Lecture for medical students

2. Anxiety…
• Is it a normal emotion?
• Reaction to stress/ threat events
• Physical symptoms of anxiety?
– Tremor
– Sweating
– Palpitations
– …
• Mental symptoms of anxiety?
– Worry
– Can’t relax
– Easily startled
– ..

8. • Anxiety: the phenotype.
• Anxiety can be
deconstructed, or broken
down, into the two core
symptoms of fear and
worry.
• These symptoms are
present in all anxiety
disorders, although what
triggers them may differ
from one disorder to the
next.

9. Aetiology?
• Often due to an interaction of biological and
psychosocial factors:
• Genetic vulnerability + past trauma + current
stress…
• In the CNS: anxiety is medicated by NT
serotonin and noradrenaline
• Peripherally, the symptoms of anxiety are
medicated by the autonomic nervous system
(esp sympathetic system)

10. • When does anxiety become a disorder?
• Types of anxiety disorders?
– Specific phobias
– Social phobia
– Panic disorder
– Generalized anxiety disorder
– Obsessive compulsive disorder
– ….and others.

11. Diagnostic criteria ICD-10
• F40 Phobic anxiety disorders
• F40.0 Agoraphobia
• .00 Without panic disorder
• .01 With panic disorder
• F40.1 Social phobias
• F40.2 Specific (isolated) phobias
• F40.8 Other phobic anxiety disorders
• F40.9 Phobic anxiety disorder, unspecified

12. • F41 Other anxiety disorders
• F41.0 Panic disorder [episodic paroxysmal anxiety]
• .00 Moderate
• .01 Severe
• F41.1 Generalized anxiety disorder
• F41.2 Mixed anxiety and depressive disorder
• F41.3 Other mixed anxiety disorders
• F41.8 Other specified anxiety disorders
• F41.9 Anxiety disorder, unspecified

14. Specific phobias…
• A strong, irrational fear of something that
poses little or no actual danger.

15. ICD diagnostic criteria for specific phobia…
• The psychological or autonomic symptoms
must be due to anxiety
(not secondary to other symptoms such as
delusions or obsessions)
• The anxiety must be restricted to the presence
of the particular object or situation
• Phobic situation is avoided whenever possible

16. Social phobia
• “In any social situation, I feel fear.
…..I feel anxious before I even leave the house,
and it becomes worse as I get closer to a class,
a party, or whatever. I feel sick in my stomach-
it almost felt like I had the flu. My heart
pounds, my palms get sweaty.”

17. ICD criteria to diagnose social phobia…
• All the symptoms are primarily due to anxiety
• The anxiety is restricted to (or mostly seen in)
particular social situations
• These social situations are avoided as far as
possible

18. Panic disorder
• “For me, a panic attack is almost a violent
experience. I feel like I’m losing control. My heart
pounds really hard, I feel like I can’t get my breath,
and there’s an overwhelming feeling that things are
crashing in on me.
• ….It started 10 years ago. I was sitting in my room
and this thing came out of the blue. I felt like I was
dying.
• ….In between attacks there is this dread and anxiety
that it’s going to happen again. I’m afraid to go back
to places where I’ve had an attack”.

19. Panic disorder…diagnosis:
1. Several ‘attacks’ of anxiety should have
occurred during one month
2. The panic attacks occur when there is no
objective danger
3. Not confined to any particular situation
4. In-between attacks, there is comparative
freedom from anxiety (though pt often has
anticipatory anxiety

20. OCD- diagnostic criteria
1. Obsessional thoughts or compulsive acts
2. for at least 2 weeks
3. Symptoms cause distress or interfere with activities
4. The obsessional thoughts are
i. Recognized to be the person’s own thoughts or impulses
ii. At least one thought or impulse must be resisted
iii. The thought of carrying out the act itself must not be
pleasurable
iv. The thoughts, images or impulses are unpleasantly
repetitive

21. Obsessive compulsive disorder
“Getting dressed in the morning was tough, because I
had a long routine. If I didn’t follow the routine, I’d
get anxious and would have to get dressed again. I
worried that if I didn’t follow the routine, my parents
were going to die.
This was completely irrational, but the thoughts caused
me lots of anxiety.
Because of the time I spent on rituals, I was unable to
do a lot of things that were important to me.”
Males = females
Onset: often childhood or early adult life

22. Management of anxiety disorders- overview
• Often best management:
Combination of medication
+
Psychological therapy

23. Medication used for anxiety?
• Anxiolytics: usually medication that increases
serotonin levels
E.g. SSRI
Some TCAs, e.g.Clomipramine
Venlafaxine

24. Psychological therapies for anxiety disorders…
• Different types of therapies for different
disorders
• Basic relaxation strategies maybe helpful in
general e.g.
– Deep breathing
– Progressive muscle relaxation
• More specific therapies:
– OCD: Cognitive behaviour therapy
– Behaviour therapy