NEUROTIC DISORDERS

Presented By:
Akash Kumar
Aradhana Tewatia
Sweta Kumari
Gurleen Kaur
Ritika Khanna
Nikita Bhardwaj
 ANXIETY DISORDER
• Anxiety is a ‘normal’ phenomenon, which is
characterized by a state of apprehension or unease
arising out of anticipation of danger
• Anxiety is often differentiated from fear, as fear is an
apprehension in response to an external danger while
in anxiety the danger is largely unknown (or internal)
• Normal anxiety becomes pathological when it causes
significant subjective distress and/or impairment in
functioning of an individual
Some authors separate anxiety into two types:
1. Trait anxiety: This is a habitual tendency to
be anxious in general (a trait) and is
exemplified by ‘I often feel anxious’.
2. State anxiety: This is the anxiety felt at the
present, cross-sectional moment (state) and is
exemplified by ‘I feel anxious now’
• Persons with trait anxiety often have episodes of state
anxiety
 SYMPTOMS
1. Physical Symptoms
A. Motoric Symptoms: Tremors; Restlessness;
Muscle twitches; Fearful facial expression
B. Autonomic and Visceral Symptoms:
Palpitations; Tachycardia; Sweating;
Flushes; Dyspnoea; Hyperventilation;
Constriction in the chest; Dry mouth;
Frequency and hesitancy of micturition;
Dizziness; Diarrhoea; Mydriasis
2. Psychological Symptoms
A. Cognitive Symptoms: Poor concentration;
Distractibility; Hyperarousal; Vigilance or
scanning; Negative automatic thoughts
B. Perceptual Symptoms:
Derealisation; Depersonalisation
C. Affective Symptoms: Diffuse, unpleasant, and
vague sense of apprehen sion; Fearfulness;
Inability to relax; Irritability; Feeling of impending
doom (when severe)
D. Other Symptoms: Insomnia (initial); Increased
sensitivity to noise; Exaggerated startle response.
 Generalized Anxiety Disorder
• This is characterized by an insidious onset in the third
decade and a stable, usually chronic course which
may or may not be punctuated by repeated panic
attacks (episodes of acute anxiety).
• The symptoms of anxiety should last for at least a
period of 6 months for a diagnosis of generalized
anxiety disorder to be made.
• It is the com monest psychiatric disorder in the
population. As anxiety is a cardinal feature of almost
all psychiatric disorders, it is very important to
exclude other diagnoses.
 Panic Disorder
• This is characterized by discrete episodes of
acute anxiety
• The onset is usually in early third decade with
often chronic course
• The panic attacks occur recurrently every few
weeks
• There may or may not be underlying
generalized anxiety disorder
• The episode is usually sudden on-set, lasts for a few
minutes and is characterized by very severe anxiety

• Classically the symptoms begin unexpectedly or ‘out-

of-the-blue’. Usually there is no apparent
precipitating factor, though some patients report
exposure to phobic stimuli as a precipitant
• The life time prevalence of panic disorder is 1.5-2%,
with 3-4% reporting subsyndromal panic symptoms
(i.e. panic symptoms not severe enough to qualify for
panic disorder). Panic disorder is usually seen about
2-3 times more often in females

• Panic disorder can present either alone or with

agoraphobia
 Aetiology
The cause of anxiety disorders is not clearly known.
1. Behavioural Theory
According to this theory, anxiety is viewed as an
unconditioned inherent response of the
organism to painful or dangerous stimuli. In
anxiety and phobias, this becomes attached to
relatively neutral stimuli by conditioning.
2. Cognitive Behavioural Theory (CBT)
According to cognitive behaviour theory, in
anxiety disorders there is evidence of selective
information processing (with more attention
paid to threat-related information), cognitive
distortions, negative automatic thoughts and
perception of decreased control over both
internal and external stimuli
 TREATMENT
 The treatment of anxiety disorders is usually multi
modal.

1.) Psychotherapy

– Psychotherapy is not usually indicated, unless any

personality problems co-exist. Usually supportive
psychotherapy is used either alone, when anxiety is
mild, or in combination with drug therapy.
– The establishment of a good therapist- patient
relationship is often the first step in psychotherapy.
– Recently, there has been an increasing use of CBT in
the management of anxiety disorders. CBT can be
used either alone or in conjunction with SSRIs.
2.) Relaxation Technique
 Patients with mild to moderate anxiety, relaxation
techniques are very useful. These techniques are
used by the patient himself as routine exercise
everyday and also whenever anxiety – provoking
situation is at hand.
 These techniques include Jacobson’s progressive
relaxation technique, yoga, pranayama, self-
hypnosis, and meditation.
3.) Other behaviour therapies
 The behaviour therapies include biofeedback and
hyperventilation control.

4.) Drug treatment

 The drugs of choice for generalised anxiety disorder have
traditionally been benzodiazepines, and for panic disorder,
antidepressants. It is useful to begin the treatment of panic
disorders with small doses of antidepressants, usually SSRIs (eg.
fluoxetine). Benzodiazepines ( alprazolam and clonazepam) are
useful in short- term treatment of both generalized anxiety and
panic disorders. However, tolerance and dependence potential
limit the use of these drugs.
• Beta- blockers such as propranolol and athelol are
particularly useful in the management of anticipatory
anxiety(eg. Anxiety occurring before going to stage or
examination hall)

• However, due care must be exercised in the use of

propranolol in the patients with history of asthma or
bradycardia.

• Buspirone is an anti- anxiety drug which does not have any

dependence potential, unlike benzodiazepines. It takes about
2-3 weeks before its action is apparent. It may be preferable
to benzodiazepines for the long term management of
anxiety disorder. It, however, has not much role in the
management of panic disorder.
 Obsessive-Compulsive Disorder

• Obsessive-Compulsive Disorder
(OCD) is a common, chronic and
long-lasting disorder in which a
person has uncontrollable,
reoccurring thoughts (obsessions)
and behaviors (compulsions) that
he or she feels the urge to repeat
over and over.
• The exact causes of OCD have not
been identified. An abnormality,
or an imbalance in
neurotransmitters, is thought to
be involved in OCD
Signs and Symptoms
People with OCD may have symptoms of obsessions, compulsions, or
both. These symptoms can interfere with all aspects of life, such as
work, school, and personal relationships
Obsession symptoms
• OCD obsessions are repeated, persistent and unwanted
thoughts, urges or images that are intrusive and cause
distress or anxiety. You might try to ignore them or get rid of
them by performing a compulsive behavior or ritual
• Fear of germs or getting dirty
• Worries about getting hurt or others being hurt
• Need for things to be placed in an exact order
• Belief that certain numbers or colors are “good” or “bad”
• Constant awareness of blinking, breathing, or other body
sensations
• Unfounded suspicion that a partner is unfaithful
Compulsion symptoms
 OCD compulsions are repetitive behaviors that you feel driven to
perform. These repetitive behaviors or mental acts are meant to
prevent or reduce anxiety related to your obsessions or prevent
something bad from happening, it gives only a temporary relief
from anxiety

Washing hands many times in a row

Doing tasks in a specific order every time, or a certain “good”
number of times
Repetitive checking on a locked door, light switch, and other
things
Need to count things, like steps or bottles
Putting items in an exact order, like cans with labels facing front
Fear of touching doorknobs, using public toilets, or shaking hands
TREATMENT

Psychotherapy
Cognitive behavioral therapy (CBT), a type of psychotherapy, is
effective for many people with OCD. Exposure and response
prevention (ERP), a type of CBT therapy, involves gradually exposing
you to a feared object or obsession, such as dirt, and having you learn
healthy ways to cope with your anxiety. ERP takes effort and practice,
but you may enjoy a better quality of life once you learn to manage
your obsessions and compulsions.
Medications
•Benzodiazepines
•Antidepressants – It include:
Clomipramine (Anafranil) for adults and children 10 years and older
Fluoxetine (Prozac) for adults and children 7 years and older
Fluvoxamine for adults and children 8 years and older
Paroxetine (Paxil, Pexeva) for adults only
Sertraline (Zoloft) for adults and children 6 years and older
•Antipsychotics
Epidemiology and Outcome
OCD is a common disorder that affects adults, adolescents, and
children all over the world.
In India, obsessive compulsive disorder (OCD) is more common in
unmarried males, while in other countries no sex differences
A 25% remained unimproved over time, 50% had moderate to
marked improvement while 25% had recovered completely.

Clinical Syndromes

1. Predominantly obsessive thoughts or ruminations,

2. Predominantly compulsive acts (compulsive rituals), and
3. Mixed obsessional thoughts and acts,
Depression is very commonly
Premorbidly obessional may be commoner
Four clinical syndromes
1. Washers-obsession is of contamination with dirt, germs, body
excretions and the like. The compulsion is washing of hands or the
whole body, bathroom, bedroom, door knobs and personal articles
gradually. Avoid contamination, washing becomes a ritual.
2. Checkers-multiple doubts, e.g. the door has not been locked,
kitchen gas has been left open, counting of money was not exact,
compulsion - checking repeatedly . one doubt has been cleared
3. Pure Obsessions-by repetitive intrusive thoughts, impulses or
Images not with compulsive acts
aggressive in nature
counter-thoughts (e.g. counting) and not by behavioral rituals.
obsessive rumination
4. Primary Obsessive Slowness
severe obsessive ideas and / or extensive compulsive rituals,
relative absence of manifested anxiety.
TREATMENT

Psychotherapy
Cognitive behavioral therapy (CBT), a type of psychotherapy, is
effective for many people with OCD. Exposure and response
prevention (ERP), a type of CBT therapy, involves gradually exposing
you to a feared object or obsession, such as dirt, and having you learn
healthy ways to cope with your anxiety. ERP takes effort and practice,
but you may enjoy a better quality of life once you learn to manage
your obsessions and compulsions.
Medications
•Benzodiazepines
•Antidepressants – It include:
Clomipramine (Anafranil) for adults and children 10 years and older
Fluoxetine (Prozac) for adults and children 7 years and older
Fluvoxamine for adults and children 8 years and older
Paroxetine (Paxil, Pexeva) for adults only
Sertraline (Zoloft) for adults and children 6 years and older
•Antipsychotics
 PHOBIC DISORDER

 Phobia is an irrational fear of a

specific object, situation or
activity, often leading to
persistent avoidance of the
feared object, situation or
activity.
 Characteristics features of phobia are:
I. Presence of the fear of an object, situation or
activity.
II. Patient recognizes the fear as irrational and
unjustified.
III. Patient is unable to control the fear and is very
distressed by it.
IV. This leads to persistent avoidance of the
particular object, situation or activity.
V. Leads to marked distress and restriction of
freedom and mobility.
 Common types of Phobias are:
1. Agoraphobia
2. Social phobia
3. Specific (simple)phobia.
 Agoraphobia:
• Agoraphobia is the commonest type of phobia,
this is an example of Irrational fear of
situations.
• Mostly common in women in western
countries.
• Characterized by an irrational fear of being in
places away from the familiar setting of home.
• Patient is afraid of all places or situations from
where escape may be difficult or help may not
Be available.
• Full-blown panic attack may occur, or
symptoms like dizziness or tachycardia may
occur.
• As the agoraphobia increases in severity, there
is gradual restriction in normal day to day
activities, it becomes so severely restricted that
the person becomes self- imprisoned at home
and may be relied upon one or two Persons
usually who are in close relations.
 Social Phobia:
• There is a fear of activities or social interaction,
fear of performing activities in the presence of
other people or interacting with others.
• Patient is afraid of his own actions viewed by
others resulting in embarrassment or
humiliation.
• Examples are fear of blushing
(erythrophobia),eating, public speaking,
participating in groups, speaking to strangers,
speaking to authority figures.
• Sometimes, alcohol is used to overcome the
anxiety occurring in social situations.
 Specific( Simple) Phobia:
• It is characterized by an irrational fear of a
specified object or situation.
• Anticipatory anxiety leads to persistent avoidant
behavior, while confrontation with the avoided
object or situation leads to panic attack.
• The disorder is diagnosed only if there is marked
distress or disturbances in daily functioning.
• Examples are acrophobia( fear of high places),
zoophobia( fear of animals), xenophobia( fear of
strangers), algophobia( fear of pain) and
claustrophobia( fear of closed places).
 Course:
• The phobias are more common in women
• Typically, the onset is sudden without any
apparent cause
• The course is usually chronic with gradually
increasing restriction of daily activities.