Neurosis is a class of functional mental disorder involving chronic distress but neither delusion or hallucination

1. NEUROTIC DISORDER
BY,
MS SHWETA GODSE

3. OUTLINE FOR PRACTICE TEACHING
oIntroduction
oICD Classification
oOrigin
oDefinition of neurosis
oAnxiety disorder
oPhobic anxiety disorder
oGeneralized anxiety disorder
oPanic attack
oObsessive compulsive disorder

4. INTRODUCTION
Neurotic Disorder (Neurosis) is a less severe from
of psychiatric disorder where, patient show either
excessive or prolonged emotional reaction to any
given stress. These Disorder are not caused by
organic brain disease & however severe, do not
involve Hallucination & Delusions.

5. ICD 10 CLASSIFICATION
F40-F48 – Neurotic, stress-related and
somatoform disorders (F40-F48)
•F40 – Phobic anxiety disorders.
•F41 – Other anxiety disorders.
•F42 – Obsessive-compulsive disorder.
•F43 – Reaction to severe stress, and adjustment
disorders.
•F44 – Dissociative [conversion] disorders.
•F45 – Somatoform disorders.
•F48 – Other neurotic disorders.

6. ORIGINS
The term ‘Neurosis’ is derived from two greek words
Neuron means nerve with the suffix osis means diseased
or abnormal condition.
The word neurosis means "nerve disorder," and was first
coined in the late eighteenth century by William Cullen, a
Scottish physician.
Cullen's concept of neurosis encompassed those nervous
disorders and symptoms that do not have a clear organic
cause.
Sigmund Freud later used the term anxiety neurosis to
describe mental illness or distress with extreme anxiety as
a defining feature.

7. DEFINITION OF NEUROSIS
1) The presence of a symptom or group of symptoms
which cause subjective distress to the patient.
2) Neurosis is an illness that represents a variety of
psychiatric conditions in which emotional distress or
unconscious conflict is expressed through various
physical, physiological and mental disturbances which
may include physical symptoms.
e.g Anxiety, Hysteria, phobia, depression, obsessive
compulsive tendencies.

8. ANXIETY DISORDER
ANXIETY :It is a normal phenomenon which
is characterizing out of anticipation of
danger.
ANXIETY DISORDER :These are abnormal
stats in which symptoms of anxiety which are
not caused by organic brain disease

9. Anxiety Disorder are classified as following:-
Phobic Anxiety
Disorder
Panic Anxiety
Disorder
Generalized
Anxiety Disorder

10. PHOBIC ANXIETY DISORDER
A Phobia is an unreasonable fear of a specific
object , activity or situation. This irrational fear is
characterized by various features.

11. TYPES OF PHOBIA
1 •Simple phobia
2 •Social phobia
3 •Agoraphobia

12. 1.SIMPLE PHOBIA (SPECIFIC PHOBIA)
Simple phobia is an irrational fear of a specific
object or stimulus.
Simple phobias are common in childhood.
By early teenage most of these fears are lost,
but a few persist till adult life.

13. SIGN AND SYMPTOMS
1) Irrational and persistent fear of object/situation
2) Immediate anxiety on contact with feared object
3) Loss of control, fainting or panic response
4) Worry with anticipatory anxiety
5) Possible impaired social or work functioning
6) Avoidance of activities involving feared stimulus.

14. AIDSphobia
Hematophobia
Insectophobia
Example of simple phobia

15. 2. SOCIAL PHOBIA
Social phobia is an irrational fear of performing
activities in the presence of other people or
interacting with others.
The patient is afraid of his own actions being
viewed by others critically, resulting in
embarrassment or humiliation.

16. S/S:-
1)Hyperventilation
2) Sweating, cold, and clammy hands
3)palpitation
4)Confusion
5)Gastrointestinal symptoms
6)Trembling hands and voice

18.  S/S:-
 Overriding fear of open or public places
 When accompanied by panic disorder, fear that having
panic attacking public
It is characterized by an irrational fear of being in
places away from the familiar setting of home, in
crowds, or in situations that the patient cannot
leave easily.
3) AGORAPHOBIA

20. PSYCHODYNAMIC THEORY
Repression:- (classical defence mechanism that protects
you from unwanted ideas & fearful stimulus) When the
repression is fail the secondary defence mechanism is
displacement & come into the action that we got fear.
ETIOLOGY FOR PHOBIC ANXIETY
DISORDER

21. LEARNING THEORY
According to classical conditioning a stressful
stimulus produce an unconditioned response-
fear. (The harmless object alone produce the fear)

22. COGNITIVE
THEORY
Anxiety is the produce of
faulty cognition. Cognitive
theorists believe that some
individuals engage in
negative & irrational
thinking that produce
anxiety reaction

23. COURSE :-
 PHOBIA COMMON IN WOMEN
 ONSET IS SUDDEN WITHOUT CAUSE
 THE COURSE IS USUALLY CHRONIC
 DIAGNOSIS :-
 NO SPECIFIC DIAGNOSTIC TEST

24. TREATMENT
 PHARMOCOTHERAPY :-
 BENZODIZEPINES
 ANTIDEPRESSANT
 BETA BLOCKERS
 BEHAVIOR THERAPY :-
 Flooding
 Systematic desensitization
 Exposure and response prevention
 Relaxation techniques

25. o Flooding
A more extreme behavioural therapy is flooding.
Rather than exposing a person to their phobic
stimulus gradually, a person is exposed to the most
frightening situation immediately.
For example, a person with a phobia of dogs would
be placed in a room with a dog and asked to stroke
the dog straight away.

26. COGNITIVE THERAPY
•This therapy is used to break the anxiety patterns in
phobic disorders.
PSYCHOTHERAPY
•Supportive psychotherapy is a helpful adjunct to
behavior therapy and drug treatment.
• Group therapy Individual therapy Music
therapy Dance therapy Talking therapy Family
therapy Drama therapy

27. NURSING MANAGEMENT
Nursing Assessment
Assessment parameters focus on
oPhysical symptoms
oPrecipitating factors
oAvoidance behavior associated with phobia
oImpact of anxiety on physical functioning
oNormal coping ability
oThought content and social support systems.

28. NURSING DIAGNOSIS
Nursing Diagnosis I
Fear related to a specific stimulus (simple phobia),
or causing embarrassment to self in front of
others, evidenced by behavior directed towards
avoidance of the feared object/ situation.
Nursing Diagnosis II
Social isolation related to fear of being in a place
from which one is unable to escape, evidenced by
staying alone, refusing to leave the room/home.

29. GENERALIZED ANXIETY DISORDER
•Generalized anxiety disorders are those in which
anxiety is unvarying and persistent (unlike phobic
anxiety disorders where anxiety is intermittent and
occurs only in the presence of a particular stimulus).
•It is the most common neurotic disorder, and it occurs
more frequently in women.
•The prevalence rate of generalized anxiety disorders
is about 2.5-8%.

30. CLINICAL FEATURES
Psychological
Fearful anticipation, irritability, sensitivity to noise,
restlessness, poor concentration, worrying thoughts
and apprehension.

31. Physical symptoms of GAD

32. COURSE
It is characterized by an insidious onset in the
third decade and usually runs a chronic course.
TREATMENT FOR GAD

33. PANICDISORDER
Panic disorder is characterized by anxiety, which is
intermittent and unrelated to particular circumstances
(unlike phobic anxiety disorders where, though anxiety is
intermittent, it occurs only in particular situations).
The central feature is the occurrence of panic attacks,
i.e. sudden attacks of anxiety in which physical
symptoms predominate and are accompanied by fear of a
serious consequence such as a heart attack.
The lifetime prevalence of panic disorder is 1.5 to 2
percent.
It is seen 2to 3timesmore often in females.

34. CLINICAL FEATURES OF PANIC ATTACKS

35. ETIOLOGY OF ANXIETY DISORDERS
(BOTH GAD AND PANIC DISORDER)
1) GENETIC THEORY
Anxiety disorder is most frequent among
relatives of patients with this condition.
 15to 20%of the first-degree relatives
The concordance rate in monozygotic twins of
patients with panic disorder is 80 percent.

36. 2) BIOCHEMICAL FACTOR
Alteration in GABA levels may lead to production of clinical
anxiety.
3) PSYCHODYNAMIC THEORY
According to this theory anxiety is usually dealt with repression.
When repression fails to function adequately, other secondary
defense mechanisms of ego come into action.
In anxiety repression fails to function adequately and the
secondary defense mechanisms are not activated.
Hence anxiety comes to the forefront.

37. 4) Behavioral theory
Anxiety is viewed as an unconditional inherent
response of the organism to a painful stimulus.
5) Cognitive theory
According to this theory anxiety is related to
cognitive distortions and negative automatic
thoughts.

38. TREATMENT FOR GAD AND PANIC ATTACK
Pharmacotherapy
• Benzodiazepines (e.g. alprazolam, clonazepam)
• Antidepressantsforpanicdisorder
Beta blockers to control severe palpitations
that have not responded to anxiolytics (e.g.
propranolol)

39. Behavioral therapies
• Bio-feedback
Biofeedback is a mind-body technique that
involves using visual or auditory feedback to gain
control over involuntary bodily functions. This
may include gaining voluntary control over such
things as heart rate, muscle tension, blood flow,
pain perception, and blood pressure.
• Hyperventilation control

40. Other psychological therapies
• Jacobson's progressive muscle relaxation
technique, yoga, pranayama, meditation and self-
hypnosis
• Supportive psychotherapy

41. Nursing Management
Nursing Assessment
• Physical, psychological and social data.
•Specific symptoms should be noted, along with
statements made by the client about subjective
distress.
•The nurse must use clinical judgment to determine
the level of anxiety being experienced by the client.

42. NURSING DIAGNOSIS
Nursing Diagnosis I
Panic anxiety related to real or perceived threat to
biological integrity or self-concept, evidenced by
various physical and psychological manifestations.
Nursing Diagnosis II
Powerlessness related to impaired cognition,
evidenced by verbal expression of lack of control
over life situations and non-participation in decision-
making related to own care or significant life issues.

43. INTERVENTION
(a) Stay with the patient and offer reassurance of
safety and security.nterventions Rationale
(b) Maintain a calm, non-threatening matter of- fact
approach.
(c) Use simple words and brief messages, spoken
calmly and clearly to explain hospital experiences.
(d) Keep immediate surroundings low in stimuli (dim
lighting, few people).

44. (e) Administer tranquilizing medication as
prescribed by physician.
(f)When level of anxiety has been reduced, explore
possible reasons for occurrence.
(g) Teach signs and symptoms of escalating
anxiety and ways to interrupt its progression
(relaxation techniques, deep-breathing exercises
and meditation, or physical exercise like brisk
walks and jogging.

45. •Nursing interventions to improve self-control in
anxious patients
(a) Allow patient to take as much responsibility
as possible for self-care activities, provide positive
feedback for decisions made.
(b) Assist patient to set realistic goals.
(c) Help identify life situations that are within
patient's control.
(d) Help patient identify areas of life situation that
are not within his ability to control.
(e)Encourage verbalization of feelings related to
this inability.

46. OBSESSIVE COMPULSIVE
DISORDER

47. OVERVIEW
Obsessive-Compulsive Disorder (OCD) is a
common, chronic and long-lasting disorder in
which a person has uncontrollable, reoccurring
thoughts (obsessions) and behaviours (compulsions)
that he or she feels the urge to repeat over and over.

48. CORE CONCEPT
OBSESSIONS
Recurrent and persistent thoughts, impulses, or
images Experienced as intrusive and stressful.
Recognized as being excessive and unreasonable
even though they are a product of one’s mind. The
thought, impulse, or image cannot be expunged by
logic or reasoning

49. CORE CONCEPT
COMPULSIONS
Repetitive ritualistic behavior or thoughts, the
purpose of which is to prevent or reduce distress or
to prevent some dreaded event or situation.

50. DEFINITION
According TO ICD 9
Obsessive compulsive disorder is a state in which
“ the outstanding symptom is a feeling of subjective
compulsion- which must be resisted – to carry out some
action, to dwell on an idea, to recall an experience, or ruminate
on an abstract topic.
Obsessive-compulsive disorder (OCD) is a
mental disorder in which people have unwanted and repeated
thoughts, feelings, ideas, sensations (obsessions), and
behaviours that drive them to do something over and over
(compulsions)

51. ICD CLASSIFICATION OF OCD
F42 OBSESSIVE COMPULSIVE DISORDER
F42.0 Predominantly obsessive thoughts or
rumination
F42.1 Predominantly compulsive acts
F42.2 Mixed obsessional thoughts and act
F42.8 Other obsessive compulsive disorders
F42.9 obsessive compulsive disorders unspecified

53. CHARACTERISTICS OF OCD
•They are ideas, impulses or images, which include
into conscious awareness repeatedly.
•They are recognized as the individuals own thoughts
and impulses.
•They are unpleasant and recognized as irrational
patient tries to resist them but is unable to.

54. •Failure to resist leads to marked distress.
•Rituals are performed with a sense of subjective
compulsion (urge to act).
•They are aimed at either preventing or
neutralizing the distress or fear arising out of
obsessions.

56. ETIOLOGICAL FACTORS
•Genetic Factors
Twin studies have consistently found a significantly
higher concordance rate for monozygotic twins than
for dizygotic twins. are also affected with the
disorder.

57. •Biochemical Influences
A number of studies
suggest that the
neurotransmitter serotonin
(5-HT) may be abnormal
in individuals with
obsessive-compulsive
disorder.

58. •Psychoanalytic Theory
The psychoanalytic concept (Freud) views patients
with obsessive-compulsive disorder (OCD) as
having regressed to developmentally earlier stages
of the infantile superego, whose harsh exacting
punitive characteristics now reappear as part of the
psychopathology.

60. •Behavior Theory
This theory is more useful for treatment purposes.

61. CLINICAL FEATURES
OF OCD

62. 1) Obsessional Thoughts
e.g word, ideas, beliefs
2) Obsessional Doubts
e.g Repeteadly checking doors, gas stoves
3) Obsessional Remuneration
e.g Internal debates or arguments
4) Obsessional Rituals
e.g Repeated counting, Hand washing, repetition of words
5) Obsessional Impulse
e.g Injuring to child, shouting in church
6) Obsessional Images
e.g Violent scene, abnormal sexual activities
7) Obsessional Slowness
e.g slowness in daily activities, impairment in work

63. COURSE AND PROGNOSIS
Course is usually long and fluctuating.
A good prognosis is indicated by good social and
occupational adjustment, the presence of precipitating
event and episodic nature of symptoms.
Prognosis appears to be worse when the onset is on
childhood, the personality is obsessional, symptoms
are severe.

64. DIAGNOSIS
•Suggested by demonstration of ritualistic behavior
that is irrational or excessive.
•History taking
• MSE
•MRI and CT shows enlarged basal ganglia in some
patient

65. TREATMENT
Pharmacotherapy
•Antidepressant – fluvoxamine, sertraline
•Anxiolytics - benzodiazepines
Behaviour therapy
•Exposure and response prevention
•Thought stoppage
•Relaxation techniques
•Desensitization
•Aversive conditioning

66. •Exposure and response prevention
•This is vivo exposure procedure combined with
response prevention techniques. E.g compulsive
hand washer is encouraged to touch contaminated
object and then refrain washing in order to break the
negative reinforcement chain.

67. •Thought stoppage

68. •Relaxation techniques
•It includes deep breathing exercise, progressive
muscle relaxation, meditation, and imaginary and
music therapy.

69. •Desensitization
•In this, patient attain a state of complete relaxation
and are then exposed to the stimulus that elicits the
anxiety response.
•The negative reaction of anxiety is inhibited by the
relaxed state.

70. •It consist of three main steps
1) Relaxation techniques
•There are many methods which can be used to induce
relaxation. Some of them are Jacobson’s progressive
muscle relaxation, hypnosis, meditation or yoga,
mental imagery, biofeedback.
2) Hierarchy construction
•Here patient is asked to list all the conditions which
provoke anxiety. Then he asked to list them in a
descending order of anxiety provocation.

71. 3) Desensitization of the stimuli
•This can either be done in reality or through
imagination.
•At first, the lowest item in hierarchy is
confronted.
•The patient is advised to signal whenever anxiety
is produced.
•With each signal he is asked to relax. After a few
trial, patient is able to control his anxiety
gradually.

72. Aversive conditioning
•Pairing of the pleasant stimulus with an unpleasant
response, so that even in absence of the unpleasant
response the pleasant stimulus becomes unpleasant by
association. Punishment is presented immediately after
a specific behavioural response and the response is
eventually inhibited.
OTHER THERAPIES
•Supportive psychotherapy
•Electroconvulsive therapy

73. NURSING ASSSESSMENT
Assessment should focus on the collection of
physical, psychological and social data.
The nurse should be particularly aware of the impact
of obsessions and compulsions on physical
functioning, mood, self esteem and normal coping
ability.
The defence mechanism used, thought content or
process potential for suicide, ability to function and
social support systems available should also be noted.

74. NURSING DIAGNOSIS
•Ineffective individual coping
•Altered role performance
•Disturbed perception
•Potential foe skin integrity

75. INTERVENTION
(a) Work with patient to determine types of situations that increase
anxiety and result in ritualistic behaviours.
(b) Initially meet the patient's dependency needs. Encourage
independence and give positive reinforcement for independent
behaviours.
(c) In the..beginning of treatment, allow plenty of time for rituals. Do
not be judgmental or verbalize disapproval of the behaviour.
(d) Support patient's efforts to explore the meaning and purpose of
the behaviour.

76. (e) Provide structured schedule of activities for patient,
including adequate time for completion of rituals.
(f) Gradually begin to limit amount of time allotted for
ritualistic behaviour as patient becomes more involved in
unit activities.
(g) Give positive reinforcement for non ritualistic
behaviours.

77. EVALUATION
•Dose the patient continue to display obsessive-
compulsive symptoms?
•Is the patient able to use newly learned behaviour to
manage anxiety?
•Can the patient adequately perform self care
activities?

78. SUMMARY
A neurotic person experiences emotional distress
and unconscious conflict, which are manifested in
various physical or mental illnesses.
Neurotic tendencies are common and may
manifest themselves as acute or chronic anxiety,
depression, an obsessive–compulsive disorder, a
phobia, or a personality disorder.

79. CONCLUSION
Anxiety is a normal, but highly subjective, human
emotion. The future remains optimistic for those
who struggle with anxiety. We are confident that
advancements in the treatment of anxiety
disorders will continue to bring hope and relief to
the people, and families, affected by
these disorders.

80. BIBLIOGRAPHY
•R Sreevani, A guide to Mental Health and
Psychiatrics Nursing, Jaypee Brothers 4th
edition, page no 216-227
•KP Neeraja, Essentials of Mental Health and
Psychiatric Nursing, Volume two, Jaypee, Page No
415
•Niraj Ahuja, A short textbook of psychiatry, 6th
edition, Jaypee, page No. 95
•https://www.slideshare.net/susheeldayalwanshi/ne
urotic-disorder
•https://psychology.jrank.org/pages/450/Neurosis.h
tml