1. [NEUROTIC DISORDERS (NEUROSES) ]

2. It is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. It is the displeasing feeling of fear and concern.psychologicalphysiologicalsomaticemotionalcognitivebehavioral Anxiety is considered to be a normal reaction to a stressor. It may help an individual to deal with a demanding situation by prompting them to cope with it.normalstressor Fear is a similar alerting signal but it is a response to a known, external, definite, or non conflictual threat However, when anxiety becomes overwhelming, it may fall under the classification of an anxiety disorder.anxiety disorder

3.  Neurotransmitters: norepinephrine, serotonin, and g-aminobutyric acid (GABA) – are the three major neurotransmitters associated with anxiety.

4.  The efficacy of benzodiazepines in the pharmacological treatment of generalized anxiety disorder gave rise to theories implicating the benzodiazepine–g- aminobutyric acid (GABA) receptor system in the pathophysiology of generalized anxiety disorder, but evidence exists for the involvement of the serotonergic and noradrenergic systems as well.

5. The activity of neurones innervating the pre-frontal cortex, basal ganglia and limbic region is decreased in generalised anxiety disorder (GAD). The activity of descending neurones from serotonergic nuclei in the brainstem is unaffected in GAD. This altered neurotransmitter balance contributes towards the feeling of anxiety associated with GAD.

6.  Many studies have shown that anxiety disorders tend to run in families.  For most medical conditions, this would suffice to conclude that abnormal genes must be etiologically relevant. However, it is not difficult to conceive that growing up with anxious parents or siblings might influence the development of anxiety in any individual.  There probably is no specific “gene” for panic disorder or social phobia or generalized anxiety disorder.  At least some genetic component contributes to the development of anxiety disorders (e.g. a polymorphic variant of the gene for the serotonin transporter)

8. psychoanalytic theories: anxiety as a signal of the presence of danger in the unconscious behavioral theories: anxiety as a conditioned response to specific environmental stimulitans existential theories: anxiety as the response to existential concerns (awareness of feelings of profound nothingness in life)

9.  functional (no organic basis) disorder of gnostic, emotional, somatic and behavioral reactions of psychogenic origin

10. CONFLICT SITUATION high expectations life problems internal conflicts CHRONIC STRESS ANXIETY the cue symptom of all neuroses

11. PERSONALITY FEATURES egocentric, with high self needs and expectation, anxious, easy-frustrated, rigid in opinions, with low self-esteem and interpersonal difficulties + “NEUROTIC” COPING MECHANISMS isolation, rationalisation, intelectualisation, dissociation, regression, fixation, conversion and somatisation, “day-dreaming”, hipercompensation

12.  ANXIETY NEUROSIS  PHOBIC NEUROSIS  OBSESSIVE – COMPULSIVE NEUROSIS  DEPRESSIVE NEUROSIS  HISTERICAL NEUROSIS  HIPOCHONDRIACAL NEUROSIS  NEURASTHENIC NEUROSIS

13.  DSM (DSM-IV) includes six elements of anxiety disorders:  panic disorder with or without agoraphobia.  generalized anxiety disorder.  simple and social phobias.  obsessive-compulsive disorder.  posttraumatic stress disorder.

14.  panic attack (DSM-IV): discrete period of intense fear or discomfort - accompanied by at least four somatic or cognitive symptoms such as palpitations, trembling, shortness of breath, sweating, and feelings of choking symptoms ( develop abruptly and reach a peak within 10 min.)

15.  the spontaneous, unexpected occurrence of panic attacks,from several attacks a day to only a few attacks per year;  panic disorder is often accompanied by agoraphobia

16.  the fear of being alone in public places (shopping mall ).  Especially places from which a rapid exit would be difficult in the course of a panic attack.

17.  the lifetime prevalence rates – 1.5 – 5 % for panic disorder, 3 – 5.6 % for panic attacks and 0.6 – 6 % for agoraphobia  women are 2-3 times more likely to be affected than men  usually onset during late adolescence or early adulthood  panic disorder, in general, is a chronic disorder  91 % of patients with panic disorder have at least one other mental disorder

18.  Pharmacotherapy : alprazolam and paroxetine drugs (supporting drugs: benzodiazepines)  Psychotherapy: cognitive – behavioural - insight oriented therapy

19.  Patients with generalized anxiety disorder suffer from excessive and uncontrollable anxiety and worry for at least 6 months and experience a series of somatic symptoms such as restlessness, irritability, insomnia, and muscle tension.

20.  An excessive anxiety and worry about several events or activities for a majority of days during at least 6 months  The worry is difficult to control and is associated with somatic symptoms such as muscle tension, irritability, difficulty sleeping, and restlessness  the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

21.  anxiety – excessive and interfering with other aspects of life  motor tension – most commonly manifested as shakiness, restlessness, and headaches  autonomic hyperactivity – commonly manifested by shortness of breath, excessive sweating, palpitations, and various gastrointestinal symptoms  cognitive vigilance – evidenced by irritability and the ease with which patients are startled

22.  GAD is a common disorder – there is a lifetime prevalence of45%  the ratio of women to men with the disorder is about 2 to 1  the age of onset is difficult to specify (“as long as they can remember”)  50-90 % of GAD patients have other mental disorder – social or specific phobia, panic disorder, depressive disorder

23.  Full generalized anxiety disorder picture usually requires the use of benzodiazepines, antidepressants, or buspirone.  Isolated (but prominent) symptoms such as palpitation, tremor, and sweating may respond to b-blockers within 1 week of treatment.

24.  PHOBIA (DSM-IV): an irrational fear that produces a conscious avoidance of the feared subject, activity, or situation;  the presence or the anticipation of the phobic entity elicits severe (and disruptive) distress

25.  a strong, persisting fear of an object or situation;  people with specific phobias may anticipate harm, or may panic at the thought of losing control  SPECIFIC PHOBIAS of: animal, natural environment, blood- injection-injury, situational type of specific phobia

26.  social anxiety disorder: a strong, persisiting fear of various social situationsin which humiliation or ambarrassment can occur generalized social phobia – phobic avidance of most social situations (a chronic and disabling condition)

27.  the lifetime prevalence rates is about 11 % for specific phobia, and 3 – 13 % for social phobia  specific phobia is more common than social phobia  specific phobia is the most common mental disorder among women and the second most common among men, second only to substance-related disorders  the female-to-male ratio is about 2 to 1 usually onset during adolescence or mid-20s

28. Pharmacotherapy: b-adrenergic receptor antagonists Psychotherapy: exposure therapy insight-oriented psychotherapy hypnosis (self-hypnosis) supportive psychotherapy family therapy

29.  Stressor factor (last 6 months)  Ruminations, obsessive thouhts according to stressor factor.  Symptoms: sleep disturbances, irritation, attention deficites, memory impairment, narrowing of interests, pesimism.

30.  1 month – acutestres disorder ASD  3 months – acute PTSD  After 6 months – PTSD of late onset  Years – chronic PTSD

31.  Obsession a recurrent and intrusive thought, feeling, idea, or sensation  Compulsion a conscious, standarized, recurring pattern of behavior, such as counting, checking, or avoiding

32.  recurring obsessions or compulsions severe enough to be time consuming or cause marked distress or significant impairment  obsessions increase anxiety, whereas carrying out compulsions reduces it  when a person resists carrying out a compulsion, anxiety is increased  people with the disorder recognize that their reactions are irrational or disproportionate (ego- dysthonic)

33.  contamination – an obsession of contamination, followed by washing or accompanied by compulsive avoidance of the presumably contaminated object  pathological doubt – an obsession of doubt, followed by a compulsion of checking  intrusive thoughts – intrusive obsessional thoughts without a compulsion (usually repetitious thoughts of a sexual or aggressive act that is reprehensible to the patient)  symmetry – the obsessive need for symmetry or precision, which can lead to a compulsion of slowness

34.  the lifetime prevalence of OCD in general population is estimated at 2 to 3 %  OCD is the fourth most common psychiatric diagnosis after phobias, substance abuse and major depressive disorder  men and women are equally likely to be affected the mean age of onset is about 20 years  people with obsessive-compulsive disorder are commonly affected by other mental disorders

35. SSRIs (in higher doses) clomipramine Psychotherapy : - cognitive behavioural - insight oriented therapy

36.  a disorder characterized by the presence of one or more neurological symptoms (paralysis, blindness, mutism) that cannot be explained by a known neurological or medical disorder  psychological factors must be associated with the initiation or the exacerbation of the symptoms  the symptom of deficit is not intentionally produced or feigned

37.  SENSORY SYMPTOMS anesthesia and paresthesia are common, especially of the extremities – the disturbance distribution inconsistent with that of neurological disease (stocking- and-glove anesthesia) symptoms may involve the organs of special sense – deafness, blindness, and tunnel vision (uni- or bilateral)  MOTOR SYMPTOMS abnormal movements – gross rhythmical tremors, choreiform movements, tics, and jerks gait disturbance – astasia-abasia – ataxic, staggering gait accompanied by gross, irregular, jerky truncal movements and thrashing and waving arm movements weakness paralysis and paresis involving one, two, or four limbs  SEIZURE SYMPTOM – pseudoseizures

38.  the lifetime prevalence of some symptoms of conversion disorder may occur in one third of the general population  75 % of patients may not experience another episode  the ratio of women to men is at least 2 to 1 (to 5 to 1)  conversion disorder can have its onset at any time (most common in adolescents and young adults)  acompaining diagnoses – major depressive disorder, anxiety disorders, and schizophrenia

39.  the initial conversive symptoms of 90-100 % patients resolve spontaneously in a few days or less than a month  insight-oriented, supportive or behavior therapy, brief and direct forms of short-term psychotherapy may be effective  the most important feature of the therapy is a relationship with a caring and authoritative therapist  hypnosis, anxiolytics, and behavioral relaxation exercises are effective in some cases

40.  neurasthenia is characterized by a wide variety of signs and symptoms – chronic fatigue and disability -the most common are chronic weakness and fatigue, aches and pains, general anxiety or nervousness  most often occurs during adolescence or middle age

41. the mental fatigability : - feelings of exhaustion after a minor mental effort feelings of physical weakness and exhaustion: -after only minimal effort, accompanied by muscular aches and pains and inability to relax

42.  The key concept in the current treatment of neurasthenia is understanding that symptoms are not imaginary: they are objective and are produced by emotions that influence the autonomic nervous system, affecting body functions  patients should be reassured that the administration of medication (to relieve medical symptoms) combined with concurrent psychotherapeutic intervention will be successful

43.  a preoccupation with fears of contracting, or the false belief of having a serious disease, based on the misinterpretation of physical signs or sensations  this preoccupations result in significant distress and impairment of personal, social, and occupational functioning  there may be an obvious association between exacerbations of hypochondriacal symptoms and psychosocial stressors

44.  prevalence of 4-6 % in a general medical clinic population  men and women are equally affected by hypochondriasis  although the onset of symptoms can occur at any age, the disorder most commonly appears in 20s to 30s  hypochondriasis is often accompanied by symptoms of depression and anxiety and commonly coexists with a depressive or anxiety disorder

45.  patients are usually resistant to psychiatric treatment  most of patients with hypochondriasis eventually improve significantly  group therapy is the most effective therapy

46.  body dysmorphic disorder, characterized by a false belief or exaggerated perception that a body part is defective;  pain disorder, characterized by symptoms of pain that are either solely related to or significantly exacerbated by psychological factors

47.  defined as a state of disrupted "consciousness, memory, identity, or perception of the environment"  "a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements"  dissociation is a self-defense against trauma – it creates a vertical split so that mental contents coexist in parallel consciousness

48. An inability to remember information, usually related to a stressful or traumatic event, that cannot be explained by ordinary forgetfulness, the ingestion of substances, or a general medical condition

49.  Sudden and unexpected travel away from home or work, associated with an inability to recall the past and with confusion about a person's personal identity or with the adoption of a new identity

50.  characterized by the presence of two or more distinct personalities within a single person (generally considered the most severe and chronic of the dissociative disorders)

51.  characterized by recurrent or persistent feelings of detachment from the body or mind

52.  a somatic disorder resulting from, or being intensified by psychical factors  for example: angina pectoris, arythmias, bronchial asthma, systemic diseases (LE, RA), headaches, hypertension, colitis ulcerosa, metabolic and hormonal disturbances, gastric ulcer, and other

53.  cooperation among specialists treating psychosomatic patients  pharmacotherapy  psychotherapy - symptomatic only  supportive insight-oriented or group therapy  behavioral therapy

54. The treatments currently available for anxiety disorders are among the most effective in clinical medicine. Pharmacological, cognitive-behavioral, and psychodynamic approaches have all proved useful in combating anxiety disorder.

55. 1. Benzodiazepines - short acting (lorazepam) - long acting (klonazepam, bromazepam, cloranxen) 2. TCI (clomipramine ) 3. SSRI, SNRI, (fluoxetyna, fluwoksamina), (wenlafaksyna)

56.  4. Inhibitors MAO type A - IMAOA (moklobemid)  5. Buspiron  6. Neuroleptics