Anxiety disorders for undergraduates

1. ANXIETY DISORDERS
Dr. Mohamed Abdelghani
M.B.B.Ch., M.Sc., M.D. Psych.

2. Definition
 Anxiety is a pathological state characterized by a
feeling of dread accompanied by somatic signs that
indicate a hyperactive autonomic nervous system.
 It is differentiated from fear, which is a response to a
known and reasonable cause.

3. Aetiology

4. A- Biological
 Excessive autonomic reaction with increased
sympathetic tone, results in increased release of
catecholamines.
 Increased norepinephrine metabolites (3-methoxy 4-
hydroxyphenyl glycol).
 Hyperactivity in locus ceruleus (centre of adrenergic
neurones).
 Decreased GABA causes CNS hyperactivity.

5. B- Learning theory
 Anxiety is produced by frustration or stress. Once
experienced, anxiety becomes a conditioned
response to other, less severe, frustrating or
stressful situation----- “Classical conditioning”.
 Social learning theory: may be learned through
identification and imitation of anxiety patterns in
parents.

6. Clinical subtypes
1) Panic disorder
2) Generalized anxiety disorder.
3) Specific phobia.
4) Social phobia.
5) Obsessive compulsive disorder.
6) Post-trauamtic stress disorder.
7) Substance-induced anxiety disorder.
8) Anxiety disorder due to general medical condition.

7. Obsessive-compulsive disorder (OCD)
 Obsessions:
 Repetitive thoughts, impulses, images or ruminations.
 Resistence to this repetition, which is associated with
increased anxiety.
 Realization that these thoughts, impulses or images are
unreasonable, unpleasant and unwanted.
 Recognition that they are the product of one’s own mind
(not imposed from without as in thought insertion).

8.  Compulsions:
 Repetitive behaviours or mental acts are performed in
response to an obsessions.
 The behaviours or mental acts aim at preventing or
reducing distress.
 They are significantly interfere with the patient’s
functioning.
 Not substance-induced or not due to general medical
conditions.

9. Specific phobia
A. Excessive, unreasonable and persistent fear cued by
the presence of a specific object, e.g.,
 Animal type.
 Natural environment type (e.g., heights, storms, water).
 Blood-injection-injury type.
 Situational type (e.g., airplanes, elevators, closed or opened
places).
B. The person recognizes that the fear is excessive or
unreasonable.
C. The person avoids the feared situation.

10. Social phobia
 Excessive, unreasonable and persistent fear of social
situations.
 Exposure to the feared social situations provokes
anxiety.
 The person recognizes that his fear is excessive and
unreasonable.
 The person avoids the feared situations.

11. Panic disorder
 Definition:
Recurrent unexpected panic attacks, followed
by one month or more of persistent concern
about having additional attacks, and significant
change in behaviour.

12. Panic attack
 Intense fear or discomfort, in which four or more of the
following symptoms developed abruptly and reached a
peak within 10 minutes.
 Palpitaion, sweating, trembling, tachypnea, feeling of
choking, chest pain, nausea, dizziness, derealization
(feelings of unreality), depersonalization (being detached
from oneself), fear of going crazy, fear of dying,
numbness and hot flushes.
 Not substance-induced or not due to general medical
condition.

13. Generalized anxiety disorder (GAD)
 Excessive anxiety and worry for 6 months or more about
activities of daily living.
 The anxiety and worry are associated with three or more of
the following:
 Restlessness, easily fatigued, difficulty concentrating
irritability, muscle tension and sleep disturbance.
 Significant impairement in social , occupational functions.
 Not substance-induced or not due to general medical
condition.

14. Posttraumatic stress disorder (PTSD)
 The person exposed to or witnessed a traumatic event that
involved actual or threatened death or serious injury to self or
others.
 Re-experiencing of the traumatic event in dreams, images or
thoughts.
 Avoidance of thoughts, places, and persons associated with the
trauma.
 Increased arousal; ittitability, difficulty falling asleep, and
hypervigilance.
 Duration of the disturbance is more than one month.
 D.D if the duration less than one month, it is called acute
stress disorder.

15. Treatment

16. Pharmacological-A
Benzodiazepines:
Indications: good short-term treatment for GAD, PTSD,
panic disorder and agoraphobia.
Adverse effects: drowsiness, cognitive impairment and
dependence.
Buspirone
Indication: GAD.
Adverse effects: headache and dizziness.

17. Serotonin specific reuptake inhibitors (SSRI) :
 Indications: all types of anxiety, and depression
comorbid with anxiety.
 Adverse effects: nausea, decreased appetite, sleep
disturbances.

18. B- Psychological
1) Insight-oriented psychotherapy.
2) Cognitive Behavioural therapy ( CBT ).

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