Coupon Accepted Successfully!


Introduction to Anxiety Disorder

  1. Anxiety Attack: It is normal reaction & some amount of anxiety is required for performance however excess of anxiety will take away the performance. Various symptoms of anxiety are as below:
Clean Clean false false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4



1 Apprehension

1. Tremor

2 Fears of impending disaster

2. Sweating

3 Irritability

3. Palpitations

4 Depersonalization

4. Chest pain


5. Breathlessness


6. Headache


7. Dizziness


8. Diarrhoea;


9. Frequency of micturition


10. Initial insomnia


11. Poor concentration

Physical Illnesses which MIMIC Anxiety Disorder:
  1. Hyperthyroidism
  2. Pheochromocytoma
  3. Hypoglycemia
  4. Paroxysmal atrial arrhythmias
  5. Alcohol withdrawal
  6. Temporal lobe epilepsy
    Treatment of Acute Anxiety attack is benzodiazepine
  1. Acute Anxiety attack - is a anxiety symptoms in response to some internal / external stress. e.g. exams, Interview.
    Treatment of Acute Anxiety attack is benzodiazepine
    For performance Anxiety - when to perform on stage or just before examination
    The drug of choice is B-Blocker i.e propranolol.
  2. Generalized Anxiety disorders characterised by
Diagnostic Criteria for Generalized Anxiety Disorder
  1. Excessive anxiety and worry (apprehensive expectation), occurring more day than not for at least 6 months, about a number of events or activities (such as work or schools performance).
  2. The person finds it difficult to control the worry.
  3. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months): (1) restlessness or feeling keyed up or on edge; (2) being easily fatigued; (3) difficulty concentrating or mind going blank; (4) irritability; (5) muscle tension; (6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).

Treatment: Benzodiazepines / SSRI / TCA / Buspirone (5 HT1a A partial agonist). All are first line drug of choice.

For acute management  GAD – Benzodiazepine

For long term management SSRI / TCA / Buspirone

  1. Panic Attack
    It is sudden, severe, spontaneous attack of anxiety or discomfort, in which four or more of the following symptoms developed abruptly and reached a peak, with a feeling of impending doom that either person will die today or go crazy.
    Treatment of choice of panic attack - Benzodiazepines.
Provocation of Panic Attacks Some Challenge Paradigms also been called Panicogens. (Possible Mechanisms)
  1. Lactate (pH and pCO, changes)        
  2. Bicarbonate (pH and pCO2 changes)
  3. Hypercapnia with 5% or 35% CO2 (pCO2 changes)
  4. Hyperventilation (pCO2 changes)
  5. Caffeine (Adenosine, benzodiazepine receptors)
  6. Noradrenergic agents like isoprenaline and noradrenaline (NE)
  7. Yohimbine (NE, 5-HT)
  8. Tricyclic antidepressants (NE, 5-HT)
  9. mCPP (5-HT receptor stimulation)
  10. Benzodiazepine receptor agents
    Flumazenil (antagonist)
  11. Cholecystokinin (CNS/ peripheral action)
  12. Hypoglycemia (Peripheral autonomic activation)
  13. Cognitive (Catastrophic misinterpretation)    
  14. Clomipramine (5-HT)
  1. Panic Disorder:
    (Episodic paroxysmal anxiety) - occurrence of at least 4 Panic attack per month is described as panic disorder.
Clinical features :
  1. Recurrent attacks of severe anxiety.
  2. Autonomic symptoms – palpitation, choking sensation, dizziness etc.
  3. Fear of dying, losing control or going mad.
  4. Anticipatory anxiety ( ie persistent fear of having another attack) Duration of attack- last for minutes only, though sometimes longer.
T/t of panic disorder -:
SSRI: Sertraline (SSRI) Paroxetine (SSRI), TCA (Imipramine)
  1. PHOBIA:
    Clinical features: Irrational Excessive of thing, not usually feared by others fear, leading to conscious avoidance of the feared object, activity or situation. Presence of anxiety when exposed to the situation.
Certain age related phobias considered normal includes
3 years : School phobia
5 years : Darkness
8 years : Animal
11 years : Thanatophobia or fear of death

Type                       Precipitation Situation
Agoraphobia  - Fear of place from where easy escape is not possible.
                       - Most common Q & most disabling
                       - Only one or two persons are relied upon K\a Phobia companions Q
Claustrophobia - Fear of closed spaces Q
Acro\Aero-phobia  - Fear of high places Q
Algophobia  - Fear of pain Q
Xenophobia - Fear of strangers Q
Zoo-phobia - Fear of animals Q
Sito phobia - Fear of eating
Thanato phobia - Fear of death
Social phobia - Fear of social activates interactions.
Ex: Shy-Bladder : - Fear of urinating in public lavatory
Erythrophobia: - Fear of blushing.
Types as in psychiatry diagnosis
  1. Agoraphobia fear of places from where easy escape is not Possible : fear of being in places away from the familiar setting of home. Includes fear of open spaces, public places, crowded places or any place from where there is no easy escape to a safe place.
    1. with panic attack,
    2. without panic attack
      It is usually associated with panic attack
  2. Social phobia : Fear of Negative evaluation by others Irrational fear of social interaction, avoidance of social situations. Fear of public performance, speaking to strangers, urinating in public lavatory etc.
  3. Specific Phobia / Isolated phobia : fear of specific object. Most common phobia eg. Acrophobia (heights)/ Claustrophobia (closed places) Algophobia (pain) / Xenophobia (strangers).
    Treatment:  Multimodal I) Behavior therapy ± pharmacotherapy (SSRI, Benzodiazepine)
Treatment of choice for phobia is Behavior therapy. & Drug of choice is SSRI.
- Varions Behaviour therapies are
  1. Graded exposure - Gradual exposure to fearful stimulus in Graded manner.
  2. Systematic desensitization - Person is made to relax and under relaxation he was asked to go in imagination a go in a stepwise manner from least feared to most feared situation. It can be done directly or in Imagination.
  3. Flooding - Supra maximal exposure. The person is exposed to extreme of feared situation.
  1. Obsessive – Compulsive disorder:
Clinical Features:
  1. Repetitive thoughts, (doubts, images, words, ideas or phase ) which intrude forcibly into pt’s mind recognized as the individual’s own, Perceived as absurd as nonsensical, tries to resist but unable to do so:
  2. Resisted unsuccessfully by the individual Egodystonic ie. associated with anxiety or distress.
  3. Compulsions senseless repeated rituals eg. repeated hand washing, checkers

Test Your Skills Now!
Take a Quiz now
Reviewer Name