anxiety disorders - university of arkansas for medical sciences焦虑症-阿肯色医科大学

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1、AnxietydisordersJeffreyClothier,M.D.ObjectivesCompareandcontrasttheclinicalfeaturesofPanicDisorder,GeneralizedAnxietyDisorder,andObsessive-CompulsiveDisorderDescribethebiologicandgeneticfeaturesofPanicDisorderandOCDReviewtheeffectivetherapiesforPanicDisorder,GeneralizedAnxi

2、etyDisorder,andObsessive-CompulsiveDisorderAnxiety-symptomanddisorderAsasymptomaccompaniesmanyillnesses,bothmedicalandpsychiatric.Asadisorderhasspecificfeatureswhichindicatespecifictreatmentoptions.Goalistodistinguishthedisordersfromanxietyasasymptomandthentoidentifythespec

3、ifictypeofanxietydisorder.Performance-AnxietyCurveAnxietyPerformanceAD'sAnxietyDisordersinDSM-IVPanicDisorderSpecificPhobiaSocialPhobia/SocialAnxietyDisorder(SAD)ObsessiveCompulsiveDisorder(OCD)PosttraumaticStressDisorder(PTSD)AcuteStressDisorderGeneralizedAnxietyDisorder(G

4、AD)AnxietyDisorderduetoaGMCSubstance-InducedAnxietyDisorderPrevalenceRates(Lifetime/Year)AnyPsychiatricDisorder:48%/29.5%Anyanxietydisorder:24.9%/17.2%SAD:13.3%/4.5%GAD:5.1%/3.1%Panic:3.5%/2.3%OCD:2.5%/1.3%AnxietydisordersinHighUtilizingPatientsAnxietyDisorders-GeneralMores

5、imilaritiesthandifferences,butsomeimportantdifferencesF>M,exceptOCDSerotonergicdrugseffectiveformostdisordersCognitive-BehavioralTherapy(CBT)likelyeffectiveforallAnxietyDisorders-GeneralHighlycomorbidwithDepression,Alcoholism,otherAnxietyDisordersOftencomplicatedbysomatizat

6、ionMosttreatedinPrimaryCareUsuallymismanagedAnxietyDisordersandEtohEtoh-usedisordersareveryprevalent4xgeneralpopulationinPanicDisorder3.5xinOCD2.5xinPhobias(SimpleandSocial)MayrelatetoEtoh’sGABApropertiesAnattempttoself-medicate?Canbackfire,aswithdrawalworsensanxietyDifficu

7、lttotreatthealcoholismwithouttreatingtheanxietydisorderinthesepatientsAnxietyDisorders-NeurotransmittersNorepinephrine(NE)LocusCeruleusstimulationleadstofearresponseablationinhibitsfearresponsebetaagonists/alpha2antagonistscausepanicattacksinpredisposedGABAagonistsanxiety/

8、inverseagonistsanxietySerotonin(5-HT)ChronicSSRI’s,5-HT1aagonistsanxietyAnxietyD