anxiety related disorders

ANXIETY DISORDERS

The most common types of psychiatric disorders Diagnosed when anxiety no longer functions as a signal of danger or a motivation for needed change but becomes chronic and affects major portions of the persons life, resulting in maladaptive behaviors and emotional disability

 Anxiety

is the key feature of each anxiety disorders

ETIOLOGY

Biological;
Genetics;

OCD, GAD, Panic disorders and phobia are inherited Neurotransmitters; GABA decrease (GABA reduces cell excitability

Psychological;
Cognitive

theory; result of conditioning perceived danger/ fear inducing events/stressful events anxiety

 Psychoanalytical

; id vs. s.ego Behavioral; product of frustrations caused by anything that interferes with attaining a desired goal unrealistic goals feeling of failure, insignificance, anxiety

Social ;
Interpersonal

; problems with interpersonal relationship, loss of a love, valued person first anxiety; mother and infant

GENERALIZED ANXIETY DISORDERS

Characterized by excessive anxiety and worry occurring on most days for at least 6 mos. Exact cause is unknown 3/6 ReDFIMS

REstlessnes Difficulty concentration Fatigue Irritability

Muscle tension Sleep disturbance

 Experiences

chronic feelings of nervousness and apprehension for no apparent reason and is unable to control worry

PANIC DISORDERS

Characterized by recurrent , unexpected panic attacks followed by a month or more of worry about having additional attacks Client may worry about the possible complications of the attacks , or have a significant behavioral changes associated with the attacks

Have panic attacks without warning, sometimes attacks are associated with a stressor and sometimes they are not Panic attacks can occur anytime, even at during sleep. An attack usually peaks in severity within 10 minutes or longer, rarely last than 30 minutes

During the attack, patient may fear hes dying, going crazy or losing control of his emotions or behaviors Panic attacks- characterized by discrete period of intense apprehension or terror without any real accompanying danger Maybe with or without agoraphobia

Panic disorder with agoraphobia; meets the criteria of panic disorder + presence of agoraphobia (anxiety about places or situations from which escape might be difficult or embarrassing or in the event of panic attack avoid going out

PHOBIC DISORDERS

Characterized by irrational fear of an object, person or situation accompanied by avoidance of the object, person or situation Always anticipated and never unexpectedly unlike panic disorders Exact cause is unknown occur

TYPES OF PHOBIC DISORDERS

Agoraphobia; characterized by marked fear of being alone or in a public place from which escape would be difficult or help would be unavailable in the event of being disabled Individual may not leave home, too fearful to leave safe zone Most disabling of all the phobias Usually occurs in patients with a history of panic disorders

Social phobia; or social anxiety disorders Characterized by a marked and persistent fear of social or performance situations in which embarrassment may occur May take many forms such as meeting new people, attending social gathering, talking to people in the authority, stage fright, fear of public speaking , using public bathrooms, eating in public and being observed at work

Specific phobia/ simple phobia; characterized by marked and persistent and excessive or unreasonable fear when in the presence of, or when anticipating an encounter with a specific object or situation

An individual may have multiple specific phobias

Types
Animal

type (animals, birds and insects) Natural environment (heights, water, storms) Blood-injection- injury type; (medical or dental procedure) Situational type; (airplane, elevator) Other types; (choking, loud noise etc.)

OBSESSIVE COMPULSIVE DISORDERS

Characterized by recurrent obsessions or compulsions that are time consuming or caused significant impairment ( daily occupational, academic or personal functioning) or distress Obsessions; are recurrent and intrusive thoughts , impulses and images that caused marked distress, produce anxiety

Compulsions; are repetitive behaviors or mental acts that the affected person feels driven to perform in response to obsessive thoughts , reduces anxiety Common obsessions; dirt, germs, numbers, symmetry and order, losing things, fear of disasters, sexual concerns Common compulsion; checking, counting, cleaning, collecting, chanting, completing

STRESS DISORDERS
Consists of acute stress disorder, acute post traumatic stress disorders, chronic PTSD, delayed PTSD They are all similar in that they result from exposure to a severe or extraordinary stressor (natural , accidental human-made , intentional human-made disasters). They differ in terms of timing , duration and degree of impairment

ACUTE STRESS DISORDERS

Characterized by the development of anxiety, dissociation, and other symptoms within 1 month of exposure to an extremely traumatic stressor, it lasts 2 days to 4 weeks major precipitant is exposure to trauma Can be diagnosed as PTSD if symptoms last longer

Hallmark symptom is dissociation (defense mechanism in which patient separates anxiety provoking thoughts and emotions from the rest of psyche, view on world as a dream or unreal.

POST TRAUMATIC STRESS DISORDERS

Characterized by persistent , recurrent images and memories of a serious traumatic event that a person has either experienced or witnessed, impairing her/his ability to function Traumatic events include wartime combat, natural disasters, rapes, accidents and acts of violence

May involve flashbacks (reliving the event), nightmares about event-long with avoidance of reminders Survivors often describes painful guilt feeling (survivors guilt) about surviving when others did not, or about the things they had to do to survive

 Types:

Acute;

symptoms -less than 3 months after the event Chronic- 3 months or more Delayed- 6 months after the event

DISSOCIATIVE DISORDERS

alteration in conscious awareness, includes period of forgetfulness, memory loss for past stressful events. It affects the fundamental aspects of consciousness, memory, identity, self perception and perception of the environment (patients surroundings)

often associated with the exposure to a traumatic event The disturbance may be sudden or gradual, transient or chronic Trauma/abuse at the conscious level repress anxiety decrease But if repression fails dissociation

Dissociative amnesia Formerly known as psychogenic amnesia Essential feature is inability to recall important personal information (even basic autobiographical information) usually traumatic/ stressful nature Most common of the dissociative disorders

Unlike other types of amnesia, dissociative amnesia doesnt result from an organic disorder (such as stroke) or physical trauma (such as closed head injury)

Types: Localized amnesia- the most common form, the inability to recall all incidents associated with the traumatic event for a specific time following the event (usually a few hours to a few days)

Selective amnesia- can recall only selective parts of events

Continuous amnesia- inability to recall events occurring after a specific time up to and including the present Generalized amnesia- least common form, failure to recall ones entire life Systematized amnesia-loss of memory for specific categories of information, such as all memories related to ones occupation, or all memories that are related to ones family

Dissociative fugue characterized by a sudden unexpected travel to a far away place accompanied by an inability to recall ones past and identity confusion drifts from one place to another Often the patient forms a new identity during dissociative fugue

Depersonalization disorder Characterized by persistent or recurrent feeling of being detached from the persons own mental process or body During period of depersonalization, the patients self awareness is altered or temporary lost. Feeling like a robot or feeling as though one is in a dream or movie

Dissociative Identity Disorder Formerly known as multiple personality disorder Considers as the most severe type of dissociative disorder Characterized by 2 or more distinct personalities within an individual, each personality taking full control of the persons behavior at a given time

Each identity may exhibit unique behavior patterns, memories and social relationship The transition from one personality to another is triggered by stress, usually occurs suddenly (within seconds- minutes), can take hours or days Primary personality may be unaware of subpersonalities/alternative personality Often primary personality is religious and moralistic, but the subpersonalities are different; aggressive , pleasure seeking, sexually promiscuous

SOMATOFORM DISORDERS
Is the diagnosis given to individuals who present with symptoms suggesting a physical disorder without organic cause or physiologic mechanism (roots are psychological rather than physiological) Characterized by primary gain(anxiety relief) and secondary gains (special attention, relief from responsibilities

Some have coexisting disorders; like panic attacks or agoraphobia (common with somatization disorder), depression (common with pain disorder), OCD (common with body dysmorphic disorder) patients repeatedly seek medical diagnosis and treatment (even though they have been told that there is no known physiological/organic evidence to explain their symptoms or disability) instead of mental health professionals

TYPES OF SOMATOFORM DISORDERS

Somatization/ Briquets syndrome/ hysteria Characterized by multiple and often vague physical symptoms associated with psychosocial distress that suggest a physical disorder but have no physical basis

Physical complaints over several years, resulting in treatment being sought or impairment in functioning (occupational, social, others), individual may become extremely dependent in relationship

Symptoms are identified as pain ( at least four different sites), gastro intestinal symptoms (nausea and vomiting , diarrhea), sexual symptoms (irregular menses, erectile or ejaculatory dysfunction) and symptoms suggestive of a neurological condition (paralysis, blindness, deafness)

Pain disorder Essential feature is severe and prolonged pain that causes clinically significant distress or impairment in social, occupational or other important areas of functioning Pain is severe enough to warrant medical attention and becomes the patients main focus of attention

Pain involving part of the body; mostly at the back, head, abdomen or chest Location or complaint of the pain does not change, unlike the complaints of a client with somatization disorder

Hypochondriasis Preoccupation with fear of having, or the idea that one has a serious disease, includes misinterpretations of bodily symptoms, preoccupation persists despite medical evaluation and reassurance Preoccupied by disease conviction (fear that one has a serious disease) and disease phobia(fear of getting a serious disease)

Hypervigilance or hypersensitivity of the body and its sensation leads to misinterpretation and overreact to physical signs and symptoms E.g pimple skin cancer They often seek medical care from numerous sources, when they do not obtain satisfaction from one provider (doctor-shopping)

Conversion disorder One or more symptoms are deficit affecting voluntary motor(paralysis, seizure) or sensory function (blindness, deafness) that suggest a neurologic or general medical condition The most common somatoform disorder in children and adolescents and young adults

Key feature is la belle indifference (client has a little or no concern or anxiety about the distressing disorder)

Body dysmorphic disorder/ dysmorphophobia Characterized by the exaggerated belief that the body is deformed or defective in some specific way Most common complaints involved imagined or slight flaws of the face or head, such as thinning hair, acne, wrinkles, scars, vascular markings , facial swelling or asymmetry or excessive facial hair

Often use avoidance to cope up with their perceived defect/s. Which may lead to social isolation Consults cosmetic specialists

PSYCHOSOMATIC DISORDER
Psychosomatic or psychophysiological disorder Responses to anxiety are those in which it has been determined that psychological factors contribute to the initiation or exacerbation of physical symptom E.g asthma, cancer, ulcers, coronary heart disease

MALINGERING
Production of false or grossly exaggerated physical or psychological symptoms that are consciously motivated by external incentives to avoid unpleasant situation (e.g avoiding work, obtaining financial compensation, evading criminal persecution) Recurrent headaches and low back pains are frequently chosen as chief complain because it is difficult to disprove

FACTITIOUS DISORDER

Consciously motivated production or feigning of physical or psychological symptoms to assume sick role Emotional care and attention comes with playing the role of the patient May even inflict injury on themselves to receive attention

Although uncommon, they occur most often in people who are in or familiar with medical professions such as nurses, physicians ,medical technicians

Munchausen syndrome by proxy

Usually involves another person, usually the mother, who inflicts illness or injuries on her child to gain attention of the healthcare provider through her childs injury or to become a hero

The most common reasons these parents seek medical attention are for bleeding , seizures, apnea, diarrhea, vomiting, fever and rash It is a form of child (physical) abuse, and the child must be protected