Anxiety Disorders

Fear: apprehension about what is known, usually rational

Anxiety: apprehension about unknown, irrational or excessive

Anxiety can be normal or clinical

• -hyperthyroid
• -hypoglycemia
• -Cushings
• -Anemia
• -electrolyte imbalance
• -Mitral Valve Prolapse
• -cardiac arrhythmias

• Withdrawal from CNS depressants
• -alcohol
• -sedative hypnotics
• -antianxiety drugs

• CNS stimulant intoxication:
• -Amphetamines
• -Cocaine
• -Methylphenidate
• -Weight reducers

1. Adjustment disorder with anxious features (normal after a stress)

2. Acute stress disorder

3. Generalized anxiety disorder

4. Agoraphobia

5. Panic Disorder (+/- agoraphobia)

6. Phobic Disorders (specific phobias, social phobias)

7. PTSD

8. OCD

• -lifetime prevalence 3%
• -1-2% annually with sx
• -women > men
• -onset by 30 years

-may fluctuate in severity but rarely disappear

-not a prodrome

-secondary depression is common

excessive anxiety and worry for more days than not for at least 6 months w/ 3+ of the following:

• -restlessness
• -increased fatigue
• -decreased concentration
• -irritability
• -muscle tension
• -sleep distrubance

-anxiety about being in places or situations from which escape might be difficult or embarassing (outside home, crowd, line etc)

-avoids these situations

• Recurrent unexpectant panic attacks followed by 1+ month of:
• -concern of another attack
• -worry about consequences
• -behaviour changes

• Discrete period of intense fear or discomfort
• -develop abruptly and peak within 10 minutes
• -comes on with a stressor
• with 4+ of the following:

• -palpitations
• -sweating
• -trembling
• -SOB
• -chest pain
• -nausea
• -dizzy
• -numbness or tingling
• -chills or hot flushes

-marked and persistent fear of scrutiny

-exposure to feared social situation provokes anxiety

-recognize that fear is unreasonable

• 1. Generalized (3% of pop)
• 2. Public Speaking (10% of pop)

-exposed to traumatic event (threatened death or serious injury)

-Reexperience: thoughts, dreams, recurring, cues

-Avoid Stimuli

-Persistent sx of increased arousal

-duration > 1 month

• Obsessions:
• -persistent thoughts, impulses
• -have insight
• -attempt to ignore but can't
• -cause anxiety

• Compulsions:
• -repetitive behaviours pt feels they need to perform in response to an obsession
• -rituals to reduce anxiety

• 1. rule out secondary causes
• 2. diganose major anxiety disorder
• 3. CBT
• 4. Relaxation, meditation, exercise
• 5. Behaviour therapies
•      -Desensitization (phobia)
•      -Forced immersion (phobia)
•      -Thought-stopping (OCD)

• 1. Antidepressants
•       -SSRIs (may increase anxiety in the first wks)
•      -response in 2-3 weeks
•      -decrease panic and anxiety
•      -sx reappear when drug is stopped

2. beta blockers

3. Benzos (not usually good)