1. PHR 202 Anxiety VC FINAL

Introduction to Pharmacy 202 - Management of Anxiety Disorders

This course will cover sensitive topics that may be distressing, such as depression, self-harm, and suicide. Students are encouraged to seek support from the lecturer, personal tutor, student wellbeing services, or health practitioners if they experience distress.

Famous Movies Featuring Protagonists with Anxiety Disorders

Notable films that explore anxiety disorders include "Le Fabuleux Destin d'Amélie Poulain" featuring Audrey Tautou, "Adaptation" with Mathieu Kassovitz, "The King's Speech" starring Colin Firth, "Black Swan" featuring Natalie Portman, and "Puss in Boots: The Last Wish".

Learning Objectives

By the end of the session, students should be able to identify different types of anxiety disorders and their symptoms, discuss treatment options along with their benefits and drawbacks, select appropriate treatments based on guidelines, evidence, and patient factors, and identify pharmaceutical care issues in patients treated for anxiety disorders.

Overview of Anxiety Disorders

Anxiety disorders are prevalent mental health issues, with a global prevalence of around 4%. They often correlate with higher rates of depression, substance abuse, and increased risks of accidental death and suicide. Undiagnosed anxiety can lead to overutilization of healthcare resources and higher morbidity and mortality.

Definition of Anxiety

Anxiety is a common emotional response characterized by physiological activation (sympathetic nervous system response), cognitive awareness of fear, and a behavioral tendency to escape threatening situations. Excessive anxiety that disrupts daily functioning is referred to as a pathological anxiety disorder, which may be classified as primary or secondary anxiety.

Symptoms of Anxiety Disorders

Common symptoms may include an inability to settle in jobs, difficulty sleeping, persistent feelings of pressure, early morning awakening, dizziness, concentrating issues, irritability, social avoidance, and obsessive thoughts.

Risk Factors for Anxiety Disorders

Recognized risk factors include a family history of anxiety or related disorders, life events leading to emotional or physical stress, personality traits, learned responses, perfectionism, or shyness. Additionally, demographic factors such as being female, unmarried, socially isolated, unemployed, or living in poverty contribute to higher risk, as do comorbid medical conditions and medications affecting mental health.

Theoretical Perspectives on Anxiety Disorders

Neurotransmitter theories suggest involvement of noradrenaline, serotonin, GABA, cholecystokinin, dopamine, neuropeptide Y, and corticotrophin-releasing factor, while neuroanatomical theories highlight hyperactivity of the amygdala and the basal ganglia's role in obsessive-compulsive disorder (OCD).

Forms of Anxiety Disorders

Primary Anxiety includes disorders such as panic disorder, phobias, and generalized anxiety disorder (GAD). Secondary Anxiety can arise due to psychiatric disorders (e.g., depression) or physical illnesses (e.g., hyperthyroidism).

Communication Strategies with Patients Experiencing Anxiety

To effectively communicate with patients experiencing anxiety, it is crucial to maintain a calm demeanor and be attentive to body language for signs of anxiety such as fidgeting. Avoid dismissing a patient's fears and remain patient if they experience panic attacks.

Types of Anxiety Disorders

Anxiety disorders encompass various types, including generalized anxiety disorder (GAD), panic disorder, specific and social phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), body dysmorphic disorder, and health anxiety (hypochondriasis).

Generalized Anxiety Disorder (GAD)

GAD is characterized by persistent, uncontrollable worry that affects around 8% of primary care patients. Symptoms may include disrupted sleep, muscle tension, difficulty concentrating, and distress impacting quality of life. The GAD-2 screening tool assesses the frequency of feeling nervous or unable to control worrying in the past two weeks.

Overview of Panic Disorder

Panic attacks represent episodes of intense fear that peak quickly, typically within 10 minutes, accompanied by significant physical symptoms such as sweating and palpitations. Panic disorder may lead to anticipatory anxiety and avoidance behaviors, ultimately affecting daily functioning.

Specific Phobias

This disorder involves intense fear of specific situations or objects, leading to avoidance behavior that impairs functioning. Effective treatment options include cognitive-behavioral therapy (CBT) that focuses on graduated exposure.

Agoraphobia

Characterized by fear of being in situations where escape is difficult, agoraphobia often leads to avoidance behavior. Symptoms can take on behavioral (avoiding crowded places), cognitive (fear of panic attacks), or physical (palpitations) forms.

Social Anxiety Disorder

This disorder is marked by an overwhelming fear of social situations, significantly impacting individuals' lives. Treatment options include CBT, with SSRIs as a second-line medication option if necessary.

Post-Traumatic Stress Disorder (PTSD)

PTSD can develop after trauma and affect recovery chances, with symptoms including intrusive memories, hyperarousal, and emotional numbing. Management strategies encompass psychological therapies and potential referrals to specialists.

Obsessive-Compulsive Disorder (OCD)

OCD is characterized by time-consuming obsessions and compulsions that cause significant distress or functional impairment. Common treatments involve CBT utilizing exposure and response prevention (ERP) techniques.

Body Dysmorphic Disorder (BDD)

BDD is defined by excessive concern about perceived defects in appearance, which can lead to distress and impaired functionality. Diagnosis utilizes specific screening questions regarding appearance fixation and its daily impact.

Health Anxiety (Hypochondriasis)

Health anxiety presents as an intense fear of having a serious illness, persisting despite medical evaluations. Its management typically involves CBT, though SSRIs show less effectiveness.

Treatment Pathways

Guidelines emphasize stepped-care models for treatment pathways depending on severity and functional impairment. Referral should be considered for severe cases or when initial treatments prove ineffective.