ANXIETY DISORDERS (phobia, GAD, OCD)

 

Anxiety- increased arousal accompanied by generalized feelings of fear or apprehension.

Anxiety disorders- psychological disorders that take several different forms, but which are all related to a generalized feeling of anxiety.

Anxiety- an uneasy, fearful feeling - is the hallmark of many psychological disorders. It is often concealed and reduced by defensive behaviours such as avoidance or ritualistic action. Anxiety disorders are those in which intense, observable anxiety or fear is central to the problem. Among the major anxiety disorders are phobias, generalized anxiety disorder, panic disorder, obsessive- compulsive disorder etc.

Phobic disorders 

Phobic disorder is defined as an irrational fear of a specific object, situation or activity, often leading to persistent avoidance of the feared object, situation or activity. 

Features :

1) presence of the fear of an object, situation, or activity.

2) The fear is out of proportion to the dangerous perceived.

3) Insight is present.

4) patient is unable to control the fear and is very distressed by it.

5) This leads to persistent avoidance of the particular object, situation or activity.

6) phobia become preoccupational with patient resulting distress and restricted freedom.

Three main Types of phobia :

1) Agro phobia

2) Social phobia

3) Specific phobia

1) Agro phobia : Irrational fear of situation, fear of being in places away from familiar setting. It could be fear of close spaces, fear of open spaces, public places, crowded places or any other place where there is escape is difficult or no easy escape to a safe place.

2) Social phobia or social anxiety disorder :

Intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation. People with social phobia may worry about acting or appearing visibly anxious or being viewed as stupid, awkward, or boring. 

3) Specific phobias.

Treatment plans for phobic disorders :

Psychotherapy

Cognitive behavioural therapy (CBT)

Behaviour therapy (BT) - flooding, systematic desensitisation, exposure and response prevention, relaxation techniques.

Drug treatment - benzodiazepines, alprazolam, clonazepam, diazepam, antidepressants, paroxetine, fluoxetine, sertraline, imipramine (TCA), phenelzine (MAOI) etc.

 Generalized anxiety disorder (GAD) 

Essential feature is anxiety which is generalized and Persistent.

Excessive or disproportionate anxiety about several aspects of life such as work, school performance, social relationships or financial matters.

The patient is unable to control worry or anxiety.

The anxiety or worry cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

Symptoms of generalized anxiety disorder :

• Trembling.

• Muscular tension.

• Sweating.

• Light headedness.

• Palpitations.

• Dizziness.

• Epigastric discomfort.

• Sleep disturbance.

• Restlessness.

• Easily fatigue.

• Difficulty in concentration.

Treatment plans for Generalized anxiety disorder :

Psychotherapy - psychoanalytic psychotherapy, supportive Psychotherapy.

Relaxation techniques - jacobson's progressive techniques, yoga, pranayama, self hypnosis, meditation.

Cognitive behavioral therapy (CBT).

Drug treatment - benzodiazepines, antidepressants, propranolol, atenolol, buspirone.

Behaviour therapies (BT) - biofeedback and hyperventilation control etc.

Obsessive compulsive disorder (OCD)

An obsession defined as -

• An idea, impulse or image which include conscious awareness repeatedly.

• Recognised as one's own idea but perceived as ego - alien. 

• Insight is present.

• Patient tries to resist against it but unable to do.

• failure tries to resist leads to marked distress.

A compulsion defined as - 

• A form of behaviour which usually follows obsessions.

• Preventing the distress or fear arising out of obsession.

• Insight is present.

• Behaviour is not realistic and either irrational or excessive.

• Behaviour performed with a sense of subjective compulsion.

Clinical features :

• Washers.

• Pure obsession.

• Checkers.

• Primary obsessive slowness.

Treatment plans for Obsessive compulsive disorder (OCD) :

Psychotherapy - psychoanalytic psychotherapy, supportive Psychotherapy.

Cognitive behaviour therapy (CBT).

Behaviour therapy (BT) - response prevention, systematic desensitisation, modelling, thought stopping and modification.

Drug treatment - benzodiazepines, antidepressants, antipsychotics, buspirone etc.