An Introduction to Anxiety Disorders

Transcription

1 An Introduction to Anxiety Disorders LPT Gondar Mental Health Group

2 Discussion What is fear?- how is it helpful- when does it become unhelpful? What is anxiety- how is it helpful

3 What is anxiety Apprehension, tension or uneasiness which stems from the anticipation of danger, the source of which is largely unknown or unrecognised. (American Psychiatric Association 1975) An unpleasant emotional state or condition which is characterised by subjective feelings of tension, apprehension and worry and by activation or arousal of the autonomic nervous system. (Speilberger 1972)

4 Anxiety Vs Anxiety Disorders Anxiety is a normal human response to many everyday situations. Mild anxiety often improves performance and is adaptive. Anxiety disorders are more intense, last longer and may lead to problems that interfere with everyday life. Anxiety disorders are characterised by anticipation of and preparation for negative outcomes of future events ie danger and threat to self.

5 Anxiety Disorders Anxiety disorders occur because people believe situations to be more dangerous than they really are (over-estimate likelihood that feared event will occur, under-estimate ability to cope with that event). Good clinicians help patients to consider alternative, less threatening explanations of their problem.

6 Anxiety as a Normal and an Abnormal Response Some amount of anxiety is normal and is associated with optimal levels of functioning. Only when anxiety begins to interfere with social or occupational functioning is it considered abnormal.

7 The Fear and Anxiety Response Patterns Fear Panic Anxiety Anxiety Disorder

8 An Important Law- The Yerkes Dodson Law

9 Another Bell Curve-

10 Three Components of Anxiety Physical symptoms Cognitive component Behavioral component

11 Physiology of Anxiety: Physical System Perceived danger Brain sends message to autonomic nervous system Sympathetic nervous system is activated (all or none phenomena) Sympathetic nervous system is the fight/flight system Sympathetic nervous system releases adrenaline and noradrenalin (from adrenal glands on the kidneys). These chemicals are messengers to continue activity

12 Parasympathetic system Built in counter-acting mechanism for the sympathetic nervous system Restores a realized feeling Adrenalin and noradrenalin take time to destroy

13 Cardiovasular Effects Increase in heart rate and strength of heartbeat to speed up blood flow Blood is redirected from places it is not needed (skin, fingers and toes) to places where it is more needed (large muscle groups like thighs and biceps) Respiratory Effects-increase in speed and dept of breathing Sweat Gland Effects-increased sweating

14 Behavioral System Fight/flight response prepares the body for action-to attack or run When not possible behaviors such as foot tapping, pacing, or snapping at people

15 Cognitive System Shift in attention to search surroundings for potential threat Can t concentrate on daily tasks Anxious people complain that they are easily distracted from daily chores, cannot concentrate, and have trouble with memory

16 Locus Ceruleus: It receives signals from the amygdala and is responsible for initiating many of the classic anxiety responses: rapid heartbeat, increased blood pressure, sweating and pupil dilation. Hippocampus: This is the memory centre, vital to storing the raw information coming in from the senses along with the emotional baggage attached to the data during their trip through the amygdala.

17 DIAGNOSIS DSM-II Anxiety neurosis DSM-III- panic disorder, agoraphobia, other phobias DSM-IV included the above and generalised anxiety disorder, social phobia and anxiety disorder secondary to substance misuse and general medical disorders Advantages of this classification enables research Disadvantage is the extent of co morbidity

18 DSM IV Anxiety disorders Panic disorder With agoraphobia Without agoraphobia Agoraphobia without panic Social phobia Specific phobia Animal Natural environment Blood, Injection, Injury Situational Other Obsessive compulsive disorder Post-traumatic stress disorder Acute stress disorder Generalised anxiety disorder

19 ICD 10 F40 Phobic Anxiety Disorders F40.0 Agoraphobia Without panic disorder With panic disorder F40.1 Social phobia F40.2 Specific (isolated) phobias F40.8 Other phobic anxiety disorders F40.9 Phobic anxiety disorder, unspecified F41 Other Anxiety Disorders F41.0 Panic disorder (episodic paroxysmal anxiety) F41.1 Generalised anxiety disorder F41.2 Mixed anxiety and depressive disorder F41.8 Other specified anxiety disorders F41.9 Anxiety disorder, unspecified

20 Dimensions of anxiety The positive dimension- symptoms of anxiety The negative dimension- avoidance

21 Epidemiology Anxiety disorders have been shown to be chronic disabling and costly in both low income and high income countries Often under diagnosed and under treated Most prevalent of psychiatric disorders in USA. More common in women In primary care generalised anxiety disorder most common and is associated with particularly high medical system use.

22 Epidemiology In one study OCD was found to be tenth most disabling of all disorders Affect functioning in academic and occupational functioning and negatively affects relationships with family and friends One third of costs of psychiatric disorders

23 Pathogenesis Fear conditioning- the amygdala in brain and its inputs and outputs play a crucial role in fear development and responses to fear Hippocampus appears to play an important role in remembering the context in which fear conditioning has taken place

24 Pathogenesis- many theories Early work focused on noradrenergic system Focus also on serotonin receptors Faster acting excitatory and inhibitory systems such as glutamate and GABA- as evidenced by anxiolytic effects of benzodiazepines Data are increasing on the genetics of fear conditioning

25 Pathogenesis Nature and nurture important in causes of anxiety E.g. Early trauma has an impact on neurocircuitry, neurochemistry and neuroendocrinology

26 Evolutionary bases for anxiety The first emphasises the role of anxiety as a normal defence that promotes survival Certain types of anxiety may be seen as defects- e.g. The type of anxiety associated with PTSD

27 Management Early psychotherapeutic interventions were based on psychodynamic theory and relied on theories of unconscious Benzodiazepines advanced pharmacological therapies More recent advancements in cognitive and behavioural techniques Book page 9 Table 1-1

28 Behavioral and Cognitive Therapy Teaches patient to react differently to situations and bodily sensations that trigger anxiety Teaches patient to understand how thinking patterns that contribute to symptoms Patients learn that by changing how they perceive feelings of anxiety, the less likely they are to have them Examples: Hyperventilating, writing down list of top fears and doing one of them once a week, spinning in a chair until dizzy; after awhile patients learned to cope with the negative feelings associated with them and replace them with positive ones

29 Psychodynamic Psychotherapy Psychodynamic therapy is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Psychodynamic Psychotherapy uses the basic assumption that everyone has feelings held in the subconscious which are too painful to be faced. We then come up with defenses (such as denial) to protect us knowing about these painful feelings. Psychodynamic psychotherapy assumes that these defenses have gone wrong and are causing more harm than good, making you seek help. It tries to subdue them, with the intention that once you are aware of what is really going on in your mind the feelings will not be as painful. Takes an extremely long time and is labour intensive

30 Acupuncture Caused by the imbalance of chi coming about by keeping emotions in for too long Emotion effects the chi to move in an abnormal way: when fearful it goes to the floor, when angry the neck and shoulders tighten Redirects the chi into a balanced flow, releases tension in the muscles, increases flow of blood, lymph, and nerve impulses to affected areas Takes weekly sessions

31 Aromatherapy Calming Effect: vanilla, orange blossom, rose, chamomile, and lavender Reducing Stress: Lavender, sandalwood, and nutmeg Uplifting Oils: Bergamot, geranium, juniper, and lavender Essential Oil Combination: 3 parts lavender, 2 parts bergamot, and 1 part sandalwood

32 Exercise Benefits: symbolic meaning of the activity, the distraction from worries, mastery of a sport, effects on self image, biochemical and physiological changes associated with exercise, symbolic meaning of the sport Helps by expelling negative emotions and adrenaline out of your body in order to enter a more relaxed, calm state to deal with issues and conflicts

33 Meditation Cultivates calmness to create a sense of control over life Practice: Sit quietly in a position comfortable to you and take a few deep breaths to relax your muscles, next choose a calming phrase (such as om or that with great significance to you), silently repeat the word or phrase for 20 minutes

34 Nutrition and Diet Therapy Foods to Eat: whole grains, bananas, asparagus, garlic, brown rice, green and leafy veggies, soy products, yogurt Foods to Avoid: coffee, alcohol, sugar, strong spices, highly acidic foods, foods with white flour Keep a diary of the foods you eat and your anxiety attacks; after awhile you may be able to see a correlation East small, frequent meals

35 Vitamins B-Vitamins stabilize the body s lactate levels which cause anxiety attacks (B-6, B-1, B-3) Calcium (a natural tranquilizer) and magnesium relax the nervous system; taken in combination before bed improves sleep Vitamin C taken in large doses also has a tranquilizing effect Potassium helps with proper functioning of adrenal glands Zinc has a calming effect on the nervous system

36 Self Love The most important holistic treatment of all Laugh: be able to laugh at yourself and with others; increases endorphin levels and decreases stress hormones Let go of frustrations Do not judge self harshly: don t expect more from yourself than you do others Accept your faults

37 Provided by The Leicester Gondar Link Collaborative Teaching Project This work is licensed under a Creative Commons Attribution-NonCommercial- NoDerivs 3.0 Unported License.