6.
AstheniaAsthenia
• General asthenia occurs in many chronic wasting diseases
anemia and cancer,
is probably most marked in diseases of the adrenal gland.
Asthenia may be limited to certain organs or systems of
organs, as in asthenopia, characterized by ready
fatiguability.
Asthenia is also a side effect of Ritonavir (Protease Inhibitor
used in HIV treatment) and fentanyl patches (an opioid
used to treat pain).
The condition is also commonly seen in patients suffering
from chronic fatigue syndrome, sleep disorders or chronic
disorders of the heart, lungs or kidneys.
Differentiating between psychogenic asthenia and true
asthenia with muscular weakness is often difficult, and in
time apparent psychogenic asthenia accompanying many
chronic disorders is seen to progress into a primary
weakness.
10.
Asthenic syndromes treatmentAsthenic syndromes treatment
• Asthenic syndromes with symptoms of a
"simple" fatigue (feeling tired, increased
sensitivity to external stimuli and
pathological bodily sensations) are
preferred tranquilizers narrow spectrum of
action - oxazepam, medazepam, tofizapam,
trioxazine in combination with stimulants
and nootropics
23.
Phobic (anxiety) disordersPhobic (anxiety) disorders
(cont’d)(cont’d)
• Social phobia - the fear and avoidance of social situations:
crowds, strangers, parties and meetings. Public speaking
would be the sufferer’s worst nightmare. It is suffered by
2% of the population.
• Simple phobias - The commonest is the phobia of spiders
(arachnophobia), particularly in women. The prevalence of
simple phobias is 7% in the general population.
• Other common phobias include insects, moths, bats, dogs,
snakes, heights, thunderstorms and the dark.
• Children are particularly phobic about the dark, ghosts and
burglars, but the large majority grow out of these fears.
24.
Treatment of anxiety disorders
• Psychological treatments
■ Relaxation techniques can be effective in mild/moderate
anxiety. Relaxation can be achieved in many ways,
including complementary techniques such as meditation
and yoga. Conventional relaxation training involves
slowing down the rate of breathing, muscle relaxation
and mental imagery.
■ Anxiety management training involves two stages. In the
first stage, verbal cues and mental imagery are used to
arouse anxiety to demonstrate the link with symptoms.
In the second stage, the patient is trained to reduce this
anxiety by relaxation, distraction and reassuring
self-statements.
25.
Treatment of anxiety
disorders(cont’d)
• Behaviour therapies are treatments that are
intended to change behaviour and thus symptoms.
The most common and successful behaviour
therapy (with 80% success in some phobias) is
graded exposure, otherwise known as systematic
desensitization. First, the patient rates the phobia
into a hierarchy or ‘ladder’ of worsening fears
(e.g. in agoraphobia: walking to the front door
with a coat on; walking out into the garden;
walking to the end of the road). Second, the
patient practises exposure to the least fearful
stimulus until no fear is felt. The patient then
moves ‘up the ladder’ of fears until they are cured.
27.
Drug treatmentsDrug treatments
• Initial ‘drug’ treatment should involve advice to
gradually cease taking anxiogenic recreational
drugs such as caffeine and alcohol (which can
cause a rebound anxiety and withdrawal).
• Prescribed drugs used in the treatment of anxiety
can be divided into two groups:
- those that act primarily on the central nervous
system,
- those that block peripheral autonomic receptors.
31.
Anxiety. Drug treatmentsDrug treatments
SELECTIVE SEROTONIN REUPTAKESELECTIVE SEROTONIN REUPTAKE
INHIBITORSINHIBITORS
• Most SSRIs (e.g. fluoxetine, paroxetine, sertraline,
escitalopram, citalopram) are useful symptomatic
treatments for general anxiety and panic disorders,
as well as some phobias (social phobia).
Imipramine and clomipramine are alternative
symptomatic treatments for panic disorder and
GAD. Treatment response is often delayed several
weeks; a trial of treatment should last 3 months.
32.
Anxiety. Drug treatmentsDrug treatments
TRICYCLIC/POLYCYCLICTRICYCLIC/POLYCYCLIC
ANTIDEPRESSANTSANTIDEPRESSANTS
(block norepinephrine, and serotonin(block norepinephrine, and serotonin
uptake into the neuron)uptake into the neuron)
• Imipramine and clomipramine are
alternative symptomatic treatments for
panic disorder and GAD. Treatment
response is often delayed several weeks; a
trial of treatment should last 3 months.
33.
Anxiety. Drug treatmentsDrug treatments
• Many of the symptoms of anxiety are due to
an increased or sustained release of
epinephrine (adrenaline) and
norepinephrine (noradrenaline) from the
adrenal medulla and sympathetic nerves.
Thus, betablockers such as propranolol (20–
40 mg two or three times daily) are
effective in reducing peripheral symptoms
such as palpitations, tremor and
tachycardia, but do not help central
symptoms such as anxiety.