ANXIETY DISORDERS
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Transcript of ANXIETY DISORDERS
ANXIETY DISORDERS
DEFINITION: Anxiety disorders include a constellation of disorders in which anxiety
and associated symptoms are experienced at level of severity that impairs functioning.
Types of Anxiety Disorder
1.Generalised Anxiety Disorder.2.Social Anxiety Disorder.3.Post Trauma Stress Disorder
PATHOPHYSIOLOGY:
Noradrenergic model :The locus ceruleus may have a role in regulating anxiety, as it activates
norepinephrine (NE) release and stimulates the sympathetic and parasympathetic nervous systems.
Chronic noradrenergic overactivity downregulates
α2 adrenoreceptors in patients with generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD).
Patients with social anxiety disorder (SAD) appear to have a hyperresponsive adrenocortical response to psychological stress.
γ- aminobutyric acid (GABA) receptor model:Anxiety symptoms may be linked to underactivity of GABA systems or
downregulated central BZ receptors. Abnormalities of GABA inhibition may lead to increased response to
stress in PTSD patients.
Serotonin (5-HT) model:
The 5-HT and 5-HT2 antagonist meta-chlorophenylpiperazine (m-CPP) causes increased anxiety in PTSD patients.
Dysregulation of the hypothalamic-pituitary-adrenal axis may be a risk factor for eventual development of PTSD.
Symptoms:Generalized Anxiety disorders:Psychological and congnitive :Excessive anxiety, Poor concentration or mind going blank.
Physical symptomsRestlessness, Fatigue, Sleep disturbance, Irritability
Social Anxiety DisorderSome feared situations Eating or writing in front of others, Interacting with authority figures,
Speaking in public,
Physical symptomsDiarrhea, Sweating, Tachycardia
Posttraumatic stress disorder:Decreased concentration Insomnia
DIAGNOSIS:
Physical and mental status examination.Patients with GAD have irritable bowel syndrome.Anxiety symptoms may associated with medical illness
Cardiovascular
Respiratory systemAnxiety symptoms may psychiatric illnesses
mood disorders
Schizophrenia
Non drug Treatment:
Short –term counseling
Stress management
exercise
Drug management:
Benzodiazepines - Diazepam - 2-40 mg/day
Oxazepam - 30-120mg/day
Lorazepam - 0.5-10 mg/day
Azapirones - Buspirone - 15-60 mg/day
Gepirone
Antihistamines - Hydroxyzine 200-400mg/day
β blocker - propranolol
MECANISM OF ACTION
Pharmacological Treatment for Generalized Anxiety Disorder
Pharmacological Treatment for Social Anxiety Disorder
Pharmacological Treatment of Post Trauma Stress Disorder
Adverse effect:
Benzodiazepines: sedation, vertigo , increased appetite weight gain.
Azapirone: dizziness,nausea,headache.
Antihistamines: confusion,nausea, constipation.
β- blockers - bradycardia,wheezing
Drug intractions:
BZs : The combination of BZs with alcohol or other CNS depressants may be fatal.
Antacids - decreased rate of benzodiazepine absorption
β blocker :combination with cimitidine increase metabolism of propranolol.
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