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1. Anxiety disorder
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2. Anxiety disorder
Definition
 Anxiety:- a feeling of apprehension due to anticipation of danger
which may be internal or external.
Anxiety as a Normal & Abnormal Response
 Some amount of anxiety is “normal” and is associated with optimal
levels of functioning.
 Only when anxiety begins to interfere with social or occupational
functioning, it is considered “abnormal.”
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3. Anxiety disorder…
 Anxiety disorders are a non psychotic , mild , functional disorder with
anxiety as a core symptoms in all forms of the disorders
 Anxiety disorders are one of the most prevalent psychiatric conditions
in many populations studied
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4. Anxiety disorder…
They have the following features in common
 Symptoms are ego dystonic
 Insight is intact
 Ego boundary and reality testing are normal
 Symptoms are extensions of normal life experience
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5. Anxiety disorder…
Classification
 Panic Disorder
 Social Phobias
 Agora phobia
 Specific phobia
 Generalized anxiety disorder (GAD)
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6. Anxiety Disorder
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Learning objectives
After completing this session the students will be
able to:
oDefine GAD
oIdentify the epidemiology of GAD
oList the etiology of GAD
oDescribe the clinical features of GAD
oList the Diagnostic criteria of GAD
oDescribe the DDx of GAD
oList the Diagnostic method of GAD
oDescribe the treatment of GAD

8. Anxiety disorder…
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GENERALIZED ANXIETY DISORDER()
Definition
 Generalized Anxiety Disorder is characterized by excessive worry
about a variety of topics.
 People with GAD have ongoing, severe GAD tension that interferes
with daily functioning

9. Anxiety disorder…
Epidemiology
 Lifetime Prevalence: ~ 5%
 25% in anxiety d/o clinics
 F:M= 2:1
 Age of onset: 15-25years
 50% start before age 20
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10. Anxiety disorder…
Etiology
oThe cause of GAD is not known.
Clinical features
oSustained and excessive worry
oMuscle tension
oSleep disturbance
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11. Anxiety disorder…
Diagnostic criteria
 Excessive anxiety/worry on most days for >6 months of several
events/activities.
 Difficulties controlling the worry.
 At least 3: Note: Only one item is required in children
Blank Mind/Difficulty concentrating
Energy low/Easily fatigued
Sleep disturbance
Keyed up/Restless/On Edge
Irritability
Muscle Tension (can be headaches, shakiness…)
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12. • It cause clinically significant impairment
• It is not attributable to the physiological effects of a substance
• It is not better explained by another mental disorder
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13. Anxiety disorder…
DDx
oPTSD
oMDD
oOCD
oPanic disorder
oPhobic disorder
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14. Anxiety disorder…
Diagnostic methods
 History
 Physical examination
 Mental status examination
 Laboratory investigation
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Learning objectives
At the end of this session the students will be able to:
 Define OCD, Obsessions, Compulsions and anxiety
disorder
 List the classification of anxiety disorder
 Identify the epidemiology of OCD
 List the etiology of OCD
 Describe the Clinical features of OCD
 List the Diagnostic criteria of OCD
 Describe the DDx of OCD
 List the Diagnostic method of OCD
 Describe the treatment of OCD

16. OBSESSIVE-COMPULSIVE DISORDER
Definition
 Obsessive-compulsive disorder (OCD) is
represented by a diverse group of symptoms that
include intrusive thoughts, rituals, preoccupations,
and compulsions.
 Obsessions- repetitive unwanted ideas that the
person recognizes are irrational
 Compulsions- repetitive, often ritualized behavior
whose behavior serves to diminish anxiety caused
by obsessions
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17. OCD …
They cause great anxiety, which cannot be controlled through
reasoning.
Common obsessions include
Preoccupations with dirt or germs,
Nagging doubts, symmetry
 A need to have things in a very particular order.
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18. OCD …
To minimize these obsessions, many people with
obsessive-compulsive disorder (OCD) engage in
repeated behavior, or compulsions.
Examples include repeated
Hand washing,
Constant rechecking to satisfy doubts, and
Following rigid rules of order.
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19. OCD …
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Epidemiology
 The life-time prevalence of OCD in the general population is about
2.5%.
 M=F
 Is the 4th most common psychiatric diagnosis.
 About 2/3 of the patients have onset before age 25.

20. OCD …
Etiology
 The exact cause is unknown
Clinical features
 Typical clinical features of OCD include obsessions and overt
(behavioral) compulsions.
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21. OCD …
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Diagnostic criteria
Either obsessions or compulsions:
Obsessions as defined by (1) and (2)
 Recurrent and persistent thoughts, impulses, or images
 The person attempts to ignore or suppress such
thoughts, impulses, or images

22. OCD …
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Compulsions as defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or
mental acts
2. The behaviors or mental acts are aimed at preventing or reducing
distress
It is time-consuming
Cause impairment in functioning
Substance or GMC exclusion

23. OCD …
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DDx
 Pathological Gambling
 Body Dysmorphic disorder
 Trichotillomania
 Hypochondriasis
 Kleptomania
 OC personality disorder

24. OCD …
Diagnostic methods
 History
 Physical examination
 Mental status examination
 Laboratory investigation
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25. OCD …
Treatment
 Antidepressants or
 Anxiolytics(Benzodiazepine)
 Psychotherapy
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26. Phobic disorders
phobia refers to an excessive fear of a specific object,
circumstance, or situation.
A specific phobia is a strong, persisting fear of an object or
situation
A social phobia is a strong, persisting fear of situations in
which embarrassment can occur.
The diagnosis of both phobias requires the development of
intense anxiety, when exposed to the feared object or situation.
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27. Epidemiology
Phobias affect 5 to 10 percent of the population
The lifetime prevalence of specific phobia is about 11 percent
 The lifetime prevalence of social phobia has been reported to be 3 to
13 percent.
Specific phobia is more common than social phobia
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28. Specific Phobias
Acrophobia fear of heights
 Agoraphobia fear of open places
Ailurophobia fear of cats
Hydrophobia fear of water
 Claustrophobia fear of closed spaces
 Cynophobia fear of dogs
Mysophobia fear of dirt and germs
Pyrophobia fear of fire
Xenophobia fear of strangers
Zoophobia fear of animals
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29. Panic Disorder
Is an acute intense attack of anxiety accompanied by feelings of
impending doom
Is characterized by discrete periods of intense fear that can vary from
several attacks during one day to only a few attacks during a year
It can be with and without agoraphobia
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30. Epidemiology
The lifetime prevalence of panic disorder is in the 1 to 4
percent
6-month prevalence approximately 0.5 to 1.0 percent, and 3
to 5.6 percent for panic attacks
Women are two to three times more likely to be affected
than men
The lifetime prevalence of agoraphobia is somewhat more
controversial, varying between 2 to 6 percent across studies
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31. The presence of four (or more) of the following symptoms developed
abruptly and reached a peak within 10 minutes: palpitations, pounding
heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
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32. chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady, lightheaded, or faint
derealization (feelings of unreality) or depersonalization (being detached from
oneself)
fear of losing control or going crazy
fear of dying
paresthesias (numbness or tingling sensations)
chills or hot flushes
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33. DSM-V- Criteria for Panic Disorder without Agoraphobia
Both (1) and (2):
Recurrent unexpected panic attacks
At least one of the attacks has been followed by 1 month
(or more) of one (or more) of the following:
• persistent concern about having additional attacks their
consequence
• a significant change in behavior related to the attacks
Absence of agoraphobia
The panic attacks are not due to the direct physiological
effects of a substance or a general medical condition.
The panic attacks are not better accounted for by another
mental disorder
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34. Treatment
Antidepressants or
Anxiolytics (Benzodiazepine)
Psychotherapy
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35. Deribachew H/mariam(Asst. professor)
Chapter 6: Epilepsy
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36. Epilepsy…
Definition
• Epilepsy is an abnormal and excessive electrical activity arising from
the brain resulting in sudden and recurrent loss of consciousness with
falling attacks.
• This activity may be recurrent with periods of normal electrical
activity in between episodes
• An individual is said to suffer from epilepsy if he has had at least two
distinct episodes of an epileptic attack.
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37. Epilepsy…
Epidemiology
• Epilepsy is one of the most common ailments involving the CNS in
Africa.
• Prevalence of epilepsy has been estimated at 2-5 per 1000 members of the
general population.
• Among children under 5 years of age, 2 percent suffer from convulsions
during fever.
• There are two broad classes of epilepsy
1. Partial seizures
2. Generalized seizures
• The division emphasizes whether the epilepsy has an identifiable focus of
onset in the brain or not.
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38. Epilepsy…
Classification
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Major class of seizure
disorders
Sub-classes of seizure disorders
Partial seizures beginning
focally
 Simple motor or sensory (without
impaired consciousness).
 Complex partial (secondarily
generalized; with impaired
consciousness)
Generalized seizures
without focal onset
 Tonic-colonic convulsion
 Myoclonic,
 Atonic
 Absences
 Tonic

39. Epilepsy…
Causes of Epilepsy
• Genetic factors
• Febrile convulsions
• Post-traumatic epilepsy
• Other diseases of the brain
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40. Epilepsy…
Clinical Presentations of Epilepsy
oThe typical case of Epilepsy
• Sudden falling attack
• body stiffens
• body, arms and legs jerk - then relaxation
• waking up after a few minutes or hours
• may be sleepy or confused afterwards
• may have passed urine or bitten tongue.
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Organic brain syndrome

41. Epilepsy…
Clinical Presentations of Epilepsy…
 The atypical epilepsies
 Atypical seizures belong either to the absences group
of seizures, the secondary or focal seizures.
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42. Epilepsy…
Absences
• Usually a disorder of children and may end by the time of puberty.
• Attacks last for very brief periods of 15-30 seconds each, and there
may be several hundred per day.
• The problems of affected children are not appreciated by caretakers
or teachers.
• The typical episode takes the form of repeated blank stares into
space.
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43. Epilepsy…
Absences…
• The child loses consciousness and is totally
unaware of their environment.
• The child does not fall, however, and remains
sitting or standing.
• May appear blank in the face, stop talking
momentarily and resume conversation at the end of
the attack in a totally different topic unrelated to
what was being discussed.
• Children also tend to sleep heavily.
• At school the child is considered dull as the
frequent attacks interfere with effective learning.
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44. Epilepsy…
Akinetic seizures
• Less common variants of absences which are
characterized by repeated sudden loss of muscle
tone, resulting in unexplained stumbling and falls.
• Usually occur while the child is playing.
• The falls are associated with total loss of
consciousness lasting 15-30 seconds each.
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45. Epilepsy…
Partial or focal seizures
• A partial seizure may manifest solely in the form of an abnormal
motor, behavior disorder, mental activity or state of emotion.
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46. Treatment
oTherapy of epilepsy has three goals:
1. To eliminate seizures or reduce their frequency to the maximum
extent possible.
2. To avoid the side effects associated with long-term treatment.
3. To assist the patient in maintaining or restoring normal psychosocial
and vocational adjustment.

47. Treatment…
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Drugs Average dose range Possible side effects
Phenobarbitone 60-120mg/day as a single dose Drowsiness tired or almost
asleep , congenital
malformations if given during
pregnancy, skin rashes
Phenytoin 200-400mg/day Gum hypertrophy, itchy skin
rashes, unexplained falls
Carbamazepine 400-1400mg/day in 2 divided
doses
Itchy skin rash which may be
very serious and if it occurs
the drug should be stopped
quickly
Sodium valproate 400-2000mg/day as a divided
doses

48. Epilepsy…
Advise Epileptics
• Not to drive vehicles until they are seizure free for at
least 2 or 3 years
• Not to work at heights such as at construction sites,
electric and telephone poles.
• Not to work on electric installations and near fire,
deep waters and rotating machines.
• Not to swim .
• Other than these people with epilepsy can be engaged
in any activity and they can hold any level of
responsible positions in the society and can progress to
any level of academic and social positions.
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49. Management of mentally ill patient
• General Principles of Care
Communication
o Establish communication and build trust
 Conduct assessment
Plan and start management
•Explain results and likely diagnosis while keeping a realistic
and positive outlook
• Explain and discuss all treatment options including benefits
and risks
• Provide psychoeducation and other psychosocial support
• Explain any possible medications before prescribing
• Make sure that everyone understands the plan
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50. What do we communicate in psychoeducation
I. Empowerment
• Focus on what the person and family can do now to improve
their situation
• Emphasize the importance of involving the person with the
disorder in all decisions
II. Facts
• Take time to explain the prognosis. Be realistic but emphasize
that with proper management, many people improve
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51. III. Coping strategies
• Recognize and encourage things people are doing
well
• Discuss actions that have helped in the past
• Discuss local options for community resources
IV. Advice on overall wellbeing
• Encourage a healthy lifestyle including a good diet,
regular physical exercise and routine health checks
at the doctor
• Advise the person and the carers to seek help when
needed
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52. Addressing stressors
oOffer an opportunity to talk, preferably in a private space
oAsk about current stressors
oAssess for any maltreatment or abuse
oBrain storm together for solutions or for ways of coping
oIdentify and involve supportive family members
oEncourage involvement in self-help and family support
groups
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53. Prescribing principles
• Medication treatment depends on the condition
• Worldwide more than 50% of all medicines are prescribed, dispensed, or sold
inappropriately, while 50% of patients fail to take them correctly (WHO, 2002)
• Safe prescribing
• Explain effects, time of onset, side effects
• Obtain consent
• Start low, go slow
• Follow up on a regular basis with thorough assessment
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54. Link with other services and supports
• Many people with mental, neurological and
substance use disorders have many, serious needs
• Some of these needs may be non-medical, but you
have a crucial role to play in improving these
people's lives by linking them to relevant services
and supports
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55. Link with other services and supports
• Other sectors and services have a role to play in the complete care of the
person, e.g.
• Housing
• Employment
• Education
• Child protection and social services
• In addition, there are people in the community who may be of help, e.g.
• Community leaders
• Women's groups
• Self-help and family support groups
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56. Schedule follow up appointment
• Make a clear follow up plan (e.g., date, person)
• The frequency of follow up depends on the condition and resources
available
• In your context, what are the best methods for arranging follow up?
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57. What would you do during a follow up visit
• Assess progress in a number of areas
• Symptoms and well-being of both the person and
carer
• Check for new symptoms
• Ongoing stressors
• Medication effectiveness, adherence, side effects
• Links to community resources
• Make changes to the management plan as necessary.
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58. COUNSELING
• Its purpose are developing the patient’s maturity and self control
• Contain four parts includes:
• 1. Listening 2. Exploring
• 3. Understanding 4. Problem solving
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59. Listening
• The goal of listening is to help the person to talk
A. Showing respect and care, this will make it easier for the person to
talk.
B. Demonstrating the body language of listening:
1. Face them
2. Look at them
3. Keep an open posture
4. Lean forward
5. Be relaxed but not too relaxed.
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60. C. Listening for non-verbal messages. Notice:
1. Body movements
2. Gestures
3. Facial expression
4. Tone of voice.
D. Listen to everything, even things you don’t want to hear.
E. Listen to yourself
1. Saying yes or mmm or nodding your head at the right time
tells someone you are listening.
2. Repeating a few words a person has said lets them know
you heard them and encourages them to go on.
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61. Exploring the person and their problems
A. The counselor must try to understand.
1. What has happened
2. How the person feels.
B. Try to make statements instead of asking questions
1. Start statements with “I” not “You”
2. Make statements that start with, “It seems to me,” or “I wonder if”,
or “I think that you are telling me….”
C. If you must ask a question make it an open question, not a closed
one for example, do not ask, “Why“, but rather, ask “What”.
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62. D. Be concrete
E. If you don’t understand, say, “I don’t understand”
F. Do not give advice
Understanding the person’s point of view
help them see the problem clearly
A. The counselor acts as a mirror
1. We show how it looks from our point of view
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63. 2. We show the good and the bad
a. Strengths
b. Resources
c. Ineffective response patterns
d. Inconsistencies
e. Other ways to label the problem
f. Hidden or double messages
g. Things he or she may be avoiding
h. Challenges to magical thinking.
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64. B. Do not give advice
Problem solving
• The goal of is to encourage action that leads to change
• In order to achieve this clinician should:
A. Help the person find a better way to solve his or her problem,
but remember:
1. People are usually doing the best they know how
2. Perhaps the best way for you is not the best way for them.
B. List alternatives:
1. Do not judge them, just list them
• 2. Be creative
• .
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65. C. Evaluate the alternatives, list advantages and disadvantages
D. Choose one solution
1. The person with the problem should make the decision if at all
possible.
2. Give your opinion if you want but remember to let the person have
control and take responsibility.
3. Be realistic
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66. E. Encourage the patient to try it:
1. Be specific
2. Set time limits
F. Evaluate results.
G. If not successful explore the reasons why, list new alternatives and
try again.
H. Don’t give up
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67. How to manage illness and symptoms
Recognizing early signs of relapse
Developing a plan to address relapse signs
 Importance of maintaining prescribed medication
regimen and regular follow-up
 Avoiding alcohol and other drugs
Self-care and proper nutrition
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68. Teaching social skills through education, role modeling, and
practice
Seeking assistance to avoid or manage stressful situations
 Educating family/significant others about the biologic causes
and clinical course of
Importance of maintaining contact with community
participating in supportive organizations and care
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