Anxiety disorders.ppt

Anxiety disorders Jeffrey Clothier, M.D. Objectives Compare and contrast the clinical features of Panic Disorder, Generalized Anxiety Disorder, and Obsessive-Compulsive Disorder Describe the biologic and genetic features of Panic Disorder and OCD Review the effective therapies for Panic Disorder, Generalized Anxiety Disorder, and Obsessive-Compulsive Disorder Anxiety- symptom and disorder As a symptom accompanies many illnesses, both medical and psychiatric. As a disorder has specific features which indicate specific treatment options. Goal is to distinguish the disorders from anxiety as a symptom and then to identify the specific type of anxiety disorder. Performance-Anxiety Curve Anxiety Disorders in DSM-IV Panic Disorder Specific Phobia Social Phobia/Social Anxiety Disorder (SAD) Obsessive Compulsive Disorder (OCD) Posttraumatic Stress Disorder (PTSD) Acute Stress Disorder Generalized Anxiety Disorder (GAD) Anxiety Disorder due to a GMC Substance-Induced Anxiety Disorder Prevalence Rates (Lifetime/Year) Any Psychiatric Disorder: 48% / 29.5% Any anxiety disorder: 24.9% / 17.2% SAD: 13.3% / 4.5% GAD: 5.1% / 3.1% Panic: 3.5% / 2.3% OCD: 2.5% / 1.3% Anxiety disorders in High Utilizing Patients Anxiety Disorders-General More similarities than differences, but some important differences FM, except OCD Serotonergic drugs effective for most disorders Cognitive-Behavioral Therapy (CBT) likely effective for all Anxiety Disorders-General Highly comorbid with Depression, Alcoholism, other Anxiety Disorders Often complicated by somatization Most treated in Primary Care Usually mismanaged Anxiety Disorders and Etoh Etoh-use disorders are very prevalent 4x general population in Panic Disorder 3.5x in OCD 2.5x in Phobias (Simple and Social) May relate to Etoh’s GABA properties An attempt to self-medicate? Can backfire, as withdrawal worsens anxiety Difficult to treat the alcoholism without treating the anxiety disorder in these patients Anxiety Disorders-