ANXIETY DISORDERS

1. ANXIETY DISORDERS

2. DEFINITION:
Anxiety disorders include a constellation of disorders in which anxiety
and associated symptoms are experienced at level of severity that impairs
functioning.
Types of Anxiety Disorder
 1.Generalised Anxiety Disorder.
 2.Social Anxiety Disorder.
 3.Post Trauma Stress Disorder

3. PATHOPHYSIOLOGY:
Noradrenergic model :
 The locus ceruleus may have a role in regulating anxiety, as it activates
norepinephrine (NE) release and stimulates the sympathetic and
parasympathetic nervous systems.
 Chronic noradrenergic overactivity downregulates
α2 adrenoreceptors in patients with generalized anxiety disorder (GAD) and
posttraumatic stress disorder (PTSD).
 Patients with social anxiety disorder (SAD) appear to have a
hyperresponsive adrenocortical response to psychological stress.
γ- aminobutyric acid (GABA) receptor model:
 Anxiety symptoms may be linked to underactivity of GABA systems or
downregulated central BZ receptors.
 Abnormalities of GABA inhibition may lead to increased response to stress
in PTSD patients.

4. Serotonin (5-HT) model:
 The 5-HT and 5-HT2 antagonist meta-chlorophenylpiperazine (m-CPP)
causes increased anxiety in PTSD patients.
 Dysregulation of the hypothalamic-pituitary-adrenal axis may be a risk
factor for eventual development of PTSD.

5. Symptoms:
Generalized Anxiety disorders:
Psychological and congnitive :
 Excessive anxiety, Poor concentration or mind going blank.
Physical symptoms
 Restlessness, Fatigue, Sleep disturbance, Irritability
Social Anxiety Disorder
Some feared situations
 Eating or writing in front of others, Interacting with authority
figures, Speaking in public,
Physical symptoms
 Diarrhea, Sweating, Tachycardia
Posttraumatic stress disorder:
 Decreased concentration
 Insomnia

6. DIAGNOSIS:
 Physical and mental status examination.
 Patients with GAD have irritable bowel syndrome.
 Anxiety symptoms may associated with medical illness
Cardiovascular
Respiratory system
 Anxiety symptoms may psychiatric illnesses
mood disorders
Schizophrenia

7. Non drug Treatment:
 Short –term counseling
 Stress management
 exercise

8. Drug management:
Benzodiazepines - Diazepam - 2-40 mg/day
Oxazepam - 30-120mg/day
Lorazepam - 0.5-10 mg/day
Azapirones - Buspirone - 15-60 mg/day
Gepirone
Antihistamines - Hydroxyzine 200-400mg/day
β blocker - propranolol

9. MECANISM OF ACTION

10. Pharmacological Treatment for Generalized Anxiety Disorder

11. Pharmacological Treatment for Social Anxiety Disorder

12. Pharmacological Treatment of Post Trauma Stress Disorder

13. Adverse effect:
Benzodiazepines: sedation, vertigo , increased appetite weight gain.
Azapirone: dizziness,nausea,headache.
Antihistamines: confusion,nausea, constipation.
β- blockers - bradycardia,wheezing
Drug intractions:
BZs : The combination of BZs with alcohol or other CNS depressants
may be fatal.
Antacids - decreased rate of benzodiazepine absorption
β blocker :combination with cimitidine increase metabolism of propranolol.

14. THANK YOU