2. Neurotic , Stress related &
Somatoform disorders
1. Phobic anxiety disorder
2. Other anxiety disorder
3. Obsessive compulsive disorder
3. Phobic disorder
• “ Irrational fear of a specific object, situation or activity,
often leading to persistent avoidance of the feared object,
situation or activity.”
1. Agoraphobia
2. Social phobia
3. Specific (Simple) phobia
4. ANXIETY
• “ A diffuse unpleasant vague sense of apprehension often
accompanied by autonomic symptoms usually caused by
anticipation of danger”
• Anxiety is a response to a threat that is unknown,
internal, vague or conflictual.
• Fear is response to a known, external , definite or non
conflictual threat.
• Cognitive behavioural view: anxiety is a conditioned
response.
5. 1. Trait anxiety
2. State anxiety
• Trait: Habitual tendency to be anxious in general and is
exemplified by “ I often feel anxious”
• State: Anxiety felt at present, and is exemplified by “ I
feel anxious now”
• Persons with trait anxiety often have episodes of state
anxiety.
7. Psychodynamic theory
• Signal anxiety – internal psychological equilibrium
• Signal anxiety Defensive action
• In anxiety repression fails to function adequately but
secondary mechanisms are not activated, hence anxiety
comes to forefront unopposed.
Repression
(primary)
Secondary defense
mechanism
(conversion, isolation)
8. • Developmentally primitive anxiety is manifested as
somatic symptomatology while developmentally advanced
anxiety is signal anxiety.
• According to this theory panic anxiety – closely related to
separation anxiety of childhood
9. Behavioural theory
• According to this theory : Anxiety – unconditioned
inherent response of the organism to painful or
dangerous stimuli.
10. Cognitive behavioural theory(CBT)
• According to CBT:
• In anxiety disorders there is evidence of selective
information processing (with more attention paid to
threat related information )
• Cognitive distortions
• Negative automatic thoughts
• Perception of decreased control over both internal and
external stimuli.
11. Biological theory
• Genetic evidence: 15- 20% 1st degree relative.
• Concordance rate in monozygotic twins of patients with
panic disorders is as high as 80%.
• Chemically induced anxiety states:
• Infusion of chemicals( Na lactate, isoproterenol, caffeine)
• Inhalation of 5% CO2 can produce panic episodes in
predisposed individuals.
12. • GABA- BZD receptors:
• 2 types: Type I – GABA and chloride independent
• Type II - GABA and chloride dependent
• BZD facilitates GABA transmission causing generalised
effect on CNS – relieves anxiety
• BZD antagonist(flumazenil) and inverse agonist (beta
carbolines) cause anxiety – supports this hypothesis
14. • Organic anxiety disorder:
• Presence of anxiety secondary to various medical
disorders – hyperthyroidism, pheochromocytoma, CAD
15. Symptoms
Physical Symptoms Psychological Symptoms
A. Motoric Symptoms: tremors,
restlessness, muscle twitches
A. Cognitive Symptoms: poor
concentration, distractibility
B. Perceptual Symptoms:
derealisation, depersonalisation
B. Autonomic and Visceral symptoms:
Palpitations, tachycardia, sweating,
flushing, hyperventilation, diarrhoea
C. Affective Symptoms: diffuse,
unpleasant, and vague sense of
apprehension.
D. Other symptoms: insomnia,
increased sensitivity to noise.
17. Panic disorder
• “ Presence of recurrent and unpredictable panic attacks,
which are distinct episodes of intense fear and discomfort
associated with variety of physical symptoms including
• Palpitations or rapid heart rate,
• Breathlessness
• Feeling unsteady, dizzy, light-headed or faint
• Trembling or shaking
• Sweating
18. •Having a hot flush or chills
• Chest pain or discomfort
• Numbness or tingling sensations
• Feeling as if you or surroundings are unreal
• Nausea or burning stomach
• Choking
• Fear of dying
• Fear of losing control or going crazy
• At least 4 panic attacks over 4 weeks for diagnosis.
19. • Onset usually in early third decade with often c/c course
• Sudden onset developing within 10 min, resolving within
1 hour.
• Frequency and severity of panic attacks vary ranging
from once a week to clusters separated by months of well-
being.
• D/D: Cardio respiratory disorders, Pheochromocytoma,
Hypoglycemia.
• Life time prevalence: 1.5-2% with 3-4% sub syndromal
panic symptoms
• Panic disorders and Agoraphobia often co exist
20. Agoraphobia
• Marked and consistently manifest fear of crowds, public
places, travelling alone, travelling away from home
• Avoidance of these phobic situation is important
symptom.
• Symptoms of anxiety in the feared situation including
autonomic arousal, difficulty in breathing, choking,
abdominal discomfort, dizziness, fear of losing
control/dying.
23. • SSRI benefit majority of panic disorders and do not have
adverse effects of TCA.
• Drugs should be started 1/3 rd of their usual
antidepressant dose.
• MAOIs effective in patients with atypical depression –
(hypersomnia and weight gain)
• Because of anticipatory anxiety and need for immediate
relief of panic symptoms BZD are useful early in course of
treatment.
