Phobias-Management Pharmacotherapy – BDZs, SSRIs Psychotherapy – Behavior therapy is the most effective Systematic Desensitization – [Exposure / Relaxation] Best Evidence in T/T of Phobias Therapeutic graded exposure [Exposure and response prevention] Flooding [Implosion]- Exposed in Most severe form Modeling [Participant modeling]- Therapist himself makes contact with phobic stimulus Social Anxiety Disorder [Social Phobia]: Fear […]
Panic Disorder Panic attack is the intense Anxiety accompanied by Feeling of Impending doom Palpitations, chest pain and choking sensation with dizziness Fear of dying, losing control or going mad Panic Disorder – Recurrent panic attacks not restricted to particular situation Mean Age – 25 Years, Female 2-3 times more common Can be present
Agoraphobia Fear of places where escape might be difficult Fear of being in open spaces / Crowded Spaces Fear of enclosed spaces Fear of travelling alone or using public transport Very disabling phobia as patient may become home bound Management: BDZ and SSRIs Behavior therapy – Systematic desensitization, flooding, exposure and response prevention Relaxation
OCD-Etiology & Symptoms The etiology of OCD is: Serotonin dysregulation [Less evidence for Noradrenergic system] Cortico-striatal-thalamic-cortical circulatory path Prefrontal Cortex -> Striatum -> Thalamus -> Prefrontal Cortex Symptom patterns: Contamination-Washing behavior Pathological doubt-Compulsion of checking Intrusive thoughts-Intrusive Thoughts [sexual & aggressive] without an observable compulsion Symmetry-Need for Symmetry and precision. Compulsion of slowness
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OCD OCD is characterized by recurrent obsessive thoughts followed by compulsive acts Recurrent & Intrusive thoughts, images, impulses Recognizes as the product of their own mind Recognizes thoughts as Irrational & Senseless Ego dystonic – UNWANTED and UNACCEPTABLE Repetitive behaviors in response to obsession Done to reduce stress and anxiety Symptoms > 2 Weeks
Bipolar disorder-Etiology The etiology of bipolar disorder is influenced by the following 2 factors: Neurotransmitter: Increased level of dopamine in pathophysiology of Manic episode For Depression Serotonin and NE Genetic Factors: Chromosome 18q and 22q has strongest linkage to bipolar disorder Chromosome 21q has also been implicated
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Anxiety vs Fear Alerting Signal that helps a person to take measures to deal with a threat Fear is a response to a known, external, definite threat Anxiety is the response to unknown, internal and vague threat Manifestations of anxiety: Feeling of nervousness Sweating, tachycardia, restlessness, tremors, mydriasis Cold clammy skin, Hyperreflexia Urinary Frequency and
Depression-Symptoms Duration of Illness > 2 week to establish a diagnosis of depression Sleep Disturbances-Usually Insomnia [Early morning Awakening, reduced latency of REM Sleep] Loss of interest-Loses interest in activities which used to interest him earlier [Anhedonia] Guilt-Excessive Guilt Feelings Lack of energy-Decreased energy levels with easy fatigability Cognition / Concentration-Decreased energy levels with easy
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Depression-Signs The signs that are seen in depression are: Omega sign-Seen in Forehead above the root of the nose Veraguth fold-Triangular shape fold in nasal corner of upper eyelid
Schizophrenia-Negative symptoms The symptoms of schizophrenia are divided into: Positive Negative Disorganization Motor Negative Symptoms: Negative symptoms represent loss of normal functions Poor Prognostic Factor and Responds poorly to medications Avolition – Loss of Will to indulge in goal-oriented tasks [ grooming, education, job] Apathy, Anhedonia, Asociality, Alogia [Decrease in verbal communication] Affective Flattening –
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