Generalised Anxiety Disorder (GAD)
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This is characterised by pervasive anxiety symptoms which are not restricted to specific situations (phobic disorder). Generalised anxiety may accompany phobias, and may be associated with other problems such as depression and substance abuse, it may also be caused by physical illness e.g. overactive thyroid, and may be associated with the emotional response to illness, e.g. myocardial infarction. Some 15% of people with anxiety problems have a sibling or parent with a similar problem. This may reflect a genetic component to vulnerability, or the effects of family environment. Although there is biological component to anxiety disorders, psychological factors invariably play an important part. Two thirds of sufferers are female.
In panic disorder there are recurrent attacks of panic that occur unpredictably and without obvious precipitants. It commonly coexists with GAD or agoraphobia.
Panic attacks consist of attacks of severe anxiety with physical and psychological symptoms. Physical symptoms include tachycardia, palpitation, sweating, tremor etc. and may include hyperventilationa. Psychological symptoms typically include dread, particularly of extreme events such as dying, having a seizure, losing control or going mad.
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As a component of anxiety disorders hyperventilation is of particular significance as it can be misdiagnosed as physical disorders, the treatment of which can have potentially hazardous outcomes, such as epilepsy (known as non-epileptic attack disorder) or myocardial ischaemia.
Rapid shallow breathing leads to hypocapnia and respiratory alkalosis. This in turn leads to physical symptoms such as paraesthesia (typically fingertip or peri-oral), lightheadedness, tetany/carpo-pedal spasm etc. The pattern of breathing itself, without adequate expiration taking place, leads to a feeling of chest tightness. These symptoms in turn lead to an increase in anxiety and the development of a "vicious circle". Hyperventilation can occur in many psychiatric disorders, but not exclusively and can occur in "normal" individuals during unaccustomed exercise, SCUBA diving etc. Treatment is classically by rebreathing into a paper bag. This, however, is unpleasant and compliance is unlikely. More useful is to encourage slowing of respiration with complete expiration. Longer term management is usually behavioural in addition to treatment of the primary disorder. -------------------------------------------------------------------------------- A phobia is a fear that is disproportionate to the specific situation that prompts it and cannot be explained away. The person typically avoids the feared stimulus since the reduction of anxiety is powerfully reinforcing (known as negative reinforcement).
Some phobias represent heightened anxiety towards situations which people are evolutionarily 'prepared' to fear eg snakes, heights, sharp objects. In other instances a phobia may arise through conditioning. A traumatic experience may be associated with a neutral, non-threatening situation, which then itself becomes feared. Phobias are typically; situational, predictable and with anticipatory anxiety and avoidance. They are common in the general population but in only 2% are sever enough to prove disabling. Some common phobias are: -------------------------------------------------------------------------------- OCD is a relatively rare disorder. Whilst minor obsessional symptoms may occur in around 14% of a general population sample ,OCD itself has a point prevalence of only 0.05% (6 month prevalence 1.3-2%; lifetime prevalence 1.9-3.3%). It is distributed equally between both sexes and may only present late on after many years of active symptoms. --------------------------------------------------------------------------------
The psychological sequelae to stressful events often include symptoms of anxiety. There are three types of reactions that are partly characterised by their differing symptomatology, but also by their different temporal relationship to the stressful event. -------------------------------------------------------------------------------- Somatoform disorders are characterised by the primary problem being a physical presentation or concern secondary to a psychological problem. They are an important group of disorders to be aware of since patients with them often present to GP’s and physicians rather than psychiatrists. Treatment:
Psychological.
Physical.
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Panic Disorder
Treatment:
Psychological.
Physical.
Hyperventilation Syndrome
Treatment
Phobic Disorders
Simple phobias - Here the phobia is specific to objects or situations and in many cases can be understood from an evolutionary perspective. Specific phobias include:
Agoraphobia (syn. fear of the marketplace) - 75% of sufferers are women with a prevalence of 6.3 per 1000 population. Symptoms consist of intense fear of leaving the home, being in crowded spaces, travelling on public transport etc. that are difficult to leave. Agoraphobia may follow a life event threatening a persons security, or a physical illness. It can often be associated with marital problems, and may often mask them. Social phobia - The sex ratio in contrast to agoraphobia is equal. Typically it involves a diffuse fear of social interaction; of talking to others eating, drinking and speaking in public. Treatment:
Psychological.
Physical.
Obsessive Compulsive Disorder (OCD)
Symptoms.
Obsessional thoughts:
Compulsive acts (a.k.a. obsessional acts):
Aetiology.
Treatment:
Psychological.
Physical.
Stress Related Disorders
Acute stress reaction.
Adjustment reaction.
Post traumatic stress disorder (PTSD).
Somatoform Disorder
Somatisation disorder.
Hypochondriasis.
Dissociative (conversion) disorders.
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