-compulsive disorder is Clomipramine