Chapter -9

Anxiety disorder

Definition

Anxiety is a universal human characteristic involving tension apprehension or even terror

Service as an adaptive mechanism to warn about an external threat by activation the sympathetic nervous system (fight or flight)

Manifestation of anxiety can be described through

Physiology : main brain structure involved in the amygdala (fear condition)

Neurotransmitters involved include 5-HT cholecystokinin

Cpinephrine norepinephrine da

Physiology- once perception of a given situation is distort which causes one to believe it is threatening in some way

Behavior : once felling threaten one response by escaping or facing the situation thereby causing a disruption in daily functioning

Anxiety become pathological when:

fear is generally out of proportion to risk/severity of threat

Response continued beyond existence of threat or becomes generalized to other similar or dissimmilar situation

Social or occupational functioning is impaired

Medical workup of anxiety disorder

Medical workup of anxiety disorder

Routine screering : physical examination CBC, thyroid function test, electrolytes, urinalsis, urine drug screening

Additional screening : neurological consultant, chest x-ray ECG,CT

In generalized anxiety disorder, anxiety is continuous , although it may fluctuate in intensity.

In phobic anxiety disorders, anxiety is intermittent, arising in particular circumstances.

In panic disorder, anxiety is intermittent , but its occurrence is unrelated to any particular circumstances.

Classification Anxiety disorder

Agoraphobia

Without a history of panic disorder

Panic disorder with agoraphobia

Social phobia

Specific phobia

Panic disorder without agoraphobia

Generalized anxiety disorder

Symptoms of anxiety

Psychological arousal

Fearful anticipation

Irritability

Sensitivity to noise

Restlessness

Poor concentration

Worrying thoughts

Autonomic arousal

Gastrointestinal

* Dry mouth

* Difficulty in swallowing

* Epigastric discomfort

* Excessive wind

* Frequent or loose motion

Respiratory

*Constriction in the chest

* Difficulty inhaling

Cardiovascular

* Palpitation

* Discomfort in the chest

* Awareness of missed beats

Genitourinary

*Frequent or urgent micturation

*Failure of erection

*Menstrual discomfort

Muscle tension

Tremor

Headache

Aching muscle

Hyperventilation

Dizziness

Tingling in the extremities

Feeling of breathlessness

Sleep disturbance

Insomnia

Night terror

The End