Psychiatry 精神病学 Wang Keqin Jining Medical College Jining Medical Colleg
Chapter 4.Anxiety Disorders PD Frequent. Spontaneous Attacks Avoidance GAD PTSD Thoughts Panic Attack Constant worry Physical Event Shortness of Breath. Choking.Chest Pain. Symptoms Nausea,Dizziness,Unreality. Fear of Loss of Control, Fear of Dying.Paresthesias. Hot or Cold Flashes SP OCD Embarrassment & Repetitve Humiliation Thoughts in Social & Situations Behaviors PD-Panic Disorder,GAD-Generalized Anxiety Disorder, CD-bsessive-Compulsive Disordor SP-Socialob PTSD-Post-traumatic Stress Disorder
1.Introduction 1.1 Nature of Anxiety and Fear ■Anxiety Future-oriented mood state Characterized by marked negative affect Somatic symptoms of tension Apprehension about future danger or misfortune ■Fear Present-oriented mood state,marked negative affect Immediate fight or flight response to danger or threat Strong avoidance/escapist tendencies Abrupt activation of the sympathetic nervous system Anxiety and Fear are Normal Emotional States Jining Medical College
Peripheral Manifestations of Anxiety Diarrhea Dizziness,light-headedness Hyperhidrosis Hyperreflexia Hypertension Palpitations Pupillary mydriasis Restlessness (e.g.,pacing) Syncope Tachycardia Tingling in the extremities Tremors Upset stomach("butterflies") Urinary frequency,hesitancy,urgency Copyright2007 Wolters Kluwer Health|Lippincott Williams&Wilkins
Headache 1.2 Anxiety disorders Insomnia Apprehension Dizzyness Dread Fainting Fear Worry Dry mouth Panic Anxiety disorders are Irritability abnormal states in which the Palpitations most striking features are Chest pain Breathlessness mental and physical Diarrhoea. Urinary symptoms of anxiety, Afrequency occurring in the absence of organic brain disease or Sweating another psychiatric disorder. I remor Muscular pain Pins and Muscle tension Involve excessive avoidance needles Restlessness and escapist tendencies Causes clinically significant distress and impairment Jining Me Fig.2 Symptoms of anxiety
1.3 Approximate lifetime prevalence,gender ratio. and common comorbidities for the major anxiety disorders Disorder Prevalence Females:Males Comorbidity Panic disorder 2%4% 2+:1 Depression,other anxiety disorders Generalized anxiety disorder 5%-7% Overall,90%;50%-60%for major depression or other anxiety disorder Social phobia 13%-16% 1+:1 Twofold risk for alcohol dependence,three- to sixfold risk of mood disorders Specific phobias 10% 21 Depression and somatoform disorders Agoraphobia 6% 21 Obsessive-compulsive disorder 2%-3% Anxiety,depression,tics,hypochondriasis, eating disorder,body dysmorphic disorder(childhood-onset more common in males) Posttraumatic stress disorder 7%-9% 2:1 Depression,obsessive-compulsive disorder,panic,phobias Jining Medical College
1.4 Pharmacotherapy for Anxiety disorders Table30.1 The Efficacy of Psychotropic Medications for the Treatment of Anxiety Disorders Generalized Social Anxiety Post traumatic Anxiety Disorder Disorder Panic Disorder Stress Disorder Strong evidence SSRIs SSRIs SSRIs SSRIs Venlafaxine Bupropion-SR Venlafaxine TCAs MAOIs Trazodone MAOIs TCAs Benzodiazepines MAOIs Benzodiazepines TCAs Buspirone Benzodiazepines Some evidence Nefazodone Venlafaxine Mirtazepine Venlafaxine Mirtazapine Nefazodone Nefazodone Lamotrigine Clonazepam Valproate sertraline Nefazodone Gabapentin Buspirone adjunct to Mirtazapine benzodiazepine Clonidine Valproic acid Gabapentin Tiagabine
1.5 Psychotherapy for Anxiety disorders Psychotherapy (attempts to change) Interpersona Disturbed Disturbed Disturbed and life Biomedical thoughts emotions behaviors situation disturbances difficulties Jining Medical College
2.Panic disorder and agoraphobia
2.1 What Is a Panic Attack? Abrupt experience of intense fear or discomfort Accompanied by several physical symptoms DSM-IV Subtypes of Panic Attacks Situationally bound(cued)panic Unexpected (uncued)panic Situationally predisposed panic ■Facts and Statistics Panic disorder affects about 3.5%of the population Two thirds with panic disorder are female Onset is often acute,beginning between ages 25 -29 .Situationally bound:always occurring in the same situation,which may lead to extreme avoidance of triggering persons,places,or events(see specific and social phobias) Unexpected:can lead to extreme avoidance of any situation or place felt to be unsafe(agoraphobia) .Situationally predisposed:attacks may or may not occur in specific situations(between situationally