Psychiatric 3

Psychosis and Neurosis Section
ANXIETY DISORDERS
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Psychiatric Medicine 3rd presentation Dr.K.Prathapan
Neurosis
Psychosis
Judgment Insight Personality Behavior Contact with reality
preserved
impaired
Dellusion Hallucination
Usually absent
common
eg:
Absence of organic causative factor
Schizophrenia Mood disorders Delusional disorders
Dr.K.Prathapan WWW.MEDSHORTNOTES.COM
Anxiety Disorder
Minor psychiatric disorder Most common psychoneurosis (psychoneurosis is the most common psychiatric illness)
Family Hx 15% present

Anxiety
Simple phobia or Specific isolated phobia
Continuous Anxiety
Episodic
In Defined Situation
Social Phobia
Agoraphobia GENERALIZED ANXIETY DISORDER
In any situation
Panic disorder
Mixed pattern
GAD
Female>Male Persistent symptoms Chronic Pt takes time to go to sleep when asleep, wakes intermittently with worry dreams Hyperventilation Xd more common in panic. At least 6/12 hx
DD for Anxiety
Physical Disorders 1. Hyperthyroidism 2. Hypoglycemia 3. Phenochromocytoma
Psychiatric Disorders 1. Depressive illness 2. Obsessive compulsive disorder 3. Alcohol dependence 4. Drug dependence 5. Benzodiazepine withdrawal 6. Presenile dementia
Psychological Symptoms of ANXIETY

Depersonalization Derealization Distractibility Irritability Restlessness Apprehension and fear Difficulty in concentrating
Somatic symptoms of ANXIETY

GIT Dry mouth Dysphagia Aerophagia Epigastric pain Diarrhea usually Respiratory Dyspnea Chocking Overbreathing Feeling of chest constriction Genitourinary Increased frequency Erectile dysfunction Lack of libido
CVS Palpitation Awareness of missed beats Chest pain
Nervous system Fatigue Blurred vision Dizziness Sensitivity to noise and light Headache Sleep disturbance Trembling
Mixed Anxiety and Depressive Disorder
Commonest mood disorder

Anxiety and Depression present
Panic Disorder
Acute Anxiety Sudden onset No apparent precipitating factor Lasting for few minutes Hyperventilation symptoms Relative hypocalcaemia PaC02 Decreased Arterial pH Increased Sympathetic Activation symptoms Often have catastrophic illness beliefs during the panic attack patient thinks that they are about to die from a stroke or heart attack
Phobic Disorders
Patient knows that the fear is irrational but can not control it If stimuli is medical related such as Doctor, Nurse, Injection ,etc Treatment is difficult as patient prefer to avoid going to hospital. Women > men Genitic factor +
Agoraphobia: Most common, Most severe form
Fear of the market place

Fear of being away from home avoiding travelling Often associated with Claustrophobia in which fear of enclosed spaces is present.
Social phobia:
Fear and avoidance of social situations

Parties, meetings, crowds, strangers. Fear of public speaking or any public performance
Eg :Erythrophobia fear of blushing Shy bladder fear of urinating in public lavatory

Simple phobia/Specific phobia:

arachnophobia -phobia of spiders (usually in women) Algophobia fear of pain Acrophobia Fear of heights Photophobia fear of strong light Xenophobia fear of strangers Thanatophobia fear of death Zoophobia- Fear of animals
Fear of ghosts, fear of thunderstorms, fear of insects, fear of dark, claustrophobia.etc

Management
Rx for GAD and Panic Disorder Psychotherapy Relaxation therapy Behavior therapy
Drug Mx
Benzodiazepines(Drug of choice for GAD)
Antidepressants Fluoxetine DOC for Panic/ Acute Anxiety.
Rx for phobia Treatment of choice Behavior therapy Most common and successful method is Graded Exposure(Systemic Desensitization) Flooding (Kind of Behavior therapy) Directly exposed to phobia Drug of choice (DOC) Benzodiazepines SSRI( selective seratonin reuptake inhibitors) helpful in social phobia.
Benzodiazepines
Alprazolam Diazepam s/e Sedation and memory problems driving is avoided
withdrawal symptoms: Insomina Anxiety Hallucination(Visual) Hypersensitivity to light, Sound and Touch. Convulsions Perceptional disorders Tremulousness Muscle twitchings Dr.K.Prathapan
WWW.MEDSHORTNOTES.COM
SSRI (selective seratonin reuptake inhibitors)

Fluoxetine Paroxetine Sertraline Citalopram Escitalopram
Symptomatic Rx
useful in GAD,Panic Disorders and Social phobias.
Imipramine Clomipramine
B-blockers Propranolol Decreased sympathetic activation symptoms such as Tremor,Palpitation,Tachycardia. But no action on central symptoms such as Anxiety.
These are Tricycylic antidepressant drugs that can be used as alternative for SSRI in Symptomatic Rx of panic and GAD.
Do you re-check many times to confirm the room whether it is locked or not.? HAVE you ever complained any disease to get medical leave in favor of GOING OUT on a DATE with your partner? SO OUR NEXT TOPICS WILL ENTERTAIN YOU EXTREMELY !!!

Psychiatric 3

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Psychiatric 3

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Psychosis and Neurosis Section

Psychiatric Medicine 3rd presentation Dr.K.Prathapan

Judgment Insight Personality Behavior Contact with reality

Absence of organic causative factor

Schizophrenia Mood disorders Delusional disorders

Family Hx 15% present

Simple phobia or Specific isolated phobia

Agoraphobia GENERALIZED ANXIETY DISORDER

Psychological Symptoms of ANXIETY

Somatic symptoms of ANXIETY

CVS Palpitation Awareness of missed beats Chest pain

Mixed Anxiety and Depressive Disorder

Commonest mood disorder

Agoraphobia: Most common, Most severe form

Fear of the market place

Fear and avoidance of social situations

Eg :Erythrophobia fear of blushing Shy bladder fear of urinating in public lavatory

Simple phobia/Specific phobia:

Fear of ghosts, fear of thunderstorms, fear of insects, fear of dark, claustrophobia.etc

Antidepressants Fluoxetine DOC for Panic/ Acute Anxiety.

SSRI (selective seratonin reuptake inhibitors)

useful in GAD,Panic Disorders and Social phobias.

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