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.
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.
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
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 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 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.
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.
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
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 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.
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.
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 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.
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.
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
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.
- 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.
1. Shock is a life-threatening condition caused by an imbalance between oxygen supply and demand in tissues. It can lead to organ dysfunction if left untreated.
2. There are four main types of shock based on the underlying pathophysiology: distributive, cardiogenic, obstructive, and hypovolemic. Distributive shock is most often caused by sepsis.
3. The goals of treatment are to restore adequate tissue perfusion and oxygen delivery through rapid fluid resuscitation and vasopressor support if needed. Early recognition and treatment of shock is critical to prevent irreversible organ damage.
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.
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.
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 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.
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 provides an overview of epilepsy including definitions, types of seizures, causes, risk factors, diagnostic approach, treatment options, and antiepileptic drug management. Key points include: epilepsy is defined as recurrent unprovoked seizures; status epilepticus is a medical emergency; common causes include vascular, infectious, traumatic, autoimmune and metabolic factors; evaluation involves clinical history, EEG, MRI and video telemetry; treatment involves acute seizure control and chronic antiepileptic drug management to prevent recurrence; drug selection depends on seizure type and side effect profile; surgery is an option for drug-resistant cases.
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 discusses West Syndrome, a severe epilepsy syndrome seen in infants characterized by infantile spasms, a specific EEG pattern called hypsarrhythmia, and developmental delays. It provides details on the history, characteristics, subtypes, causes, diagnostic criteria including the hypsarrhythmia EEG pattern, treatment, and prognosis. Hypsarrhythmia is described as high-voltage slow waves and spikes that are chaotic, continuous, and seen in both awake and sleep states. Factors like sleep state, seizures, and time can influence the hypsarrhythmia pattern. Asymmetric or focal findings on EEG may indicate a symptomatic cause. Outcomes are often poor, with most patients developing other seizure types or Len
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.
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.
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 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.
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.
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
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.
- 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.
1. Shock is a life-threatening condition caused by an imbalance between oxygen supply and demand in tissues. It can lead to organ dysfunction if left untreated.
2. There are four main types of shock based on the underlying pathophysiology: distributive, cardiogenic, obstructive, and hypovolemic. Distributive shock is most often caused by sepsis.
3. The goals of treatment are to restore adequate tissue perfusion and oxygen delivery through rapid fluid resuscitation and vasopressor support if needed. Early recognition and treatment of shock is critical to prevent irreversible organ damage.
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.
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.
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 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.
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 provides an overview of epilepsy including definitions, types of seizures, causes, risk factors, diagnostic approach, treatment options, and antiepileptic drug management. Key points include: epilepsy is defined as recurrent unprovoked seizures; status epilepticus is a medical emergency; common causes include vascular, infectious, traumatic, autoimmune and metabolic factors; evaluation involves clinical history, EEG, MRI and video telemetry; treatment involves acute seizure control and chronic antiepileptic drug management to prevent recurrence; drug selection depends on seizure type and side effect profile; surgery is an option for drug-resistant cases.
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 discusses West Syndrome, a severe epilepsy syndrome seen in infants characterized by infantile spasms, a specific EEG pattern called hypsarrhythmia, and developmental delays. It provides details on the history, characteristics, subtypes, causes, diagnostic criteria including the hypsarrhythmia EEG pattern, treatment, and prognosis. Hypsarrhythmia is described as high-voltage slow waves and spikes that are chaotic, continuous, and seen in both awake and sleep states. Factors like sleep state, seizures, and time can influence the hypsarrhythmia pattern. Asymmetric or focal findings on EEG may indicate a symptomatic cause. Outcomes are often poor, with most patients developing other seizure types or Len
NEUROIMAGING IN PSYCHIATRY777777777777.pptxssuser7567ef
This document provides an overview of various neuroimaging techniques used in psychiatry, including their principles, applications, and advantages/disadvantages. It discusses structural neuroimaging methods like CT and MRI, as well as functional techniques including fMRI, PET, and SPECT. CT and MRI provide high-resolution images of brain structure. Functional methods like fMRI, PET, and SPECT allow measurement of brain activity by detecting changes in blood flow and glucose metabolism associated with neuronal activation. Together, these neuroimaging modalities have improved understanding of psychiatric pathophysiology and have diagnostic and research applications in conditions such as dementia, psychosis, and mood disorders.
This document provides information on factitious disorder, including:
1) It defines factitious disorder and distinguishes it from malingering, noting those with factitious disorder seek attention from the sick role rather than material gains.
2) It describes two main types - one with predominantly psychological symptoms and one with physical symptoms, where patients can induce illness through various means.
3) It discusses the challenges in diagnosing and treating factitious disorder given patients' deceitful nature and risk of harming themselves. Close monitoring is needed to reduce health risks while also addressing underlying psychiatric issues.
The document discusses various aspects of normal human sexuality. It describes sexuality as being determined by anatomy, physiology, culture, relationships and life experiences. Normal sexuality involves stimulation of sex organs and brings pleasure without inappropriate guilt or anxiety. Sexuality has biological, psychological, social and cultural dimensions that are shaped by factors like learning, perceptions and social norms. The document also outlines some health benefits of sex beyond reproduction and discusses concepts like sexual identity, gender identity and orientation.
1) Human sexuality involves the physical, psychological, and social aspects of sexual behavior. It is influenced by biological factors like anatomy and hormones, as well as environmental factors like culture, relationships, and life experiences.
2) Sexual behavior serves both reproductive and non-reproductive purposes. It provides health benefits like stress relief, immune system boosting, and cardiovascular benefits.
3) Normal sexual response involves four phases: desire, excitement, orgasm, and resolution. It is mediated by the central nervous system and hormones. Foreplay involves physical and psychological stimulation to increase arousal.
NEURO-IMAGING IN PSYCHIATRY MAY 2019.pptxssuser7567ef
Neuroimaging techniques such as CT, MRI, fMRI, SPECT, and MRS can be used in psychiatry to diagnose illnesses, develop new treatments, and analyze brain activity and clinically defined patient groups. Structural neuroimaging like CT and MRI are used to identify abnormalities, while functional techniques such as fMRI and SPECT measure brain activity and blood flow. Specific indications include evaluating neurological deficits, dementia, movement disorders, seizures, and investigating organic causes of psychiatric symptoms. Contrast agents may be used to enhance images and reveal abnormalities in vascular permeability. Each technique has advantages and limitations for clinical psychiatric applications.
The document provides an overview of impulse control disorders (ICDs). It discusses how ICDs have risen in prevalence due to increased access to potentially addictive behaviors online. ICDs are characterized by the repeated inability to refrain from harmful impulses and include disorders like kleptomania, pathological gambling, and intermittent explosive disorder. The document outlines the major ICDs according to the DSM-IV-TR classification and describes their symptoms, prevalence in the population, risk factors like substance abuse or brain injuries, and biological, psychological and social theories for their causes. It provides examples of intermittent explosive disorder cases.
This document is a PowerPoint presentation on intelligence and intelligence testing from Myers' Psychology for AP® 2nd Edition. The presentation covers various theories of intelligence, including the idea of general intelligence (g) versus multiple intelligences, as well as the origins and modern tests of intelligence. It discusses the stability and change of intelligence over the lifespan, genetic and environmental influences on intelligence, and group differences in intelligence test scores and the question of bias. The presentation is designed for an AP Psychology class and provides definitions, summaries, and discussion of key topics related to intelligence and intelligence testing.
Modern intelligence tests are divided into individual tests and group tests. Individual tests assess one person at a time through either verbal tests that use language or non-verbal performance tests. The Stanford-Binet test and Wechsler scales are two prominent individual tests. The Stanford-Binet measures cognitive abilities through tasks involving vocabulary, block counting, and abstract word definitions for individuals ages 2-23. The Wechsler scales include subtests in verbal areas like information and arithmetic as well as non-verbal performance areas like block design and object assembly for people ages 4 to 74.
This document provides information on various personality disorders. It discusses key aspects of different personality disorders like paranoid, schizoid, and schizotypal personality disorders. It covers epidemiology, clinical features, differential diagnosis, course, prognosis, and treatment approaches for these disorders. It also describes theories of personality development and assessment methods like various personality models and diagnostic instruments.
The document discusses connectomics and connectomes in psychiatry. It defines connectomes as networks of nodes and edges that represent elements like neurons and their connections. Several key networks are discussed, including the default mode network, salience network, central executive network, and others. Abnormalities in the connectivity and functioning of these networks are associated with various psychiatric disorders like schizophrenia, depression, OCD, PTSD, and others. The field of connectomics is still emerging but shows potential to provide biomarkers and insights into mental illnesses.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
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 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.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
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.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
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.