5- Anxiety AB2.pdf - Diffuse unpleasant vague sense of...

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Diffuse, unpleasant, vague sense of apprehension Often accompanied by autonomic symptoms such as headache, SOB, heart palpitations, chest tightness, stomach discomfort and restlessness Presentation depends on perception of stress, personal resources, psychological defenses, and coping mechanisms
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Nervousness and fear are common human emotions. Adaptive at lower levels; disabling at high levels. Physicians must recognize the difference between pathological anxiety and anxiety as a normal or adaptive response.
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Autonomy: no or minimal environmental trigger Intensity: exceeds patient’s capacity to bear the discomfort Duration: symptoms are persistent Behavior: anxiety impairs coping and results in disabling behaviors
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Neurophysiology Central noradrenergic systems in particular, the locus coeruleus is the major source of adrenergic innervation (increased) GABA neurons from the limbic system (decreased) Serotoninergic systems (decreased) Cognitive-Behavioral Formulations Developmental (Psychodynamic) Formulations
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The most prevalent psychiatric disorders One-quarter of the U.S. population experiences pathologic anxiety in their lifetime Presenting problem for 11% of patients visiting primary care physicians 90% of patients with anxiety present with somatic complaints
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Endocrine: thyroid dysfunction, hyper adrenalism Drug Intoxication: caffeine, cocaine Drug Withdrawal: alcohol, narcotics Hypoxia: CHF, angina, anemia, COPD Metabolic: acidosis, hyperthermia Neurological: seizures, vestibular dysfunction
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Panic Disorder Generalized Anxiety Disorder Post Traumatic Stress Disorder Social Phobia Specific Phobia Obsessive Compulsive Disorder (OCD) Substance Induced Anxiety Disorder
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Discrete episodes of intense anxiety Sudden onset Peak within 10 minutes last <25 mins Associated with at least 4 of the 13 other somatic or cognitive symptoms of autonomic arousal
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Cardiac: palpitations, tachycardia, chest pain or discomfort Pulmonary: shortness of breath, a feeling of choking GI: nausea or abdominal distress Neurological: trembling and shaking, dizziness, lightheadedness or faintness, paresthesias GI:
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Autonomic Arousal: sweating, chills or hot flashes Psychological: Derealization (feeling of unreality) Depersonalization (feeling detached from oneself) Fear of losing control or going crazy Fear of dying PANIC S
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A syndrome characterized by recurrent unexpected panic attacks (at least 4 in one month) Attacks are followed for at least one month with: Concern about having another attack Worry about implications of the attack Behavior changes because of the attacks
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Panic Attacks are associated with some conditions , such as : Mitral valve prolapse Angina Ashtma Pulmonary embolism Anaphylaxis
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Complication of panic disorder Means “ fear of the market” Anxiety or avoidance of places or situations from which escape might be difficult, embarrassing, or help may be unavailable.
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