Anxiety disorders are among the most common psychiatric disorders. Generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder are some of the main types of anxiety disorders. Non-pharmacologic treatments for these disorders include psychoeducation, counseling, stress management, psychotherapy, meditation, exercise, and avoidance of substances that can trigger attacks. Pharmacologic therapies include antidepressants such as SSRIs and SNRIs. A complete evaluation including medical history and diagnostic examination is needed to properly diagnose and treat anxiety disorders.

1. Submitted by: FARAZUL HODA
M. Pharm Pharmacy Practice (IInd Semester)
Department of Pharmacology
School of Pharmaceutical Education and Research,
Jamia Hamdard

3. Definition
Epidemiology
Pathophysiology
Types of anxiety disorders
Treatments

4. Anxiety
It is an emotional state, unpleasant in nature,
associated with uneasiness, discomfort and
concern or fear about some defined or undefined
future threat. Some degree of anxiety is a part of
normal life. Treatment is needed when it is
disproportionate to the situation and excessive.

5. Anxiety disorders, are the most commonly occurring psychiatric
disorders.
According to the National Comorbidity Survey Replication on the
prevalence, severity, and comorbidity estimates of mental disorders in
the United States, the most recent 1-year prevalence rate for anxiety
disorders was 19.1% in persons aged 18 years and older.
EPIDEMIOLOGY

6. Specific phobias were the most common anxiety disorder, with
a 12-month prevalence of 9.1%.
The 1-year prevalence of generalized anxiety disorder (GAD)
was 2.7%,
that of panic disorder was 2.7%, and
that of social anxiety disorder (SAD) was 7.1%.

7. PATHOPHYSIOLOGY
Data from biochemical and neuroimaging studies indicate that the
modulation of normal and pathologic anxiety states is associated
with multiple regions of the brain and abnormal function in several
neurotransmitter systems, including
norepinephrine (NE),
γ-aminobutyric acid (GABA),
serotonin (5-HT),
corticotrophinreleasing factor (CRF),
and cholesystokinin.

8. Current neuroanatomic models of fear (i.e., the response to danger)
and anxiety (i.e.,the feeling of fear that is disproportionate to the
actual threat) include some key brain areas. The amygdala, a temporal
lobe structure, plays a critical role in the assessment of fear stimuli and
learned response to fear. The locus ceruleus (LC), located in the brain
stem, is the primary NE-containing site, with widespread projections to
areas responsible for implementing fear responses (e.g., vagus, lateral
and paraventricular hypothalamus). The hippocampus is integral in the
consolidation of traumatic memory and contextual fear conditioning.
The hypothalamus is the principal area for integrating neuroendocrine
and autonomic responses to a threat.

11. 1.Generalized Anxiety Disorder
2.Panic Disorder
3.Social Anxiety Disorder
4.Post Traumatic Disorder

12. GENERALIZED ANXIETY
DISORDER

13. GENERALIZED ANXIETY DISORDER
•The diagnostic criteria for GAD require persistent symptoms for most days
for at least 6 months.
•The essential feature of GAD is unrealistic or excessive anxiety and worry
about a number of events or activities.
• The anxiety or apprehensive expectation is accompanied by at least three
psychologic or physiologic symptoms.

14. CLINICAL PRESENTATION OF GENERALIZED
ANXIETY DISORDER
Psychologic and Cognitive Symptoms
 Excessive anxiety
 Worries that are difficult to control
 Feeling keyed up or on edge
 Poor concentration or mind going blank
Physical Symptoms
 Restlessness
 Fatigue
 Muscle tension
 Sleep disturbance
 Irritability
Impairment
 Social, occupational, or other important functional areas
 Poor coping skills

15. PANIC DISORDER

16. PANIC DISORDER
Panic disorder begins as a series of unexpected (spontaneous) panic
attacks involving an intense, terrifying fear similar to that caused by life-
threatening danger.
During an attack, patients describe at least four physiologic and
physical symptoms.

17. CLINICAL PRESENTATION OF A PANIC ATTACK
Psychological Symptoms
 Depersonalization
 Derealization
 Fear of losing control, going crazy,
or dying
Physical Symptoms
 Abdominal distress
 Chest pain or discomfort
 Chills
 Dizziness or light-headedness
 Feeling of choking
 Hot flushes
 Palpitations
 Nausea
 Paresthesias
 Shortness of breath
 Sweating
 Tachycardia
 Trembling or shaking

18. SOCIAL ANXIETY DISORDER

19. SOCIAL ANXIETY DISORDER
SAD is characterized by an intense, irrational, and persistent fear of being
negatively evaluated or scrutinized in at least one social or performance
situation. Exposure to the feared circumstance usually provokes an immediate
situation-related panic attack.
Blushing is the principal physical indicator and distinguishes SAD from other
anxiety disorders.
 In individuals younger than 18 years of age, the duration of symptoms must be
at least 6 months to meet the diagnostic criteria.

20. CLINICAL PRESENTATION OF SOCIAL ANXIETY DISORDER
Fears of Being
 Embarrassed
 Humiliated
Some Feared Situations
 Eating or writing in front of others
 Interacting with authority figures
 Speaking in public
 Talking with strangers
 Use of public toilets
Physical Symptoms
 Blushing
 “Butterflies in the stomach”
 Diarrhea
 Sweating
 Tachycardia
 Trembling
Types
 Generalized: fear and avoidance extend to a wide range of social situations
 Nongeneralized: fear limited to one or two situations

21. POSTTRAUMATIC STRESS DISORDER

22. POSTTRAUMATIC STRESS DISORDER
• In adults and children older than 6, there is exposure to actual or
threatened death, serious injury, or sexual violence, either directly,
or by witnessing the event(s) happening to others, learning about
the event(s) happening to someone close, or experiencing
repeated or extreme exposure to details of the event(s).

23. Clinical Presentation of Posttraumatic Stress Disorder
Reexperiencing Symptoms
• Recurrent, intrusive distressing memories of the trauma
• Recurrent, disturbing dreams of the event
• Feeling that the traumatic event is recurring (eg dissociative flashbacks)
• Physiologic reaction to reminders of the trauma
Avoidance Symptoms
• Avoidance of conversations about the trauma
• Avoidance of thoughts or feelings about the trauma
• Avoidance of activities that are reminders of the event
• Avoidance of people or places that arouse recollections of the trauma
• Inability to recall an important aspect of the trauma
• Anhedonia
• Estrangement from others
• Restricted affect
• Sense of a foreshortened future (e.g., does not expect to have a career,marriage)

24. Hyperarousal Symptoms
• Decreased concentration
• Easily startled
• Hypervigilance
• Insomnia
• Irritability or anger outbursts
Subtypes
• Acute: duration of symptoms is less than 3 months
• Chronic: symptoms last for longer than 3 months
• With delayed onset: onset of symptoms is at least 6 months posttrauma

25. DIAGNOSIS
• Evaluation of the anxious patient requires a physical and mental
status examination; complete psychiatric diagnostic exam;
appropriate laboratory tests; and a medical psychiatric, and drug
history.
• Anxiety symptoms may be associated with medical illnesses or
drug therapy , and they may be present in several major
psychiatric illnesses (eg, mood disorders, schizophrenia, organic
mental syndromes, and substance withdrawal).

26. TREATMENT

27. Generalized Anxiety Disorder

28. NONPHARMACOLOGIC THERAPY
psychoeducation
short-term counseling
stress management
 psychotherapy
 meditation
 exercise

29. PANIC DISORDER

30. NONPHARMACOLOGIC THERAPY
Patients should be educated to avoid substances that can
precipitate panic attacks, including caffeine, nicotine, alcohol,
drugs of abuse, and nonprescription stimulants.
Aerobic exercise (e.g., walking for 60 minutes or running for
20–30 minutes 4 days/week) may benefit patients with panic
disorder

31. Social Anxiety Disorder

32. NONPHARMACOLOGIC THERAPY
Patients should be educated about SAD and support groups.
Selfhelp group programs that focus on effective communication
can benefit people with public-speaking phobia.