The document discusses anxiety disorders including their neurobiology, symptoms, and management. It covers types of anxiety like generalized anxiety disorder, panic disorder, and social anxiety disorder. The neurobiology sections explain the fear and worry circuits in the brain and how neurotransmitters like serotonin, GABA, and norepinephrine are involved. Symptoms of the different disorders are provided along with an overview of pharmacological and non-pharmacological treatment approaches.
This document provides an overview of anxiety disorders, including their neurobiology, symptoms, and types. It discusses the classification of anxiety disorders and conditions like generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. The neurobiology sections explain the fear and worry circuits in the brain and the role of neurotransmitters like serotonin, GABA, and norepinephrine in anxiety disorders.
This document provides an overview of anxiety disorders, including their neurobiology, symptoms, and types. It discusses the classification of anxiety disorders and covers specific disorders like generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. The neurobiology sections describe the fear and worry circuits in the brain and the role of neurotransmitters like norepinephrine, serotonin, and GABA. Symptoms for each disorder are also outlined.
The document provides an overview of anxiety disorders, including their neurobiology, symptoms, and types. It discusses the fear and worry circuits in the brain involved in anxiety disorders. Common anxiety disorders like generalized anxiety disorder, panic disorder, and social anxiety disorder are described in terms of their diagnostic criteria and characteristic psychological and physical symptoms. The roles of neurotransmitters like serotonin, GABA, and norepinephrine in the neurobiology of anxiety are also summarized.
This document provides an overview of delirium, including its definition, history, epidemiology, predisposing factors, etiology, pathophysiology, and management. Delirium is characterized by an acute decline in consciousness and cognition, particularly impaired attention. It has been described since Hippocrates' time. It commonly occurs in elderly hospitalized patients, with prevalence rates as high as 80% in intensive care units. Predisposing factors include older age, dementia, sensory impairment, and medical comorbidities. Delirium has many potential causes including infections, medications, metabolic disturbances, and neurological disorders. The pathophysiology is complex and likely involves imbalances in several neurotransmitter systems such as acetylcholine, dopamine
The slide contains how to take a history of seizure patient when to start and stop AEDs
general introduction of seizure and ILAE classification
anti-epileptic treatment and comorbidities
seizure and heart , lung , liver, kidney diseases
I hope this will help you in exams and also in your clinical practice.
Thank you
THE NEUROBIOLOGY OF PSYCHOSIS AND THE ROLE OF ANTIPSYCHOTICSSubrata Naskar
The document provides an outline for a presentation on psychosis. It discusses what psychosis is, the differences between psychosis and neurosis, symptoms of psychosis including positive and negative symptoms, and various neurobiological theories including the dopamine hypothesis and glutamate hypothesis. It also discusses the role of antipsychotic medications, how they work, and newer concepts for pharmacologically controlling psychosis.
This document discusses hypnotics and anxiolytics that are used to treat sleep difficulties and anxiety in the nervous system. It covers the management of insomnia and anxiety, both non-pharmacologically through lifestyle changes and cognitve behavioral therapy, and pharmacologically mainly through benzodiazepines. It notes that drug therapy should only be used short-term due to risks of tolerance and dependence. Specific groups like the elderly require lower doses due to increased sensitivity.
This document provides an overview of anxiety disorders, including their neurobiology, symptoms, and types. It discusses the classification of anxiety disorders and conditions like generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. The neurobiology sections explain the fear and worry circuits in the brain and the role of neurotransmitters like serotonin, GABA, and norepinephrine in anxiety disorders.
This document provides an overview of anxiety disorders, including their neurobiology, symptoms, and types. It discusses the classification of anxiety disorders and covers specific disorders like generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. The neurobiology sections describe the fear and worry circuits in the brain and the role of neurotransmitters like norepinephrine, serotonin, and GABA. Symptoms for each disorder are also outlined.
The document provides an overview of anxiety disorders, including their neurobiology, symptoms, and types. It discusses the fear and worry circuits in the brain involved in anxiety disorders. Common anxiety disorders like generalized anxiety disorder, panic disorder, and social anxiety disorder are described in terms of their diagnostic criteria and characteristic psychological and physical symptoms. The roles of neurotransmitters like serotonin, GABA, and norepinephrine in the neurobiology of anxiety are also summarized.
This document provides an overview of delirium, including its definition, history, epidemiology, predisposing factors, etiology, pathophysiology, and management. Delirium is characterized by an acute decline in consciousness and cognition, particularly impaired attention. It has been described since Hippocrates' time. It commonly occurs in elderly hospitalized patients, with prevalence rates as high as 80% in intensive care units. Predisposing factors include older age, dementia, sensory impairment, and medical comorbidities. Delirium has many potential causes including infections, medications, metabolic disturbances, and neurological disorders. The pathophysiology is complex and likely involves imbalances in several neurotransmitter systems such as acetylcholine, dopamine
The slide contains how to take a history of seizure patient when to start and stop AEDs
general introduction of seizure and ILAE classification
anti-epileptic treatment and comorbidities
seizure and heart , lung , liver, kidney diseases
I hope this will help you in exams and also in your clinical practice.
Thank you
THE NEUROBIOLOGY OF PSYCHOSIS AND THE ROLE OF ANTIPSYCHOTICSSubrata Naskar
The document provides an outline for a presentation on psychosis. It discusses what psychosis is, the differences between psychosis and neurosis, symptoms of psychosis including positive and negative symptoms, and various neurobiological theories including the dopamine hypothesis and glutamate hypothesis. It also discusses the role of antipsychotic medications, how they work, and newer concepts for pharmacologically controlling psychosis.
This document discusses hypnotics and anxiolytics that are used to treat sleep difficulties and anxiety in the nervous system. It covers the management of insomnia and anxiety, both non-pharmacologically through lifestyle changes and cognitve behavioral therapy, and pharmacologically mainly through benzodiazepines. It notes that drug therapy should only be used short-term due to risks of tolerance and dependence. Specific groups like the elderly require lower doses due to increased sensitivity.
This document provides an overview of the pharmacotherapy of Alzheimer's disease. It discusses the history and pathogenesis of the disease, focusing on the amyloid cascade hypothesis, tau hypothesis, and cholinergic hypothesis. It describes the stages of the disease and current understanding of risk factors and genetic factors. It then summarizes the current pharmacotherapy approaches, including cholinesterase inhibitors like tacrine, donepezil, and rivastigmine, which work by increasing acetylcholine levels in the brain. It discusses their mechanisms of action, pharmacokinetics, efficacy, and side effect profiles.
1362575593 genesis and mgt of paifull neuropathydfsimedia
This document discusses painful diabetic neuropathy, which is a subtype of diabetic neuropathy characterized by chronic pain. It has not been clearly defined clinically or biologically. It can present as several syndromes affecting small or large nerve fibers either distally or proximally. Autonomic dysfunction is common. Treatment options provide varying levels of pain relief but remain unsatisfactory overall. Further research is needed to better understand and manage this painful condition.
1362405151 genesis and mgt of paifull neuropathydfsimedia
This document discusses painful diabetic neuropathy, which is a subtype of diabetic neuropathy characterized by chronic pain. It has not been clearly defined clinically or biologically. It can present as several syndromes affecting small or large nerve fibers either distally or proximally. Autonomic dysfunction is common. Treatment options provide varying levels of pain relief but remain unsatisfactory overall. Further research is needed to better understand and manage this painful condition.
This document discusses psychotropic drugs and their implications for anesthesia. It begins by providing statistics on usage of antipsychotic drugs in India. It then classifies common psychotropic drugs like antipsychotics, antidepressants, mood stabilizers, and anxiolytics. The document discusses side effects and anesthetic implications of various drug classes like phenothiazines, SSRIs, lithium, and MAO inhibitors. It highlights risks like hypotension, arrhythmias, seizures, and drug interactions. The document emphasizes understanding psychopharmacology and manipulating drug levels to decrease perioperative morbidity.
AHS13 Paul Ralston — The Effect of Diet on Chronic Spinal Pain Disorders Ancestral Health Society
Despite the high frequency of spinal related pain disorders, few patients or physicians understand or even acknowledge the role nutrition plays in pain perception. This presentation will explain the anatomy of the most common spinal structures responsible for being sources of pain. The lecture will also examine the robust role diet plays in increasing or decreasing the perception of pain.
This document provides information on behavioral and psychological crises, including behavioral emergencies that interfere with activities of daily living and psychiatric emergencies that threaten health and safety. It discusses medico-legal considerations, legal options for involuntary care, causes of abnormal behavior including biological, environmental, injury/illness, and substance-related causes. It also summarizes techniques for assessing and communicating with psychiatric patients, crisis intervention skills, use of restraints, specific psychiatric disorders, psychiatric medications, special populations, and provides an example call to medical control regarding a psychiatric emergency.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures resulting from abnormal neuronal activity in the brain. Seizures can vary from brief periods of lack of awareness to major motor convulsions. The document defines different types of seizures including partial (focal) seizures which originate in one area of the brain and generalized seizures which involve both hemispheres. It also discusses the pathophysiology, classification, common syndromes, and diagnostic approach for epilepsy. The three most common epilepsy syndromes are benign childhood epilepsy, childhood absence epilepsy, and juvenile myoclonic epilepsy.
This document discusses the pharmacological treatment of schizophrenia. It covers:
- Schizophrenia is a psychotic mental illness of unknown cause characterized by disturbances in thinking, mood, and behavior.
- There are challenges in diagnosis as there is no perfect or proven diagnostic test. New ways of looking at schizophrenia include stages, dimensions, neuroimaging findings, and biomarkers.
- Antipsychotics, including first-generation and second-generation drugs, are the mainstay of pharmacological treatment. While second-generation drugs have benefits like fewer side effects, research shows they are not clearly more effective than first-generation drugs.
- Other classes of medication like antidepressants and mood stabilizers can also be useful adjunctive
- Infantile spasms, also known as West syndrome, is a specific type of epilepsy seen in infants characterized by infantile spasms, hypsarrhythmia on EEG, and developmental regression or delay.
- It represents 2% of epilepsies and typically presents between 4-6 months of age. The condition was first described in 1841 and involves sudden flexion or extension of the trunk and limbs.
- Evaluation involves neurological exam, imaging (often MRI), metabolic testing, and characteristic EEG findings of hypsarrhythmia. Treatment aims to stop spasms and normalize EEG typically within 2-4 weeks using ACTH/steroids as first line. Prognosis depends on
Anaesthesia for neurological and neuromuscular disease2Kanika Rustagi
The document discusses various neurological and neuromuscular diseases relevant to anaesthesia including epilepsy, multiple sclerosis, Guillain-Barre syndrome, poliomyelitis, and cerebral palsy. It covers the pathophysiology, clinical features, diagnostic criteria, and anaesthetic considerations for managing patients with these conditions. Key points discussed include preoperative assessment and planning, choice of anaesthetic agents to avoid exacerbating symptoms, special monitoring needs, and postoperative care considerations.
This document provides an overview of seizures in childhood, including definitions, epidemiology, classification, pathophysiology, evaluation, focal seizures and related epilepsy syndromes, generalized seizures and syndromes, and treatment. Key points include that focal seizures are the most common seizure type in children, various etiologies can cause seizures, and evaluation involves a detailed history, physical exam, EEG, imaging and potentially metabolic testing to identify underlying causes and guide treatment. Common benign childhood epilepsy syndromes like BECTS are also discussed.
The document discusses the history, definition, classification and symptoms of mood disorders. It notes that mood disorders have been described since ancient times and includes descriptions of depression, mania, bipolar disorder and their symptoms. Unipolar disorders involve only depression while bipolar disorders involve both depression and mania or hypomania. The document outlines the DSM-5 and ICD-10 classification criteria and diagnostic features of major depressive disorder, bipolar disorder, dysthymia and cyclothymia.
This document provides an overview of current trends in the treatment of schizophrenia. It discusses the causes and symptoms of schizophrenia and describes typical and atypical antipsychotic medications. Recent trends include investigating novel compounds that target additional receptors beyond dopamine, developing partial dopamine agonists, using acetylcholinesterase inhibitors to enhance cognition, employing COX-2 inhibitors to modulate the immune system, and exploring the potential of human stem cells to better understand and treat the disorder.
Chlorpromazine was the first discovered antipsychotic medication. It acts by blocking dopamine, serotonin, acetylcholine, and adrenaline receptors in the brain. It was found to effectively treat schizophrenia and manic episodes. Common side effects include sedation, extrapyramidal symptoms like akathisia, and anticholinergic effects. Chlorpromazine is generally well-absorbed orally but has a wide therapeutic range and interactions with other medications can increase risks of side effects. It remains an important treatment option for various psychiatric and medical conditions.
This document summarizes current trends in the treatment of schizophrenia. It discusses the causes and symptoms of schizophrenia and outlines typical drug treatments including typical and atypical antipsychotics. It then describes several current trends in schizophrenia treatment including the use of novel compounds that target additional receptors, partial dopamine agonists, acetylcholinesterase inhibitors to enhance cognition, COX-2 inhibitors as an adjunctive immune treatment, and exploring the potential of human stem cells, though challenges remain.
This document provides an overview of sedative hypnotics, including their terminology, pharmacology, historical perspectives, and case studies. It discusses how opioids, bromides, and barbiturates were historically used as sedatives before the development of benzodiazepines in the 1950s. Benzodiazepines like diazepam, lorazepam and alprazolam became widely prescribed to treat anxiety and insomnia in the 1960s-1980s. The document outlines the pharmacokinetics of various sedative hypnotics and risks of abuse, dependence and overdose. It also presents a case study of a man who developed hand ischemia after injecting crushed zolpidem
Depression by Dr Iqra Osman Abdullahi.MDiqra osman
DEPRESSION
Dr.Iqra Osman
1.CONTENTS
INTRODUCTION
DEFINITION
TYPES OF DEPRESSION
EPIDEMIOLOGY
ETIOLOGY
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
DIAGNOSIS
INVESTIGATIONS
TREATMENT
CONCLUSION
REFERENCES
2.INTRODUCTION
Depression is a affective disorders.
Affective disorders : mental illnesses characterized by pathological changes in mood.
Depression : pathologically depressed mood
3.DEFINITION
DEPRESSION (By WHO) : Common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self- worth, disturbed sleep or appetite, low energy, and poor concentration.
4.TYPES OF DEPRESSION
Major depressive disorder : recurrence of long episodes of low moods, or one extended episode that seems to be ‘never-ending.
Atypical depression
Post partum depression
Catatonic depression
Seasonal affective disorder
Melancholic depression
5.Manic depression (bipolar disorder)
Four ‘Episodes’ of Bipolar Disorder
depressive episode
manic episodes
hypomanic episode
mixed-mood states
6.Dysthymic depression
lasts a long time but involves less severe symptoms.
lead a normal life, but we may not be functioning well or feeling good
Situational depression
Psychotic depression
Endogenous depression
7.EPIDEMIOLOGY
Globally more than 350 million people of all ages suffer from depression. (WHO)
For the age group 15-44 major depression is the leading cause of disability in the U.S.
Women are nearly twice as likely to suffer from a major depressive disorder than men are.
With age the symptoms of depression become even more severe.
About thirty percent of people with depressive illnesses attempt suicide.
8.ETIOLOGY
Genetic cause
Environmental factors
Biochemical factors : Biochemical theory of depression postulates a deficiency of neurotransmitters in certain areas of the brain (noradrenaline, serotonin, and dopamine).
Dopaminergic activity : reduced in case of depression, over activity in mania.
Endocrine factors
- hypothyroidism, cushing’s syndrome etc
9.Abuse of Drugs or Alcohol
Hormone Level Changes
Physical illness and side effects of medications
DRUGS
Analgesics
Antidepressants
Antihypertensives
Anticonvulsants
Benzodiazipine withdrawal
Antipsychotics
10.PHYSICAL ILLNESS
Viral illness
Carcinoma
Neurological disorders
Thyroid disease
Multiple sclerosis
Pernicious anaemia
Diabetes
Systemic lupus erythematosus
Addison’s disease
11.PATHOPHYSIOLOGY
The Biogenic Amine Hypothesis
The Receptor Sensitivity Hypothesis
The Serotonin-only Hypothesis
The Permissive Hypothesis
The Electrolyte Membrane Hypothesis
The Neuroendocrine Hypothesis
12.The Biogenic Amine Hypothesis
- caused by a deficiency of monoamines, particularly noradrenaline and serotonin.
cannot explain the delay in time of onset of clinical relief of depression of up to 6-8 weeks.
The Receptor Sensitivity Hypothesis
depression is the result of a pathological alteration (supersensitivity and up-regulation) in receptor sites.
- TCAs or MAOIs causes desensitizatio
Guillain-Barré syndrome (GBS) is an acute inflammatory disorder of the peripheral nervous system that causes progressive muscle weakness and paralysis. It is caused by an immune system attack on the peripheral nerves. The main symptoms are rapidly increasing muscle weakness, numbness, and tingling in the legs and arms. Diagnosis involves spinal fluid analysis and nerve conduction tests. Treatment focuses on supporting breathing, preventing complications, and hastening recovery through treatments like plasmapheresis or intravenous immunoglobulin. Most people recover fully or nearly fully from GBS, but some continue to have some degree of weakness.
This document discusses pharmacology related to the nervous system, specifically focusing on movement disorders and degenerative CNS diseases. It provides details on Parkinson's disease and syndrome, including that it results from degeneration of dopaminergic pathways in the basal ganglia leading to an imbalance between cholinergic and dopaminergic transmission. Common symptoms are described. Treatment aims to increase dopaminergic activity or reduce cholinergic effects, often using levodopa, dopamine agonists, or anticholinergics. Adverse effects of various treatments are also summarized.
The document discusses various anxiety disorders including specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. It covers clinical descriptions of the disorders based on DSM-5 criteria, common risk factors like genetics and personality traits, and potential etiologies such as classical conditioning and cognitive factors. The disorders are highly comorbid with each other and other mental health conditions. Treatment options for anxiety disorders are also mentioned.
This document summarizes key concepts from a chapter on motivation theory and job design. It discusses how individual needs influence motivation according to various theories, including Maslow's hierarchy of needs and ERG theory. It also covers process theories of motivation like equity theory, expectancy theory, goal-setting theory, and reinforcement theory. Finally, it examines the link between job design and motivation, addressing concepts like job simplification, job enrichment, and the job characteristics model.
This document discusses the genetics of psychiatric disorders such as depression, bipolar disorder, schizophrenia, autism, and Tourette syndrome. It covers patterns of inheritance such as autosomal dominant, recessive, and X-linked traits. Specific genes have been identified for some conditions, like DISC1 for bipolar disorder and mutations in multiple small effect genes contribute to conditions like autism and schizophrenia. Genome-wide association studies and copy number variation analysis have also provided insights but most psychiatric conditions are genetically complex with both genetic and environmental factors involved.
This document provides an overview of the pharmacotherapy of Alzheimer's disease. It discusses the history and pathogenesis of the disease, focusing on the amyloid cascade hypothesis, tau hypothesis, and cholinergic hypothesis. It describes the stages of the disease and current understanding of risk factors and genetic factors. It then summarizes the current pharmacotherapy approaches, including cholinesterase inhibitors like tacrine, donepezil, and rivastigmine, which work by increasing acetylcholine levels in the brain. It discusses their mechanisms of action, pharmacokinetics, efficacy, and side effect profiles.
1362575593 genesis and mgt of paifull neuropathydfsimedia
This document discusses painful diabetic neuropathy, which is a subtype of diabetic neuropathy characterized by chronic pain. It has not been clearly defined clinically or biologically. It can present as several syndromes affecting small or large nerve fibers either distally or proximally. Autonomic dysfunction is common. Treatment options provide varying levels of pain relief but remain unsatisfactory overall. Further research is needed to better understand and manage this painful condition.
1362405151 genesis and mgt of paifull neuropathydfsimedia
This document discusses painful diabetic neuropathy, which is a subtype of diabetic neuropathy characterized by chronic pain. It has not been clearly defined clinically or biologically. It can present as several syndromes affecting small or large nerve fibers either distally or proximally. Autonomic dysfunction is common. Treatment options provide varying levels of pain relief but remain unsatisfactory overall. Further research is needed to better understand and manage this painful condition.
This document discusses psychotropic drugs and their implications for anesthesia. It begins by providing statistics on usage of antipsychotic drugs in India. It then classifies common psychotropic drugs like antipsychotics, antidepressants, mood stabilizers, and anxiolytics. The document discusses side effects and anesthetic implications of various drug classes like phenothiazines, SSRIs, lithium, and MAO inhibitors. It highlights risks like hypotension, arrhythmias, seizures, and drug interactions. The document emphasizes understanding psychopharmacology and manipulating drug levels to decrease perioperative morbidity.
AHS13 Paul Ralston — The Effect of Diet on Chronic Spinal Pain Disorders Ancestral Health Society
Despite the high frequency of spinal related pain disorders, few patients or physicians understand or even acknowledge the role nutrition plays in pain perception. This presentation will explain the anatomy of the most common spinal structures responsible for being sources of pain. The lecture will also examine the robust role diet plays in increasing or decreasing the perception of pain.
This document provides information on behavioral and psychological crises, including behavioral emergencies that interfere with activities of daily living and psychiatric emergencies that threaten health and safety. It discusses medico-legal considerations, legal options for involuntary care, causes of abnormal behavior including biological, environmental, injury/illness, and substance-related causes. It also summarizes techniques for assessing and communicating with psychiatric patients, crisis intervention skills, use of restraints, specific psychiatric disorders, psychiatric medications, special populations, and provides an example call to medical control regarding a psychiatric emergency.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures resulting from abnormal neuronal activity in the brain. Seizures can vary from brief periods of lack of awareness to major motor convulsions. The document defines different types of seizures including partial (focal) seizures which originate in one area of the brain and generalized seizures which involve both hemispheres. It also discusses the pathophysiology, classification, common syndromes, and diagnostic approach for epilepsy. The three most common epilepsy syndromes are benign childhood epilepsy, childhood absence epilepsy, and juvenile myoclonic epilepsy.
This document discusses the pharmacological treatment of schizophrenia. It covers:
- Schizophrenia is a psychotic mental illness of unknown cause characterized by disturbances in thinking, mood, and behavior.
- There are challenges in diagnosis as there is no perfect or proven diagnostic test. New ways of looking at schizophrenia include stages, dimensions, neuroimaging findings, and biomarkers.
- Antipsychotics, including first-generation and second-generation drugs, are the mainstay of pharmacological treatment. While second-generation drugs have benefits like fewer side effects, research shows they are not clearly more effective than first-generation drugs.
- Other classes of medication like antidepressants and mood stabilizers can also be useful adjunctive
- Infantile spasms, also known as West syndrome, is a specific type of epilepsy seen in infants characterized by infantile spasms, hypsarrhythmia on EEG, and developmental regression or delay.
- It represents 2% of epilepsies and typically presents between 4-6 months of age. The condition was first described in 1841 and involves sudden flexion or extension of the trunk and limbs.
- Evaluation involves neurological exam, imaging (often MRI), metabolic testing, and characteristic EEG findings of hypsarrhythmia. Treatment aims to stop spasms and normalize EEG typically within 2-4 weeks using ACTH/steroids as first line. Prognosis depends on
Anaesthesia for neurological and neuromuscular disease2Kanika Rustagi
The document discusses various neurological and neuromuscular diseases relevant to anaesthesia including epilepsy, multiple sclerosis, Guillain-Barre syndrome, poliomyelitis, and cerebral palsy. It covers the pathophysiology, clinical features, diagnostic criteria, and anaesthetic considerations for managing patients with these conditions. Key points discussed include preoperative assessment and planning, choice of anaesthetic agents to avoid exacerbating symptoms, special monitoring needs, and postoperative care considerations.
This document provides an overview of seizures in childhood, including definitions, epidemiology, classification, pathophysiology, evaluation, focal seizures and related epilepsy syndromes, generalized seizures and syndromes, and treatment. Key points include that focal seizures are the most common seizure type in children, various etiologies can cause seizures, and evaluation involves a detailed history, physical exam, EEG, imaging and potentially metabolic testing to identify underlying causes and guide treatment. Common benign childhood epilepsy syndromes like BECTS are also discussed.
The document discusses the history, definition, classification and symptoms of mood disorders. It notes that mood disorders have been described since ancient times and includes descriptions of depression, mania, bipolar disorder and their symptoms. Unipolar disorders involve only depression while bipolar disorders involve both depression and mania or hypomania. The document outlines the DSM-5 and ICD-10 classification criteria and diagnostic features of major depressive disorder, bipolar disorder, dysthymia and cyclothymia.
This document provides an overview of current trends in the treatment of schizophrenia. It discusses the causes and symptoms of schizophrenia and describes typical and atypical antipsychotic medications. Recent trends include investigating novel compounds that target additional receptors beyond dopamine, developing partial dopamine agonists, using acetylcholinesterase inhibitors to enhance cognition, employing COX-2 inhibitors to modulate the immune system, and exploring the potential of human stem cells to better understand and treat the disorder.
Chlorpromazine was the first discovered antipsychotic medication. It acts by blocking dopamine, serotonin, acetylcholine, and adrenaline receptors in the brain. It was found to effectively treat schizophrenia and manic episodes. Common side effects include sedation, extrapyramidal symptoms like akathisia, and anticholinergic effects. Chlorpromazine is generally well-absorbed orally but has a wide therapeutic range and interactions with other medications can increase risks of side effects. It remains an important treatment option for various psychiatric and medical conditions.
This document summarizes current trends in the treatment of schizophrenia. It discusses the causes and symptoms of schizophrenia and outlines typical drug treatments including typical and atypical antipsychotics. It then describes several current trends in schizophrenia treatment including the use of novel compounds that target additional receptors, partial dopamine agonists, acetylcholinesterase inhibitors to enhance cognition, COX-2 inhibitors as an adjunctive immune treatment, and exploring the potential of human stem cells, though challenges remain.
This document provides an overview of sedative hypnotics, including their terminology, pharmacology, historical perspectives, and case studies. It discusses how opioids, bromides, and barbiturates were historically used as sedatives before the development of benzodiazepines in the 1950s. Benzodiazepines like diazepam, lorazepam and alprazolam became widely prescribed to treat anxiety and insomnia in the 1960s-1980s. The document outlines the pharmacokinetics of various sedative hypnotics and risks of abuse, dependence and overdose. It also presents a case study of a man who developed hand ischemia after injecting crushed zolpidem
Depression by Dr Iqra Osman Abdullahi.MDiqra osman
DEPRESSION
Dr.Iqra Osman
1.CONTENTS
INTRODUCTION
DEFINITION
TYPES OF DEPRESSION
EPIDEMIOLOGY
ETIOLOGY
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
DIAGNOSIS
INVESTIGATIONS
TREATMENT
CONCLUSION
REFERENCES
2.INTRODUCTION
Depression is a affective disorders.
Affective disorders : mental illnesses characterized by pathological changes in mood.
Depression : pathologically depressed mood
3.DEFINITION
DEPRESSION (By WHO) : Common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self- worth, disturbed sleep or appetite, low energy, and poor concentration.
4.TYPES OF DEPRESSION
Major depressive disorder : recurrence of long episodes of low moods, or one extended episode that seems to be ‘never-ending.
Atypical depression
Post partum depression
Catatonic depression
Seasonal affective disorder
Melancholic depression
5.Manic depression (bipolar disorder)
Four ‘Episodes’ of Bipolar Disorder
depressive episode
manic episodes
hypomanic episode
mixed-mood states
6.Dysthymic depression
lasts a long time but involves less severe symptoms.
lead a normal life, but we may not be functioning well or feeling good
Situational depression
Psychotic depression
Endogenous depression
7.EPIDEMIOLOGY
Globally more than 350 million people of all ages suffer from depression. (WHO)
For the age group 15-44 major depression is the leading cause of disability in the U.S.
Women are nearly twice as likely to suffer from a major depressive disorder than men are.
With age the symptoms of depression become even more severe.
About thirty percent of people with depressive illnesses attempt suicide.
8.ETIOLOGY
Genetic cause
Environmental factors
Biochemical factors : Biochemical theory of depression postulates a deficiency of neurotransmitters in certain areas of the brain (noradrenaline, serotonin, and dopamine).
Dopaminergic activity : reduced in case of depression, over activity in mania.
Endocrine factors
- hypothyroidism, cushing’s syndrome etc
9.Abuse of Drugs or Alcohol
Hormone Level Changes
Physical illness and side effects of medications
DRUGS
Analgesics
Antidepressants
Antihypertensives
Anticonvulsants
Benzodiazipine withdrawal
Antipsychotics
10.PHYSICAL ILLNESS
Viral illness
Carcinoma
Neurological disorders
Thyroid disease
Multiple sclerosis
Pernicious anaemia
Diabetes
Systemic lupus erythematosus
Addison’s disease
11.PATHOPHYSIOLOGY
The Biogenic Amine Hypothesis
The Receptor Sensitivity Hypothesis
The Serotonin-only Hypothesis
The Permissive Hypothesis
The Electrolyte Membrane Hypothesis
The Neuroendocrine Hypothesis
12.The Biogenic Amine Hypothesis
- caused by a deficiency of monoamines, particularly noradrenaline and serotonin.
cannot explain the delay in time of onset of clinical relief of depression of up to 6-8 weeks.
The Receptor Sensitivity Hypothesis
depression is the result of a pathological alteration (supersensitivity and up-regulation) in receptor sites.
- TCAs or MAOIs causes desensitizatio
Guillain-Barré syndrome (GBS) is an acute inflammatory disorder of the peripheral nervous system that causes progressive muscle weakness and paralysis. It is caused by an immune system attack on the peripheral nerves. The main symptoms are rapidly increasing muscle weakness, numbness, and tingling in the legs and arms. Diagnosis involves spinal fluid analysis and nerve conduction tests. Treatment focuses on supporting breathing, preventing complications, and hastening recovery through treatments like plasmapheresis or intravenous immunoglobulin. Most people recover fully or nearly fully from GBS, but some continue to have some degree of weakness.
This document discusses pharmacology related to the nervous system, specifically focusing on movement disorders and degenerative CNS diseases. It provides details on Parkinson's disease and syndrome, including that it results from degeneration of dopaminergic pathways in the basal ganglia leading to an imbalance between cholinergic and dopaminergic transmission. Common symptoms are described. Treatment aims to increase dopaminergic activity or reduce cholinergic effects, often using levodopa, dopamine agonists, or anticholinergics. Adverse effects of various treatments are also summarized.
The document discusses various anxiety disorders including specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. It covers clinical descriptions of the disorders based on DSM-5 criteria, common risk factors like genetics and personality traits, and potential etiologies such as classical conditioning and cognitive factors. The disorders are highly comorbid with each other and other mental health conditions. Treatment options for anxiety disorders are also mentioned.
Similar to anxiety-150906071416-lva1-app6892.pptx (20)
This document summarizes key concepts from a chapter on motivation theory and job design. It discusses how individual needs influence motivation according to various theories, including Maslow's hierarchy of needs and ERG theory. It also covers process theories of motivation like equity theory, expectancy theory, goal-setting theory, and reinforcement theory. Finally, it examines the link between job design and motivation, addressing concepts like job simplification, job enrichment, and the job characteristics model.
This document discusses the genetics of psychiatric disorders such as depression, bipolar disorder, schizophrenia, autism, and Tourette syndrome. It covers patterns of inheritance such as autosomal dominant, recessive, and X-linked traits. Specific genes have been identified for some conditions, like DISC1 for bipolar disorder and mutations in multiple small effect genes contribute to conditions like autism and schizophrenia. Genome-wide association studies and copy number variation analysis have also provided insights but most psychiatric conditions are genetically complex with both genetic and environmental factors involved.
The document discusses treatment resistant schizophrenia, defining it as when patients do not respond to conventional antipsychotics or at least two different antipsychotics. It provides various definitions and criteria for treatment resistance proposed over time. It also discusses factors associated with poor outcomes in schizophrenia like biological, symptomatic, environmental, and illness factors. The neurobiology of treatment resistant schizophrenia is explained, involving the dopaminergic and glutamatergic systems. Evaluation of treatment resistant schizophrenia involves assessing patient factors, treatment factors, and conducting further investigations.
The frontal lobe controls important cognitive functions like problem solving, memory, language, judgment and behavior. It has several subregions that support distinct functions. Tests can evaluate specific frontal lobe areas like the motor cortex, dorsolateral prefrontal cortex and orbitofrontal cortex. Tasks examine abilities like motor skills, attention, inhibition, memory and reasoning which may be impaired with frontal lobe damage.
This document discusses stress, its causes and effects. It defines stress as any physical or mental demand placed on the body. Stress can be either good (eustress) or bad (distress) depending on whether it exceeds one's ability to cope. Short term stress symptoms include increased heart rate and sweating while long term stress can lead to insomnia, illness and depression. The document identifies common stressors like exams, relationships and health issues and provides tips for managing stress through a healthy lifestyle, relaxation techniques, mindfulness and social support.
The document discusses suicide, including its definition, types, epidemiology, etiology, assessment, and management. Some key points:
- Suicide is defined as self-inflicted death with evidence the person intended to die. It is best viewed as a symptom rather than a disease.
- 95% of suicide attempts are associated with mental disorders like depression, substance abuse, schizophrenia. Biological and genetic factors are also implicated.
- Assessment involves evaluating psychiatric symptoms, past attempts, psychosocial stressors, and directly inquiring about suicidal thoughts and plans. Tools like the Beck Scale and C-SSRS can estimate risk.
- Treatment involves ensuring safety, medical evaluation, psychotherapy, medication like antidepress
Paroxetine in Anxiety & Depression - Recent Updates.pptxRonakPrajapati61
Paroxetine is an effective treatment for several psychiatric conditions:
- It is effective at reducing symptoms of depression, social anxiety disorder, and panic disorder compared to placebo based on meta-analyses of multiple studies.
- A meta-analysis found paroxetine treatment for social anxiety disorder resulted in greater improvements in symptom scales and higher response and remission rates compared to placebo.
- A study of patients with generalized anxiety disorder found clinically significant improvements in symptom scales after paroxetine treatment, reflecting restoration of cardiac autonomic function and BDNF levels.
Disability in schizohrenia ppt.ppt · version 1.pdfRonakPrajapati61
Disability in schizophrenia can cause limitations in social and occupational functioning. It is assessed using scales like the Disability Assessment Scale (DAS) and Indian Disability Evaluation and Assessment Schedule (IDEAS), which measure impairment in domains like self-care, communication, interpersonal relationships, and employment. Disability is caused by positive and negative symptoms, cognitive impairments, comorbidities, and medication side effects. Management of disability involves a comprehensive, multidisciplinary approach including pharmacological treatment, psychosocial rehabilitation with skills training, family psychoeducation, and community support programs. The goal is to help patients achieve independent living and better social and vocational participation.
This document outlines a proposed study on the burden of care and rates of depression among primary caregivers of patients with alcohol use disorder. The study aims to estimate caregiver burden and depression prevalence, and examine correlations between these and socio-demographic and alcohol-related variables. It describes the study design as cross-sectional and outlines inclusion/exclusion criteria, sample size calculation, and methodology involving assessment of patients, identification of primary caregivers, and administration of questionnaires to measure burden, depression, alcohol dependence severity, and collect demographic details. Statistical analysis will include t-tests, chi-square tests, and use of SPSS software.
Attachment theory proposes that secure attachments to caregivers in early childhood are crucial to healthy social-emotional development. John Bowlby and Mary Ainsworth's research showed that children develop internal working models of relationships based on their caregiver's availability and responsiveness. These working models influence how people relate in future relationships. Attachment theory is applied in parenting, couples counseling, psychotherapy, education, health, leadership, and social policy areas to promote secure attachments and relationships.
This document provides an overview of tobacco use and related disorders. It discusses the history of tobacco use dating back to 600 AD, common substances found in tobacco, and the mechanisms by which nicotine acts in the body. Physical and psychological effects of tobacco are outlined, as are tobacco-related disorders according to diagnostic manuals. Statistics on tobacco use in India are presented. Common forms of tobacco use, reasons for its popularity, and health conditions associated with smoking and smokeless tobacco are summarized. The document concludes with descriptions of assessment and treatment approaches for tobacco dependence.
The document outlines the rules and structure for an undergraduate quiz competition in psychiatry organized by the Department of Psychiatry at Dr M K Shah Medical College & Research Centre and the Indian Psychiatry Society - Gujarat State Branch. It consists of 6 rounds including an MCQ round, a "who am I" round, a scientist round, a movie round, a famous celebrities round, and a rapid fire round. The top 4 teams will advance based on scores in the initial MCQ round. Subsequent rounds involve answering psychiatry-related questions within time limits, with points awarded for correct answers and no negative points for incorrect answers.
This document discusses disorders of consciousness and describes various levels and types of diminished or altered consciousness. It outlines 3 dimensions of normal consciousness - vigilance, lucidity, and self-awareness. It then describes quantitative and qualitative changes in consciousness, including clouding, drowsiness, coma, delirium, confusion, twilight states, automatism, dream-like states, and stupor. Various conditions and substances that can cause these altered states of consciousness are also mentioned.
Learning can occur through classical conditioning, instrumental conditioning, and other forms of associative and non-associative learning. Classical conditioning involves forming an association between an unconditioned stimulus that naturally elicits a response and a neutral conditioned stimulus, so that the conditioned stimulus comes to elicit the response. Instrumental conditioning occurs when voluntary behaviors are strengthened or weakened based on their consequences. Learning theories aim to explain how learning takes place through various processes like acquisition, extinction, generalization, and discrimination.
This document discusses erectile dysfunction (ED) and the role of Tetrafol Plus supplement. It defines ED and notes its prevalence increases with age. Common causes of ED include cardiovascular disease, hypertension, high cholesterol, and diabetes, which are highly prevalent in India. The document explains penile anatomy and blood flow physiology related to erections. It discusses how conditions like hyperhomocysteinemia, diabetes, and the MTHFR gene polymorphism can cause endothelial dysfunction and reduce nitric oxide, impairing the erection process. Two studies show that treating the underlying conditions like high homocysteine and low folate levels in non-responders to ED drugs like sildenafil can help resolve ED issues. The document
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
2. PLAN OF PRESENTATION
• INTRODUCTION
• TYPES OF ANXIETY
• NEUROBIOLOGY OF ANXIETY DISORDERS
• SYMPTOMATOLOGY
• MANAGEMENT
• PHARMACOLOGICAL
• NON PHARMACOLOGICAL
• RECENT ADVANCES
3. WHAT IS ANXIETY ?
• ANXIETY IS A DIFFUSE, HIGHLY UNPLEASANT, OFTEN VAGUE FEELING OF
APREHENSION, ACCOMPANIED BY ONE OR MORE BODILY SENSATIONS-
PALPITATIONS, PERSPIRATIONS, HEADACHE ETC.
• PHILOSOPHERS AND THINKERS HAVE LONG WRITTEN ABOUT THE
CENTRALITY OF ANXIETY IN HUMAN LIFE AND EXPERIENCES.
• ON THE OTHERHAND, IT IS ONE OF THE NEWEST OF SUBJECTS AS THE
SCIENTISTS ARE UNDERSTANDING THE UNDERLYING PSYCHOBIOLOGY AND
ITS MANAGEMENT, EFFECTIVELY ONLY FOR LAST FEW DECADES.
4. DEFINITION
“Feeling of apprehension caused by anticipation of danger,
which may be internal or external”
“Anxiety isan emotional state commonly caused by the
perception of real or perceived danger that threatens the
security of an individual. It allows a person to prepare for or
react to environmental changes.”
• This is an adaptive response, and is transient in nature.
5. • ANXIETY IS A NORMAL EMOTION UNDER CIRCUMSTANCES OF THREAT AND IS
THOUGHT TO BE PART OF THE EVOLUTIONARY “FIGHT OR FLIGHT” REACTION OF
SURVIVAL.
• ANXIETY CAN PRODUCE UNCOMFORTABLE AND POTENTIALLY DEBILITATING
PSYCHOLOGICAL (E.G., WORRY OR FEELING OF THREAT) AND PHYSIOLOGICAL
AROUSAL (E.G., TACHYCARDIA OR SHORTNESS OF BREATH) IF IT BECOMES EXCESSIVE.
• SOME INDIVIDUALS EXPERIENCE PERSISTENT, SEVERE ANXIETY SYMPTOMS AND
POSSESS IRRATIONAL FEARS THAT SIGNIFICANTLY IMPAIR NORMAL DAILY
FUNCTIONING.
• THESE PERSONS OFTEN SUFFER FROM AN ANXIETY DISORDER.
6. TYPES OF ANXIETY
• AN INTEGRAL PART OF OUR DAY TO DAY LIFE
AND HELPS THE INDIVIDUAL IN COPING WITH
STRESS DEVELOPING
• BETTER ADAPTIVE SKILL
• PLANNING AHEAD
• BETTER PERFORMANCE
• INTENSED INTERNAL UNCOMFORTABLE
FEELING STATE LEADS TO MALADAPTIVE
BEHAVIOUR, THOUGHT AND COGNITONS
AND POORER PERFORMANCE.
NORMAL ANXIETY PATHOLOGICAL ANXIETY
ANXIETY DISORDER
7. CLASSIFICATION OF ANXIETY DISORDER
• PANIC DISORDER WITHOUT
AGORAPHOBIA.
• PANIC DISORDER WITH
AGORAPHOBIA.
• AGORAPHOBIA WITHOUT H/O PANIC
DISORDER.
• SPECIFIC PHOBIA.
• SOCIAL PHOBIA.
• OCD
• PTSD
• ACUTE STRESS DISORDER
• GENERALISED ANX- DISORDER.
• ANXIETY DISORDER DUE TO
• GENERAL MEDICAL CONDITION.
• SUBSTANCE INDUCED ANXIETY
DISORDER.
• ANXIETY DIS ORDER NOS.
8. • SEPARATION ANXIETY DISORDER
• SELECTIVE MUTISM NEW !!!
• SPECIFIC PHOBIA
• SOCIAL ANXIETY DISORDER
• PANIC DISORDERNEW !!!
• PANIC ATTACKNEW !!!
• AGORAPHOBIA NEW !!!
• GENERELIZED ANXIETY DISORDER
• SUBSTANCE/MEDICATION INDUCED ANXIETY DISORDER
• ANXIETY DISORDER DUE TO ANOTHER MEDICAL CONDITION
• OTHER SPECIFIED ANXIETY DISORDER
• UNSPECIFIED ANXIETY DISORDER
10. ALL ANXIETY DISORDERS HAVE 2 COMPONENTS
TO UNDERSTAND THE NEUROBIOLOGY OF ANY ANXIETY DISORDER WE
NEED TO UNDERSTAND THE NEUROBIOLOGY OF BOTH
FEAR
WORRY
12. LINKING ANXIETY SYMPTOMS TO CIRCUITS
ANXIETY AND FEAR SYMPTOMS ARE REGULATED BY AN AMYGDALA-
CENTERED CIRCUIT.
WORRY, ON THE OTHER HAND, IS REGULATED BY A CORTICO-STRIATO-
THALAMOCORTICAL (CSTC) LOOP.
THESE CIRCUITS MAY BE INVOLVED IN ALL ANXIETY DISORDERS, WITH
THE DIFFERENT PHENOTYPES REFLECTING NOT UNIQUE CIRCUITRY BUT
RATHER DIVERGENT MALFUNCTIONING WITHIN THOSE CIRCUITS.
13. LOOKING AFRAID/ AFFECT OF FEAR
ORBITO FC
AMYGDALA
• FEELINGS OF FEAR ARE REGULATED BY
RECIPROCAL CONNECTIONS BETWEEN
THE AMYGDALA AND THE ANTERIOR
CINGULATE CORTEX (ACC) AND THE
AMYGDALA AND THE ORBITOFRONTAL
CORTEX (OFC).
ACC
• SPECIFICALLY, IT MAY BE THAT OVER
ACTIVATION OF THESE CIRCUITS
PRODUCES FEELINGS OF FEAR.
15. AVOIDANCE/FIGHT/FLIGHT/FREEZE MOTOR
RESPONSE
AMYGDALA
PAG
• FEELINGS OF FEAR MAY BE EXPRESSED
THROUGH BEHAVIORS SUCH AS AVOIDANCE,
WHICH IS PARTLY REGULATED BY RECIPROCAL
CONNECTIONS BETWEEN THE AMYGDALA AND
THE PERIAQUEDUCTAL GRAY (PAG).
• AVOIDANCE IN THIS SENSE IS A MOTOR
RESPONSE.
• OTHER MOTOR RESPONSES ARE TO FIGHT OR
TO RUN AWAY (FLIGHT) IN ORDER TO SURVIVE
THREATS FROM THE ENVIRONMENT.
17. CHANGES IN RESPIRATORY RATE
AMYGDALA
PBN
• CHANGES IN RESPIRATION MAY OCCUR DURING
A FEAR RESPONSE; THESE CHANGES ARE
REGULATED BY ACTIVATION OF THE
PARABRACHIAL NUCLEUS (PBN) VIA THE
AMYGDALA.
• INAPPROPRIATE OR EXCESSIVE ACTIVATION OF
THE PBN CAN LEAD NOT ONLY TO INCREASES IN
THE RATE OF RESPIRATION BUT ALSO VARIOUS
SYMPTOMS.
SHORTNESS OF BREATH
EXACERBATION OF ASTHMA, OR
A SENSE OF BEING SMOTHERED.
18. AUTONOMIC OUTPUT OF FEAR
ATHEROSCLEROSIS
CARDIAC ISCHEMIA
BLOOD PRESSURE
MYOCARDIAL INFARCTION
SUDDEN DEATH
“SCARED TO DEATH” MAY NOT ALWAYS BE
AN EXAGGERATION OR A FIGURE OF SPEECH!
19. AUTONOMIC OUTPUT OF FEAR
AMYGDALA
LC
• AUTONOMIC RESPONSES ARE TYPICALLY
ASSOCIATED WITH FEELINGS OF FEAR.
• THESE INCLUDE INCREASES IN HEART RATE
(HR) AND BLOOD PRESSURE (BP), WHICH
ARE REGULATED BY RECIPROCAL
CONNECTIONS BETWEEN THE AMYGDALA
AND THE LOCUS COERULEUS (LC).
• LONG-TERM ACTIVATION OF THIS CIRCUIT
MAY LEAD TO INCREASED RISK OF
ATHEROSCLEROSIS, CARDIAC ISCHEMIA,
CHANGE IN BP, DECREASED HR
VARIABILITY, MYOCARDIAL INFARCTION
(MI), OR EVEN SUDDEN DEATH.
21. ENDOCRINE OUTPUT OF FEAR
AMYGDALA
HYPOTHALAMUS
• THE FEAR RESPONSE MAY BE
CHARACTERIZED IN PART BY ENDOCRINE
EFFECTS SUCH AS INCREASES IN CORTISOL,
WHICH OCCUR BECAUSE OF AMYGDALA
ACTIVATION OF THE HYPOTHALAMIC–
PITUITARY–ADRENAL (HPA) AXIS.
• PROLONGED HPA ACTIVATION AND
CORTISOL RELEASE CAN HAVE SIGNIFICANT
HEALTH IMPLICATIONS, SUCH AS INCREASED
RISK OF CORONARY ARTERY DISEASE, TYPE 2
DIABETES, AND STROKE.
22. STRESS AND THE HPA AXIS
ADULT STRESSORS
DISINHIBITION
OF HPA AXIS BY HIPPOCAMPUS
CRF
RELEASE
ACTH
RELEASE
GLUCO-
CORTICOID
RELEASE
HIPPOCAMPAL
ATROPHY
ABNORMAL STRESS RESPONSE
MDD ANXIETY DISORDER
CRF
RELEASE
GLUCOCORTICOIDS
INHIBIT CRF
RELEASE
ACTH RELEASE
GLUCO-
CORTICOID
RELEASE
NORMAL STRESS RESPONSE
23. PATHOPHYSIOLOGY
• DATA FROM BIOCHEMICAL AND NEUROIMAGING STUDIES INDICATE
THAT THE MODULATION OF NORMAL AND PATHOLOGIC ANXIETY
STATES IS ASSOCIATED WITH MULTIPLE REGIONS OF THE BRAIN AND
ABNORMAL FUNCTION IN SEVERAL NEUROTRANSMITTER SYSTEMS,
INCLUDING
• NOREPINEPHRINE (NE)
• SEROTONIN (5-HT)
• γ –AMINOBUTYRIC ACID (GABA)
24. NORADRENERGIC MODEL
• THIS MODEL SUGGESTS THAT THE AUTONOMIC NERVOUS SYSTEM OF ANXIOUS PATIENTS IS
HYPERSENSITIVE AND OVERREACTS TO VARIOUS STIMULI.
• THE LOCUS CERULEUS MAY HAVE A ROLE IN REGULATING ANXIETY, AS IT ACTIVATES
NOREPINEPHRINE RELEASE AND STIMULATES THE SYMPATHETIC AND PARASYMPATHETIC
NERVOUS SYSTEMS.
5-HT MODEL
• GAD SYMPTOMS MAY REFLECT EXCESSIVE 5-HT TRANSMISSION OR OVERACTIVITY OF THE
STIMULATORY 5-HT PATHWAYS.
• PATIENTS WITH SAD HAVE GREATER PROLACTIN RESPONSE TO BUSPIRONE CHALLENGE,
INDICATING AN ENHANCED CENTRAL SEROTONERGIC RESPONSE.
• THE ROLE OF 5-HT IN PANIC DISORDER IS UNCLEAR, BUT IT MAY HAVE A ROLE IN
DEVELOPMENT OF ANTICIPATORY ANXIETY.
• PRELIMINARY DATA SUGGEST THAT THE 5-HT AND 5-HT2 ANTAGONIST
METACHLOROPHENYLPIPERAZINE CAUSES INCREASED ANXIETY IN PTSD PATIENTS.
25. γ-AMINOBUTYRIC ACID (GABA) RECEPTOR MODEL
• GABA IS THE MAJOR INHIBITORY NEUROTRANSMITTER IN THE CNS.
• MANY ANTIANXIETY DRUGS TARGET THE GABA RECEPTOR.
• BENZODIAZEPINES (BZS) ENHANCE THE INHIBITORY EFFECTS OF GABA,WHICH
HAS A STRONG REGULATORY OR INHIBITORY EFFECT ON SEROTONIN (5-HT),
NOREPINEPHRINE, AND DOPAMINE SYSTEMS.
• ANXIETY SYMPTOMS MAY BE LINKED TO UNDERACTIVITY OF GABA SYSTEMS OR
DOWNREGULATED CENTRAL BZ RECEPTORS.
• IN PATIENTS WITH GAD, BZ BINDING IN THE LEFT TEMPORAL LOBE IS REDUCED
ABNORMAL SENSITIVITY TO ANTAGONISM OF THE BZ BINDING SITE AND
DECREASED BINDING WAS DEMONSTRATED IN PANIC DISORDER.
• ABNORMALITIES OF GABA INHIBITION MAY LEAD TO INCREASED RESPONSE TO
STRESS IN PTSD PATIENTS.
26. NEUROTRANSMITTER IN CIRCUITS
• 5HT
• GABA
• GLUTAMATE
•CRF/HPA
• NE
• VOLTAGE GATED ION CHANNELS.
AMYGDALA CENTRED CIRCUIT CSTC [WORRY LOOP]
[ FEAR LOOP]
• 5HT
• GABA
• GLUTAMATE
•DA
• NE
• VOLTAGE GATED ION CHANNEL.
28. GENERALIZED ANXIETY DISORDER
• THE DIAGNOSTIC CRITERIA FOR GAD REQUIRE
PERSISTENT SYMPTOMS FOR MOST DAYS FOR AT LEAST
6 MONTHS.
• THE ESSENTIAL FEATURE OF GAD IS UNREALISTIC OR
EXCESSIVE ANXIETY AND WORRY ABOUT A NUMBER OF
EVENTS OR ACTIVITIES OR OTHER IMPORTANT AREAS
OF FUNCTIONING.
29.
30. PRESENTATION OF GENERALIZED ANXIETY DISORDER
• PSYCHOLOGICAL AND COGNITIVE SYMPTOMS :
• EXCESSIVE ANXIETY
• WORRIES THAT ARE DIFFICULT TO CONTROL
• FEELING KEYED UP OR ON EDGE
• POOR CONCENTRATION OR MIND GOING BLANK
• PHYSICAL SYMPTOMS :
• RESTLESSNESS
• FATIGUE
• MUSCLE TENSION
• SLEEP DISTURBANCE
• IRRITABILITY
31. PANIC DISORDER
• PANIC DISORDER BEGINS AS A SERIES OF UNEXPECTED
(SPONTANEOUS) PANIC ATTACKS INVOLVING AN INTENSE,
TERRIFYING FEAR SIMILAR TO THAT CAUSED BY LIFE-
THREATENING DANGER.
• DURING AN ATTACK, PATIENTS OFTEN DESCRIBE AN
OVERWHELMING SENSE OF DOOM, A FEAR OF DYING OR
LOSING CONTROL.
• PANIC ATTACKS USUALLY LAST NO MORE THAN 20 TO 30
MINUTES,
• WITH THE PEAK INTENSITY OF SYMPTOMS WITHIN THE
FIRST 10 MINUTES.
• SECONDARY TO THE PANIC ATTACKS, MANY PATIENTS
EVENTUALLY DEVELOP AGORAPHOBIA.
32.
33. SYMPTOMS OF A PANIC ATTACK
• DEPERSONALIZATION
• DEREALIZATION
• FEAR OF LOSING CONTROL
• FEAR OF GOING CRAZY
• FEAR OF DYING.
• PSYCHOLOGICAL SYMPTOMS • PHYSICAL SYMPTOMS :
• ABDOMINAL DISTRESS
• CHEST PAIN OR DISCOMFORT
• CHILLS
• DIZZINESS OR LIGHT-HEADEDNESS
• FEELING OF CHOKING
• HOT FLUSHES
• PALPITATIONS
• NAUSEA
• SHORTNESS OF BREATH
• SWEATING
• TACHYCARDIA
• TREMBLING OR SHAKING.
34. SOCIAL ANXIETY DISORDER
• SAD IS CHARACTERIZED BY AN INTENSE, IRRATIONAL, AND
PERSISTENT FEAR OF BEING NEGATIVELY EVALUATED OR
SCRUTINIZED IN ATLEAST ONE SOCIAL OR PERFORMANCE
SITUATION.
• EXPOSURE TO THE FEARED CIRCUMSTANCE USUALLY
PROVOKES AN IMMEDIATE SITUATION-RELATED PANIC
ATTACK.
• ADULTS WITH SAD USUALLY RECOGNIZE THEIR FEAR IS
EXCESSIVE AND UNREASONABLE; HOWEVER, THEY ARE
UNABLE TO OVERCOME IT WITHOUT TREATMENT.
WHY CAN’T I
TALK TO
PEOPLE ?
35.
36. SOCIAL ANXIETY DISORDER
• IN INDIVIDUALS UNDER 18 YEARS OF AGE, THE DURATION OF
SYMPTOMS IS AT LEAST 6 MONTHS. THE FEAR OR AVOIDANCE IS NOT
CAUSED BY A DRUG OR OTHER SUBSTANCE (E.G., COCAINE), OR A
GENERAL MEDICAL OR PSYCHIATRIC DISORDER.
• THE MEAN AGE OF ONSET OF SAD IS DURING THE MID-TEENS. RATES
OF SAD ARE SLIGHTLY HIGHER AMONG WOMEN THAN MEN AND
MORE FREQUENT IN YOUNGER COHORTS. IT IS A CHRONIC DISORDER
WITH A MEAN DURATION OF 20 YEARS.
38. POSTTRAUMATIC STRESS DISORDER (PTSD)
• POSTTRAUMATIC STRESS DISORDER (PTSD) IS A CONDITION MARKED BY
THE DEVELOPMENT OF SYMPTOMS AFTER EXPOSURE TO TRAUMATIC LIFE
EVENTS.
• THE PERSON REACTS TO THIS EXPERIENCE WITH FEAR AND HELPLESSNESS,
PERSISTENTLY RELIVES THE EVENT, AND TRIES TO AVOID BEING REMINDED
OF IT.
• PTSD CAN OCCUR AT ANY AGE, AND THE COURSE IS VARIABLE.
• ONE-THIRD OF PATIENTS WITH PTSD HAVE A POOR PROGNOSIS, AND
ABOUT 80% HAVE A CONCURRENT DEPRESSION OR ANXIETY DISORDER.
39.
40. THE HIPPOCAMPUS AND RE-EXPERIENCING
AMYGDALA
HIPPOCAMPUS
• ANXIETY CAN BE TRIGGERED NOT ONLY BY AN
EXTERNAL STIMULUS BUT ALSO BY AN
INDIVIDUAL’S MEMORIES. TRAUMATIC
MEMORIES STORED IN THE HIPPOCAMPUS CAN
ACTIVATE THE AMYGDALA, CAUSING THE
AMYGDALA, IN TURN, TO ACTIVATE OTHER
BRAIN REGIONS AND GENERATE A FEAR
RESPONSE.
• THIS IS TERMED RE-EXPERIENCING, AND IT IS A
PARTICULAR FEATURE OF POSTTRAUMATIC
STRESS DISORDER.
41. PTSD SYMPTOMS
RE-EXPERIENCING SYMPTOMS
AVOIDANCE SYMPTOMS
• RECURRENT, INTRUSIVE DISTRESSING MEMORIES OF THE
TRAUMA
• RECURRENT, DISTURBING DREAMS OF THE EVENT
• FEELING THAT THE TRAUMATIC EVENT IS RECURRING (E.G.,
DISSOCIATIVE FLASHBACKS)
• PHYSIOLOGIC REACTION TO REMINDERS OF THE TRAUMA
• AVOIDANCE OF CONVERSATIONS ABOUT THE TRAUMA
• AVOIDANCE OF THOUGHTS OR FEELINGS ABOUT THE
TRAUMA, AVOIDANCE OF ACTIVITIES THAT ARE REMINDERS
OF THE EVENT
• AVOIDANCE OF PEOPLE OR PLACES THAT AROUSE
RECOLLECTIONS OF THE TRAUMA
• INABILITY TO RECALL AN IMPORTANT ASPECT OF THE
TRAUMA
• ANHEDONIA
• RESTRICTED AFFECT
• SENSE OF A FORESHORTENED FUTURE (E.G., DOES NOT
EXPECT TO HAVE A CAREER, MARRIAGE)
42. • HYPER-AROUSAL SYMPTOMS
• DECREASED CONCENTRATION
• EASILY STARTLED
• HYPERVIGILANCE
• INSOMNIA
• IRRITABILITY OR ANGRY OUTBURSTS
• SUBTYPES
• ACUTE: DURATION OF SYMPTOMS IS LESS THAN 3 MONTHS
• CHRONIC: SYMPTOMS LAST FOR LONGER THAN 3 MONTHS
• WITH DELAYED ONSET: ONSET OF SYMPTOMS IS AT LEAST 6 MONTHS
POSTTRAUMA
44. OBSESSIVE-COMPULSIVE DISORDER (OCD)
• OBSESSIVE-COMPULSIVE DISORDER (OCD) IS ONE OF THE TEN LEADING
CAUSES OF DISABILITY.
• PATIENTS WITH OCD EXPERIENCE SIGNIFICANT IMPAIRMENT IN THEIR
QUALITY OF LIFE (QOL), WITH REDUCTIONS IN SOCIAL, FAMILY, AND
OCCUPATIONAL FUNCTIONING.
• BECAUSE OF THE NATURE AND POTENTIAL SEVERITY OF SIGNS AND
SYMPTOMS AND THE RESULTANT NEGATIVE EFFECTS ON QOL, OCD IS
CONSIDERED A MAJOR MEDICAL CONDITION.
45. NEURAL CIRCUITS OF OBSESSION/WORRY
THALAMUS
STRIA
TUM
DLPFC SHOWN HERE IS A CORTICO-
STRIATOTHALAMO- CORTICAL
(CSTC) LOOP ORIGINATING
AND ENDING IN THE
DORSOLATERAL PREFRONTAL
CORTEX (DLPFC).
OVERACTIVATION OF THIS
CIRCUIT MAY LEAD TO
WORRY OR OBSESSIONS.
46. PRESENTATION
• OBSESSIONS
• REPETITIVE THOUGHTS (E.G., FEELING CONTAMINATED AFTER TOUCHING AN OBJECT,
DOUBTING WHETHER THE STOVE WAS TURNED OFF)
• REPETITIVE IMAGES (E.G., RECURRENT SEXUALLY EXPLICIT PICTURES)
• REPETITIVE IMPULSES (E.G., NEED FOR SYMMETRY OR PUTTING THINGS IN SPECIFIC
ORDER, IMPULSE TO SHOUT OUT OBSCENITIES IN A TEMPLE)
• COMPULSIONS
• REPETITIVE ACTIVITIES (E.G., HAND WASHING, CHECKING, ORDERING, NEED TO ASK,
NEED TO CONFESS)
• REPETITIVE MENTAL ACTS (E.G., COUNTING, REPEATING WORDS SILENTLY, PRAYING)
50. INVESTIGATIONS
• BLOOD SUGAR – T2 DM
• LIPID PROFILE
• CORTISOL LEVEL
• URINE DRUG SCREEN: SHOULD BE ORDERED TO RULE OUT SUSPECTED STIMULANT ABUSE
• TFTS: RECOMMENDED IF THE PATIENT HAS SUSPECTED THYROID DISEASE (E.G., WEIGHT
LOSS, GOITRE)
• 24-HOUR URINE TEST FOR VANILLYLMANDELIC ACID AND METANEPHRINES: ORDERED TO
RULE OUT PHAEOCHROMOCYTOMA IF CARDIAC SYMPTOMS SUCH AS TACHYCARDIA
AND/OR HYPERTENSION ARE PRESENT
• ECG AND ECHOCARDIOGRAM: RECOMMENDED FOR PATIENTS WITH A HIGH RISK OF
CARDIAC DISEASE OR EVIDENCE OF CARDIAC DISEASE
• PULMONARY FUNCTION TESTS: SHOULD BE CONSIDERED FOR PATIENTS WITH SHORTNESS
OF BREATH AND EVIDENCE OF PULMONARY DISEASE
• EEG: USEFUL FOR EVALUATING PATIENTS WHERE ANXIETY IS SUSPECTED TO BE A SEIZURE
PRODROMAL SYMPTOM.
54. PHARMACOLOGICAL
• 3 MAJOR NEUROTRANSMITTERS ARE TARGETTED IN
PHARMACOLOGICAL TREATMENT OF ANXIETY DISORDERS
1. GABA -
2. SEROTONIN -
3. NOREPINEPHRIN -
A. BENZODIAZEPINES
B. SSRIs
C. SNRIs
55. A) BENZODIAZEPINES
• BENZODIAZEPINES, PERHAPS THE BEST-KNOWN AND MOST WIDELY USED
ANXIOLYTICS, ACT BY ENHANCING GABA ACTIONS AT THE LEVEL OF THE
AMYGDALA AND AT THE LEVEL OF THE PREFRONTAL CORTEX WITHIN CSTC
LOOPS TO RELIEVE ANXIETY.
3 MAJOR TYPES
1,4 BENZODIAZEPINES
1,5 BENZODIAZEPINES
2,3 BENZODIAZEPINES
57. 1,5 BENZODIAZEPINE
• CLOBAZAM
• ADVANTAGES & DISADVANTAGES
• ANXIOLYTIC
• ANTIEPILEPTIC
• DECREASED SEDATION
• LOW DEPENDENCE
• LOW MUSCLE RELAXATION
• CAN BE USED IN EXECUTIVE GROUPS
• CAN BE CONTINUED FOR LONG PERIOD OF TIME
58. 2,3 BENZODIAZEPINES
• TOFISOPAM
• TOFISOPAM, A RACEMIC 2,3-BENZODIAZEPINE
COMPRISED OF R- AND S-ENANTIOMERS, IS
UNLIKE TRADITIONAL 1,4-BENZODIAZEPINES.
• ADVANTAGES
• LIKE OTHER BENZODIAZEPINES, IT POSSESSES
ANXIOLYTIC PROPERTIES BUT UNLIKE OTHER
BENZODIAZEPINES IT DOES NOT HAVE
ANTICONVULSANT*, SEDATIVE, SKELETAL MUSCLE
RELAXANT, MOTOR SKILL-IMPAIRING OR
AMNESTIC PROPERTIES.
*WHILE IT MAY NOT BE AN ANTICONVULSANT IN AND OF ITSELF, IT HAS BEEN SHOWN TO ENHANCE THE ANTICONVULSANT ACTION OF CLASSICAL 1,4-BENZODIAZEPINES SUCH AS
DIAZEPAM.
BETTER RESOLUTION OF ANXIETY & EXISTING
DEPRESSION WITHOUT SEDATION, MUSCLE
RELAXATION
CLIN.TRIAL SUGGEST IT TO BE USEFUL IN ANXIETY
DISORDERS, ANXIETY NEUROSIS, MIXED ANXIETY
DEPRESSION, SOMATOFORM DISORDER, ALCOHOL
WITHDRAWAL, MENOPAUSAL SYNDROME
BINDS TO 2,3 BDZS
SITES IN THE
SUBCORTICAL AREA.
IT DOES NOT BIND TO
GABA-A RECEPTOR
COMPLEX IN
CORTICAL AREAS
59. B) SELECTIVE SEROTONIN REUPTAKE INHINITOR
• SEROTONIN IS A KEY NEUROTRANSMITTER
THAT INNERVATES THE AMYGDALA AS WELL
AS ALL THE ELEMENTS OF CSTC CIRCUITS,
NAMELY, PREFRONTAL CORTEX, STRIATUM,
AND THALAMUS, AND THUS IS POISED TO
REGULATE BOTH FEAR AND WORRY.
• ANTIDEPRESSANTS THAT CAN INCREASE
SEROTONIN OUTPUT BY BLOCKING THE
SEROTONIN TRANSPORTER (SERT) ARE ALSO
EFFECTIVE IN REDUCING SYMPTOMS OF
ANXIETY AND FEAR IN EVERY ONE OF THE
ANXIETY DISORDERS
60. SOME WIDELY USED SSRIs
• FLUOXETINE
• PAROXETINE
• ESCITALOPRAM
• SERTRALINE
• FLUVOXAMINE
• SIDE EFFECTS: STOMACHACHE, INCREASED ACTIVITY
LEVEL, INSOMNIA, AGITATION/DISINHIBITION AT
HIGHER DOSES
• LESS OFTEN DIARRHEA, HEADACHES, TICS,
CRAMPS/TWITCHING, SEXUAL SIDE EFFECTS.
• START AT A LOW DOSE AND INCREASE SLOWLY
BASED ON TREATMENT RESPONSE AND SIDE EFFECTS
61. C) NOREPINEPHRINE REUPTAKE INHIBITOR
SYMPTOMS OF HYPERAROUSAL SUCH AS
NIGHTMARES CAN BE REDUCED AND WORRY
CAN BE REDUCED BY NOREPINEPHRINE
REUPTAKE INHIBITORS (ALSO CALLED NET OR
NOREPINEPHRINE TRANSPORTER INHIBITORS).
HYPERACTIVITY OF CSTC
NRI ACTION ON NE NEURONAL
OUTPUT TO CSTC
63. OTHER COMMONLY USED DRUGS
• GABAPENTIN AND PREGABALIN
• ALSO KNOWN AS α2δ LIGANDS
• BIND TO THE α2δ SUBUNIT OF PRESYNAPTIC N AND P/Q VSCCS, BLOCK THE
RELEASE OF EXCITATORY NEUROTRANSMITTERS SUCH AS GLUTAMATE WHEN
NEUROTRANSMISSION IS EXCESSIVE.
• THEY HAVE DEMONSTRATED ANXIOLYTIC ACTIONS IN SOCIAL ANXIETY
DISORDER AND PANIC DISORDER
• 5-HT1A RECEPTOR PARTIAL AGONIST - BUSPIRONE
64. OTHER COMMONLY USED DRUGS
• MONOAMINE OXIDASE INHIBHITORS
• HYDROXYZINE
• ANTI-PSYCHOTICS – HAS LIMITED EVIDENCE AND HIGH SIDE EFFECTS
• PROPRANOLOL & OXPRENOLOL- LICENSED TO TREAT ANXIETY
SYMPTOMS- USED IN PTSD
65. PSYCHOTHERAPY IN ANXIETY DISORDER
NUMEROUS STUDIES HAVE SHOWN THE IMPORTANCE OF
COMBINING PSYCHOTHERAPY WITH PHARMACOTHERAPY IN
ANXIETY DISORDERS.
66. Psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive
disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive
counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with
tricyclic antidepressants (g=0.21).
67. There was sufficient evidence that combined treatment is superior for major depression, panic disorder, and
obsessive compulsive disorder (OCD). The effects of combined treatment compared with placebo only were
about twice as large as those of pharmacotherapy compared with placebo only, underscoring the clinical
advantage of combined treatment. The results also suggest that the effects of pharmacotherapy and those of
psychotherapy are largely independent from each other, with both contributing about equally to the effects of
combined treatment.
69. BEHAVIOUR THERAPY
• EXPOSURE AND RESPONSE PREVENTION
• SYSTEMATIC DESENSITIZATION
• IMPLOSIVE THERAPY/FLOODING
• ANXIETY MANAGEMENT
• RELAXATION TECHNIQUES – YOGA, ZEN, JPMR
• BIOFEEDBACK
• DESENSITIZATION OF THE STIMULUS
• EYE MOVEMENT DESENSITIZATION AND REPROCESSING
• SOCIAL SKILLS TRAINING
70. COGNITIVE BEHAVIOUR THERAPY
• CONTROL OF AUTOMATIC THOUGHTS
• CORRECTION OF COGNITIVE ERRORS
• BREAKING THE ASSOCIATION BETWEEN THE EVENTS, COGNITIVE
AROUSAL AND MALADAPTIVE BEHAVIOUR
71. PSYCHOANALYTIC PSYCHOTHERAPY
• THE PSYCHOANALYTIC PROCESS INVOLVES BRINGING TO THE SURFACE
REPRESSED MEMORIES AND FEELINGS BY MEANS OF A SCRUPULOUS
UNRAVELING OF HIDDEN MEANINGS OF VERBALIZED MATERIAL AND OF
THE UNWITTING WAYS IN WHICH THE PATIENT WARDS OFF UNDERLYING
CONFLICTS THROUGH DEFENSIVE FORGETTING AND REPETITION OF THE
PAST.
72. PSYCHOANALYTICALLY ANXIETY IS CLASSIFIED
INTO 4 TYPES
THE CLASSIFICATION IS BASED ON THE TYPES OF PRIMARY COMPLEX AND
THE SUBSEQUENT NATURE OF ITS CONFLICT WITH THE EGO (CONSCIOUS
MIND).
1. TRAUMATIC ANXIETY (PANIC ATTACK) – EGO BECOMES PARALYSED
2. SEPARATION ANXIETY – SEPARATION FROM LOVED/VALUABLE OBJECTS
3. CASTRATION ANXIETY – LOSS OF LOVED/VALUABLE OBJECT
4. SUPEREGO ANXIETY
DEPENDING ON THE TYPE OF ANXIETY PSYCHOANALYTIC METHODS ARE
ADAPTED.