Anxiety, anxiety disorders, somatoform disorders. Zoltán Hidasi
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1 Anxiety, anxiety disorders, somatoform disorders Zoltán Hidasi
2 Anxiety Definition Normal anxiety Signs and symptoms Anxiety disorders Anxiolitic therapy Special importance for dentists
3 Fear v. anxiety Anxiety: Feeling of apprehension caused by anticipation of danger (internal or external) threat: unknown, internal, vague, conflictual Fear: anxiety caused by conciously recognized and realistic danger threat: known, external, definite, nonconflictual
4 Normal v. pathological anxiety Alerting signal - warning for danger lifesaving effect Is anxiety adaptive? Bodily damage, pain, helplessness, possible punishment, frustration of social or bodily needs helps dealing with threats (taking steps to prevent threat or lessen consequencies)
5 Symptoms of anxiety Subjective - psychological - verbal unpleasant emotion learning, concentration, making associations perception, thinking Behavioural - motor symptoms psychomotor retardation or agitation (restlessness), mimics, gestures Vegetative symptoms
6 hyperhydrosis, flushing hypertension tachycardia, tachypnoe palpitations syncope, dizziness dry mouth diarrhea upset stomach urinary frequency, urgency hyperreflexia pupillary mydriasis Autonomic symptoms
7 Anxiety in dentistry common feature trait anxiety anxiety disorders treating anxiety
8 Anxiety disorders (DSM IV TR) lifetime prevalence: 30.5% fm, 19.2% m Panic disorder and agoraphobia Specific phobia and social phobia Obsessive-compulsive disorder Posttraumatic stress disorder Generalized anxiety disorder Other anxiety disorders due to a general medical condition substance induced anxiety disorder
9 Panic disorder, Agoraphobia lifetime prevalence: 1.5-5% Panic attacks (20-30 minutes - extreme fear, fear of dying, palpitations, sweating, trembling, short of breath, chest pain, nausea, dizziness, etc. ) Anticipatory anxiety Agoraphobia: fear of being alone in public places
10 Specific phobias, Social phobia Phobia: Excessive fear of a specific object, circumstance or situation (unreasonable, marked, persistent) 6 month prevalence: 5-10% Exposure: immediate anxiety Types: animal type, natural environment type (e.g., storms, water), blood-injection-injury type, situational type (e.g., airplanes), other Social phobia: social performance
11 Obsessive-compulsive Disorder Lifetime prevalence: 2-3% obsessions (recurrent, persistent, intrusive thoughts causing anxiety) compulsions (repetitive behaviors or mental acts responding to obsessions) ego-alien (absurd, irrational) symptom patterns (contamination, pathological doubt, intrusive thoughts, symmetry, etc.)
12 Therapy of anxiety disorders Pharmacotherapy Benzodiazepines (alprazolam, clonazepam) Buspirone Antidepressants (SSRI, heterocyclic, MAOI, others) Psychotherapy cognitive-behaviour therapy relaxation
13 Somatization Somatization: somatic complaints or symptoms of psychological (mental) origin Somatoform disorders somatization disorder conversion disorder hypochondriasis body dysmorphic disorder pain disorder Other mental disorders with somatic complaints and symptoms
14 Mental disorders with somatic complaints and/or symptoms Somatoform disorders Mood disorders Anxiety disorders Eating disorders Schizophrenia and related disorders Substance use disorders Organic psychiatric disorders
15 Somatization disorder lifetime prevalence : 0.2-2% women many somatic complaints affecting many organ systems (pain, gastrointestinal,sexual, pseudoneurological) chronic, before 30 years
16 Conversion disorder m : f 1:2-1:10 prevalence? one or more neurological symptoms with no neurological origin Symptoms: motor (involuntary movements, tics, seizures, paralysis, astasia-abasia, etc.) sensory deficits (anesthesia, blindness, etc.) visceral symptoms (vomiting, diarrhea, syncope)
17 Hypochondriasis 6 month prevalence: 4-6% peoccupation with fears of having a serious disease misinterpretation of bodily symptoms, sensations preoccupation persists
18 Anxiety-somatoform disorders fear anxiety depression autonomic reactions somatic complaints somatic symptoms
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