1. Neurotic disorders

2. Psychosis vs. Neurosis Specifications Psychosis Neurosis
Genetic factors
More important
Less important
Stressful life events
More
Less
Behavior
Severely affected
Not affected
Thinking and perception
Disturbed
Not disturbed
Judgment
Impaired
Intact
Insight
Lost
Present
Drugs
Major tranquilizers
Minor tranquilizers
ECT
Very useful
Not needed
Prognosis
Bad
Good

3. Neurosis are classified under F4 in ICD 10
F40-F49- Neurotic, stress related and somatoform disorders
F40 – phobic anxiety disorders
F 41 – other anxiety disorders
F 42 – Obsessive compulsive disorder
F 43 – Reaction to severe stress and adjustment disorders
F 44 – Dissociative (conversion) disorder
F 45 – Somatoform disorders
F 48 – other neurotic disorders

4. Psychopathology
Disturbances in serotonin, norepinephrine and gamma aminobutyric acid (GABA) appear to be most significant.
Serotonin is thought to be decreased and norepinephrne is thought to be increased in anxiety disorders.
GABA is decreased in anxiety disorders , allowingfor increased cellular excitability.

5. Etiological factors Psychoanalytic theories
Freud proposed that anxiety is a signal to the ego to take defensive action against the “pressure” from within. If repression is unsuccessful as a defense, other defense mechanisms may result in symptom formation

6. Generalized Anxiety Disorders (GAD)
It is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry
It is a common chronic disorder characterized by long lasting anxiety that is not focused on any one subject or situation.

7. Biological theories 1. Autonomic nervous system
James Lange theory states that subjective anxiety is a response to peripheral phenomena. Stimulation of autonomic nervous system causes cardio vascular, respiratory and GI symptoms

8. 2. Norepinephrine (NE)
Studies have found that, in patients with panic disorder, - adrenergic agonists (isoproterenol) and - adrenergic antagonists (yohimbine) can produce frequent and severe panic attacks, conversely clonodine, an adrenergic agonist, reduces anxiety symptoms in some experimental and therapeutic situations

9. Environmental factors
Trauma, stressful events, changing jobs or schools
GAD s worse during the period of stress
Use and withdrawal from addictive substances, alcohol, caffeine, nicotine etc can worsen anxiety

10. Epidemiology Onset is usually from childhood to late adulthood
Onset is approximately 31
More in women
Common in elderly population also

11. symptoms Cardiovascular Tachycardia Chest pain Palpitations Flushing
fainting

12. Respiratory
Sighing
Choking
Yawning
Dyspnoea

13. Alimentary symptoms
Dry mouth
Dysphagia
Dyspepsia
Butterflies in stomach
Nausea
Abdominal pain
diarrhea

14. Genito urinary symptoms
Frequency
Hesitation
Sexual dysfunctions
Nerveous symptoms
Tension headache
Blurring of vision
Tinnitus
Tremor
Dilated pupils

15. Musculo skeletal symptoms
Aches and pains
Teeth clenching
Chronic jerks

16. Physiological symptoms
Anxious mood
Worry or fear
Irritability
Inability to relax
Feeling of being unable to cope
Feeling restless
Depersonalization
Initial insomnia
Nightmare

17. Treatment Medication Benzodiazepines (valium, librium)
Anti depressants (paxil, prozac, zoloft)
TCA, SSRI
Psychotherapy
CBT
Biofeedback
Relaxation therapy
Supportive therapy

18. Prevention Stop consuming products contain caffeine
Do not take OTC medicines
Exercise daily and eat healthy diet
Seek counseling help after traumatic experience
Practice stress management techniques

19. Panic disorder
A sudden overwhelming feeling of terror or impending doom. This severe form of emotional anxiety is usually accompanied by behavioral, cognitive and physiological signs and symptoms considered to be outside the expected range of normalcy

20. Classification F41.0 – panic disorder
F41.1 – Generalized Anxiety Disorder
F 41.2 – Mixed anxiety and depressive disorder
F41.9 – other specified anxiety disorders

21. Epidemiology
Lifetime prevalence estimates range from 1.5 – 5% for panic disorder and % for panic attacks
Women are more likely to be affected than men by a 2-3 fold factor
Highest incidence is in late adolescence and second peak in mid 30s.

22. Causes
Genetic factors (the concordance rate in monozygotic twins of patients with panic disorder is 80%)
Biochemical factors (reduction in GABA activity in brain)
Malfunctioning of brain structure such as amyldala and hormonal/ adrenaline glands.
Co morbid condition with heridity disorders , such as bipolar disorder and genetic predisposition to alcoholism

23. Medical conditions like hypoglycemia, hyperthyroidism, mitral valve prolapse, labirinthitis and pheochromocytoma can aggravate panic disorder
Stressful life events, life transitions and environment play a role in the onset of panic disorder.

24. psychopathology
Serotonergic model suggests an exaggerated or inefficient post synaptic receptor response to synaptic serotonin
Catecholamine model postulates increased sensitivity to or improper processing of adrenergic CNS discharge, with potential hypersensitivity of presynaptic alpha-2 receptors

25. Lactate model focuses on symptom production by postulated aberrant metabolic activity induced by lactate.
GABA model postulates decreased inhibitory receptor sensitivity, with a resultant excitatory effect
Neuroanatomic model suggests panic attacks are mediated by a fear network in the brain that involves amygdala, hypothalamus and brainstem centers.

26. Clinical features Shortness of breath and smothering sensations
Pounding and rapid heart beat
Palpitations
Chocking, chest discomfort and pain
Sweating, dizziness, unsteady feelings or fainting
Nausea or abdominal discomfort

27. Depersonalization or derealization
Numbness or tingling sensations
Flushes or chills
Trembling or shaking
Fear of dying or having heart attack
Fear of being out of control, agoraphobia, depression

28. Diagnostic criteria Recurrent unexpected panic attacks
At least one of the attacks has been followed by 1 month with the following
Persistent concern about having additional attacks
Worry about implications of the attack or its consequences
Significant change in behavior related to the attacks
Presence or absence of agarophobia

29. Treatment Pharmacotherapy SSRI Benzodiazepines
Sedating antidepressants (TCA)
Lorazapam (Avitan) mg IV/ IM 1-2mg PO bid/tid
Clonazepam (Klonopin) 0.5-2mg PO bid/tid

30. Psychotherapy CBT Psychodynamic psychotherapy Relaxation techniques
Respiratory techniques
Interoceptive training
Interoceptive exposure is a behavioral therapy technique used in the treatment of panic disorder.[1] It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and can be contrasted with in vivo exposure, which exposes the person directly to a feared situation. Interoceptive exposure can be used as a means to induce depersonalization and derealization.[2]

31. Nursing management Panic anxiety
Stay with client and offer reassurance
Maintain a calm, non threatening, matter of fact approach
Use simple words and brief massages.

32. Keep immediate surroundings low in stimuli
Administer tranquilizing medication as ordered by physician
When level of anxiety has been reduced, explore possible reasons for re occurrence
Teach symptoms of escalating anxiety and ways to interrupt its progression

33. powerlessness
Allow client to take as much responsibility as possible for self care practices
Provide client with privacy as needed
Provide positive feedback on decisions made
Assist client to set realistic goals
Help identify areas of life situation that client can control
Encourage verbalization of feelings related to inability

34. Phobia
A phobia is defined as an irrational fear that produces a conscious avoidance of the feared subject, activity or situation. The affected person usually recognizes that the reaction is excessive

35. Classification Agoraphobia Social phobia Specific phobia
Other phobic anxiety disorders
Phobic anxiety disorder, unspecified