H). NEUROTIC DISORDER (Phobia, anxiety disorders, obsessive compulsive disorders, depressive neurosis, conversion disorders, dissociative reaction, psychosomatic disorders, post traumatic stress disorder.)

PHOBIA

*Definition: Phobia is an anxiety disorder. An unprovoked fear of any person, thing or a situation and activity is called a phobia.

CAUSES OF PHOBIA

(Causes of Phobia)

*Genetics and environmental factors can cause phobias.

• Children who have close relatives with an anxiety disorder are at risk of developing phobias.
• People with medical condition or health anxiety can have phobia.
• The incidence of phobias is higher in people after traumatic brain injury, substance abuse and depression.

*Caused by failure of defense mechanism Usually, phobias occur when repression and substitution defense mechanisms fail.

CLASSIFICATION OF PHOBIA

(Classification of Phobias)

•Specific phobia

• Social phobia

•Agoraphobia

•Specific phobia

• Fear of any specific object or thing without any reason is called specific phobia. Specific phobia is more common in childhood. Many fears disappear in teenage age but some fear remains till adult life.

*Some exapmples of specific phobias.

Acrophobia – fear of height

Hematophobia – fear of blood

•Claustrophobia -fear of closed space

•Gamophobia – Fear of marriage

Insectophobia – Fear of insects

AIDS phobia – Fear of AIDS

•Zoophobia – Fear of animals

Algophobia – Fear of pain

Arachnophobia-Fear of spiders

Ophidiophobia – Fear of snakes

Aerophobia – Fear of flying

Cynophobia – Fear of dogs

Trypanophobia – Fear of injections.

SIGNS AND SYMPTOMS OF SPECIFIC PHOBIA

(Signs and Symptoms of Specific Phobia)

*Loss of control.

*Fanting (sweating)

*Anxiety

• Impaired daily function

*Avoid activity.

SOCIAL PHOBIA

(Social Phobia)

*Feeling fear of doing any activity in front of other people or even fear of interacting with people is called social phobia or social anxiety disorder.

SIGNS AND SYMPTOMS OF SOCIAL PHOBIA

(Signs and Symptoms of Social Phobia)

*Hyperventilation

• Sweating

*Cold Hands

*Palpitation

• Confusion

*Fear

AGORAPHOBIA

(agoraphobia)

*Agoraphobia is the fear of any public place where there is a large crowd and the person is afraid of being alone (supermarket as an example).

• The severity of agoraphobia increases. In severe cases, the person locks himself in the house.

SIGNS AND SYMPTOMS OF AGORAPHOBIA

(Signs and Symptoms of Agoraphobia)

*Avoid going to public places.

*Fear

• Dry mouth

*Dyspnea

*Speaking too fast or not being able to speak.

DIAGNOSTIC EVALUATION

(Diagnostic Evaluation)

-History Collection

-Physical Examination

-MSE (Mental States Examination)

-Biochemical test (to check neurotransmitter levels)

TREATMENT OF PHOBIA

(Treatment of Phobia)

• Pharmacotherapy :
• Benzodiazepines (Alprazolam, Clonazepam, Diazepam)
• Antidepressants (sertraline, imipramine)

*Psychotherapy:

•Cognitive Behavioral Therapy

• Supportive therapy
• Individual therapy

•Group therapy

•Exposure therapy (Their fear is eliminated by exposure to the feared object or activity.)

• Systemic desensitization (in which the phobia is removed by imagining what the person is afraid of.

NURSING MANAGEMENT OF PATIENTS WITH PHOBIA

(Nursing Management of Patients with Phobia)

*Focus should be on physical symptoms, precipitating factors and avoidance behavior associated with the phobia.

*Thought process, communication, physiological and psychomotor responses should be observed during the assessment of patients with high anxiety.

*Direct questions should be asked about the patient’s current condition and what happened before the onset of symptoms.

*The patient should be asked about somatic symptoms such as fatigue, muscle pain, eating patterns, bowel habits and sleeping patterns.

• Reassure the patient that they are safe. Involve the patient in the decision to select coping strategies.

*Should be present in group activities with the patient.

*Maintain patient privacy during dressing, toileting, and bathing.

*Give medication to the patient as per the doctor’s prescription and monitor the effectiveness and side effects of the medicine.

*Do not give false assurances to the patient, the patient should be encouraged to tell his feelings and emotions.

*The patient should be asked to identify his abilities and strengths.

*Anxiety-increasing signs and symptoms should be discussed with the patient.

*Patient should be encouraged to interact with others.

ANXIETY DISORDERS

(Anxiety Disorders)

*It is a condition in which a person has excessive anxiety, fear and anxiety.

*Anxiety is mental discomfort. Which appears with physical symptoms. In which the feeling of tension and fear is seen.

CLASSIFICATION OF ANXIETY DISORDERS

(Classification of Anxiety Disorders)

•GAD (Generalized Anxiety Disorder)

•Panic anxiety disorder

•GAD (Generalized Anxiety Disorder)

*Generalized Anxiety Disorder is a condition in which there is excessive worry about everyday issues and situations. Its duration is more than 6 months. It is more in female than male.

CAUSES OF GAD

(Causes of Generalized Anxiety Disorder)

*Chemical Imbalance: This can occur due to low levels of GABA (Gamma Amino Butyric Acid) neurotransmitter.

*Psychodynamic theory: Repression means forgetting an event unconsciuosly is likely to cause generalized anxiety disorder.

*Cognitive theory: A person can get anxiety due to frequent negative thoughts.

*Learning Theory: Can also happen by coming in contact with stressful stimuli.

*Medication: Some medications increase anxiety levels. Ex. Sodium lactate.

*Medical conditions: acute myocardial infarction, hypoglycemia, caffeine intoxication, substance abuse, encephalitis, brain injury.

SIGNS AND SYMPTOMS OF GAD

Signs and Symptoms of GAD

*Psychological symptoms

• Anxious mood
• Fear
• Irritability
• Nightmares

*GI (Gastro-Intestinal) Symptoms

-Anorexia (loss of appetite)

-Nausea

-Abdominal cramps

• Dry mouth

*Cardiovascular symptoms

• Palpitation
• Chest pain

-Bounding pulse

• Tachycardia

*Other symptoms

-Urinary incontinence

-Diaphoresis (excessive sweating)

-Sleep disturbance

-Difficulty breathing

TREATMENT OF GAD

(Treatment of GAD)

*Generalized anxiety disorder is treated using a combination of therapy and medication.

*Medication:

-benzodiazepines such as Librium, Ativan, and Valium.

-Antidepressants: SSRIs and SNRIs group of antidepressants are used.

*CBT (Cognitive Behavioral Therapy):

CBT is a psychological method for the treatment of GAD. This therapy helps the patient to change and understand the thought processes and behaviors that contribute to anxiety.

*Support Group:

• Connect with people who have GAD to get tips to deal with anxiety.

*Alternative Therapies:

• Some people use alternative therapies like acupuncture, yoga, herbal to relieve anxiety symptoms.

NURSING MANAGEMENT OF PATIENTS WITH PANIC ANXIETY DISORDERS

(Nursing Management of Patients with Panic Anxiety Disorder)

-Patient should be taught to replace negative thoughts with more realistic, positive ways of viewing panic attacks.

-Help the patient identify potential triggers for panic attacks, such as a specific thought or situation.

-Help the patient identify and evaluate the thoughts preceding the anxiety and then gain a more realistic perception.

• Benzodiazepines and as per doctor’s prescription

Medications like antidepressants should be given.

• Health education about risk factors, symptoms, treatment of panic disorder should be provided to the patient and his family.

-The patient should be given emotional support and counselling.

-Regular follow up assessments should be done so that the patient’s progress can be monitored and the treatment plan can be adjusted as needed.

(H). NEUROTIC DISORDER (Phobia, anxiety disorders, obsessive compulsive disorders, depressive neurosis, conversion disorders, dissociative reaction, psychosomatic disorders, post traumatic stress disorder.)

PHOBIA

*Definition: Phobia is an anxiety disorder. An unprovoked fear of any person, thing or a situation and activity is called a phobia.

CAUSES OF PHOBIA

(Causes of Phobia)

*Genetics and environmental factors can cause phobias.

• Children who have close relatives with an anxiety disorder are at risk of developing phobias.
• People with medical condition or health anxiety can have phobia.
• The incidence of phobias is higher in people after traumatic brain injury, substance abuse and depression.

*Caused by failure of defense mechanism Usually, phobias occur when repression and substitution defense mechanisms fail.

CLASSIFICATION OF PHOBIA

(Classification of Phobias)

•Specific phobia

• Social phobia

•Agoraphobia

•Specific phobia

• Fear of any specific object or thing without any reason is called specific phobia. Specific phobia is more common in childhood. Many fears disappear in teenage age but some fear remains till adult life.

*Some exapmples of specific phobias.

Acrophobia – fear of height

Hematophobia – fear of blood

•Claustrophobia -fear of closed space

•Gamophobia – Fear of marriage

Insectophobia – Fear of insects

AIDS phobia – Fear of AIDS

•Zoophobia – Fear of animals

Algophobia – Fear of pain

Arachnophobia-Fear of spiders

Ophidiophobia – Fear of snakes

Aerophobia – Fear of flying

Cynophobia – Fear of dogs

Trypanophobia – Fear of injections.

SIGNS AND SYMPTOMS OF SPECIFIC PHOBIA

(Signs and Symptoms of Specific Phobia)

*Loss of control.

*Fanting (sweating)

*Anxiety

• Impaired daily function

*Avoid activity.

SOCIAL PHOBIA

(Social Phobia)

*Feeling fear of doing any activity in front of other people or even fear of interacting with people is called social phobia or social anxiety disorder.

SIGNS AND SYMPTOMS OF SOCIAL PHOBIA

(Signs and Symptoms of Social Phobia)

*Hyperventilation

• Sweating

*Cold Hands

*Palpitation

• Confusion

*Fear

AGORAPHOBIA

(agoraphobia)

*Agoraphobia is the fear of any public place where there is a large crowd and the person is afraid of being alone (supermarket as an example).

• The severity of agoraphobia increases. In severe cases, the person locks himself in the house.

SIGNS AND SYMPTOMS OF AGORAPHOBIA

(Signs and Symptoms of Agoraphobia)

*Avoid going to public places.

*Fear

• Dry mouth

*Dyspnea

*Speaking too fast or not being able to speak.

DIAGNOSTIC EVALUATION

(Diagnostic Evaluation)

-History Collection

-Physical Examination

-MSE (Mental States Examination)

-Biochemical test (to check neurotransmitter levels)

TREATMENT OF PHOBIA

(Treatment of Phobia)

• Pharmacotherapy :
• Benzodiazepines (Alprazolam, Clonazepam, Diazepam)
• Antidepressants (sertraline, imipramine)

*Psychotherapy:

•Cognitive Behavioral Therapy

• Supportive therapy
• Individual therapy

•Group therapy

•Exposure therapy (Their fear is eliminated by exposure to the feared object or activity.)

• Systemic desensitization (in which the phobia is removed by imagining what the person is afraid of.

NURSING MANAGEMENT OF PATIENTS WITH PHOBIA

(Nursing Management of Patients with Phobia)

*Focus should be on physical symptoms, precipitating factors and avoidance behavior associated with the phobia.

*Thought process, communication, physiological and psychomotor responses should be observed during the assessment of patients with high anxiety.

*Direct questions should be asked about the patient’s current condition and what happened before the onset of symptoms.

*The patient should be asked about somatic symptoms such as fatigue, muscle pain, eating patterns, bowel habits and sleeping patterns.

• Reassure the patient that they are safe. Involve the patient in the decision to select coping strategies.

*Should be present in group activities with the patient.

*Maintain patient privacy during dressing, toileting, and bathing.

*Give medication to the patient as per the doctor’s prescription and monitor the effectiveness and side effects of the medicine.

*Do not give false assurances to the patient, the patient should be encouraged to tell his feelings and emotions.

*The patient should be asked to identify his abilities and strengths.

*Anxiety-increasing signs and symptoms should be discussed with the patient.

*Patient should be encouraged to interact with others.

ANXIETY DISORDERS

(Anxiety Disorders)

*It is a condition in which a person has excessive anxiety, fear and anxiety.

*Anxiety is mental discomfort. Which appears with physical symptoms. In which the feeling of tension and fear is seen.

CLASSIFICATION OF ANXIETY DISORDERS

(Classification of Anxiety Disorders)

•GAD (Generalized Anxiety Disorder)

•Panic anxiety disorder

•GAD (Generalized Anxiety Disorder)

*Generalized Anxiety Disorder is a condition in which there is excessive worry about everyday issues and situations. Its duration is more than 6 months. It is more in female than male.

CAUSES OF GAD

(Causes of Generalized Anxiety Disorder)

*Chemical Imbalance: This can occur due to low levels of GABA (Gamma Amino Butyric Acid) neurotransmitter.

*Psychodynamic theory: Repression means forgetting an event unconsciuosly is likely to cause generalized anxiety disorder.

*Cognitive theory: A person can get anxiety due to frequent negative thoughts.

*Learning Theory: Can also happen by coming in contact with stressful stimuli.

*Medication: Some medications increase anxiety levels. Ex. Sodium lactate.

*Medical conditions: acute myocardial infarction, hypoglycemia, caffeine intoxication, substance abuse, encephalitis, brain injury.

SIGNS AND SYMPTOMS OF GAD

Signs and Symptoms of GAD

*Psychological symptoms

• Anxious mood
• Fear
• Irritability
• Nightmares

*GI (Gastro-Intestinal) Symptoms

-Anorexia (loss of appetite)

-Nausea

-Abdominal cramps

• Dry mouth

*Cardiovascular symptoms

• Palpitation
• Chest pain

-Bounding pulse

• Tachycardia

*Other symptoms

-Urinary incontinence

-Diaphoresis (excessive sweating)

-Sleep disturbance

-Difficulty breathing

TREATMENT OF GAD

(Treatment of GAD)

*Generalized anxiety disorder is treated using a combination of therapy and medication.

*Medication:

-benzodiazepines such as Librium, Ativan, and Valium.

-Antidepressants: SSRIs and SNRIs group of antidepressants are used.

*CBT (Cognitive Behavioral Therapy):

CBT is a psychological method for the treatment of GAD. This therapy helps the patient to change and understand the thought processes and behaviors that contribute to anxiety.

*Support Group:

• Connect with people who have GAD to get tips to deal with anxiety.

*Alternative Therapies:

• Some people use alternative therapies like acupuncture, yoga, herbal to relieve anxiety symptoms.

NURSING MANAGEMENT OF PATIENTS WITH GAD

(Nursing Management of Patients with GAD)

-Anxiety should be assessed when the patient shows feelings of nervousness, fear and anxiety.

-Autonomic nervous system should be assessed including assessment of heart rate, breathing, sweating, dry mouth, tremors etc.

-Checking the severity of symptoms using anxiety tools.

-The healthcare team should work closely with psychiatrists, psychologists, nurses and other healthcare workers to provide comprehensive healthcare.

• Benzodiazepines and as per doctor’s prescription

Medications like antidepressants should be given.

-Health education regarding risk factors, symptoms, treatment of GAD should be provided to the patient and his family.

-Regular exercise, healthy eating, adequate sleep and education about stress management techniques should be provided to reduce the symptoms of anxiety.

-The patient should be given emotional support and counselling.

-Regular follow up assessments should be done so that the patient’s progress can be monitored and the treatment plan can be adjusted as needed.

PANIC ANXIETY DISORDER

(Panic Anxiety Disorder)

*Panic anxiety disorder is a disorder characterized by unpredictable and frequent episodes of fear accompanied by physical symptoms including chest pain, increased heart rate, breathing difficulties, dizziness, and abdominal pain.

CAUSES OF PANIC ANXIETY DISORDER

(Causes of Panic Anxiety Disorder)

*Chemical Imbalance: This can occur due to low levels of GABA (Gamma Amino Butyric Acid) neurotransmitter.

*Psychodynamic theory: Repression means forgetting an event unconsciuosly is likely to cause generalized anxiety disorder.

*Cognitive theory: A person can get anxiety due to frequent negative thoughts.

*Learning Theory: Can also happen by coming in contact with stressful stimuli.

*Medication: Some medications increase anxiety levels. Ex. Sodium lactate.

*Medical conditions: acute myocardial infarction, hypoglycemia, caffeine intoxication, substance abuse, encephalitis, brain injury.

SIGNS AND SYMPTOMS OF PANIC DISORDER

(Signs and Symptoms of Panic Anxiety Disorder)

*Psychological symptoms

• Anxious mood
• Fear
• Irritability
• Nightmares

-Depression

-Agoraphobia

*GI (Gastro-Intestinal) Symptoms

-Anorexia (loss of appetite)

-Nausea

-Abdominal cramps

• Dry mouth

*Cardiovascular symptoms

• Palpitation (increased heart rate)
• Chest pain

-Bounding pulse

• Tachycardia

*Other symptoms

-Urinary incontinence

-Diaphoresis (excessive sweating)

-Sleep disturbance

-Difficulty breathing

-Numbness (empty numbness)

DIAGNOSIS

(Diagnosis)

*Physical Examination

*History Collection

*Family history

*MSE (Mental States Examination)

*MRI

*CT Scan

• X-ray

TREATMENT OF PANIC ANXIETY DISORDER

(Treatment of Panic Anxiety Disorder)

*Medication:

-benzodiazepines such as Librium, Ativan, and Valium.

-Antidepressants: SSRIs and SNRIs group of antidepressants are used.

-Beta blocker medication is also used.

*CBT (Cognitive Behavioral Therapy):

CBT is a psychological method of treatment. This therapy helps the patient to change and understand the thought processes and behaviors that contribute to anxiety.

*Support Group:

• Connect with people who have panic disorder to get tips to deal with anxiety.

*Family therapy:

-Family therapy is useful for the management of panic anxiety disorder.

*Alternative Therapies:

-Some people use alternative therapies like acupuncture, yoga, herbal to relieve anxiety symptoms.

NURSING MANAGEMENT OF PATIENTS WITH PANIC ANXIETY DISORDERS

(Nursing Management of Patients with Panic Anxiety Disorder)

-The patient should be taught to replace negative thoughts with more realistic, positive ways of viewing panic attacks.

-Help the patient identify potential triggers for panic attacks, such as a specific thought or situation.

-Help the patient identify and evaluate the thoughts preceding the anxiety and then gain a more realistic perception.

• Benzodiazepines and as per doctor’s prescription

Medications like antidepressants should be given.

• Health education about risk factors, symptoms, treatment of panic disorder should be provided to the patient and his family.

-The patient should be given emotional support and counselling.

-Regular follow up assessments should be done so that the patient’s progress can be monitored and the treatment plan can be adjusted as needed.

OBSESSIVE COMPULSIVE DISORDERS (OCD)

(Obsessive Compulsive Disorders-OCD)

*Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable recurrent thoughts (obsessions) and behaviors (compulsions) that they feel the urge to repeat. Obsessions and compulsions are common.

*Obsession

Repetition of thoughts happens even though the person does not want to and all this happens in the conscious state. Which causes Anxiety and Fear. For example, a person may have frequent thoughts of contamination by insects.

*Compulsion

Constant repetition of purposeless actions despite lack of will and cannot be controlled. Example washing hands frequently, checking whether the door is locked or not.

CAUSES OF OCD

(Causes of OCD)

*Biological factor:

If a parent or sibling has OCD, the chances increase. Identical twins are more likely to develop OCD than dizygotic twins.

*Brain Chemistry: Mood changes due to serotonin neurotransmitter imbalance.

*Environmental Factors: Symptoms of OCD can be triggered by traumatic events, abuse and stress.

*Cognitive factor: Certain thought patterns and beliefs such as excessive need for control result in OCD.

*Neurological factor: Abnormalities in the structure and function of the brain can cause OCD.

*Infection: Streptococcal infection can cause OCD.

CLINICAL MANIFESTATION OF OCD

(Clinical Manifestation of OCD)

*Obsession:

*Fear of contamination

*Doubting

*Requirement for order

• Aggressive thought

*Compulsion:

-Washing/cleaning

-Checking (locks, door)

• Activity Repetition (repeated counting)
• Touching (touching the wall repeatedly)

TREATMENT MODALITIES

(Treatment Modalities)

*Pharmacological treatment

*Benzodiazepines:

• Alprazolam (0.5-1mg/day)

Clonazepam (0.25-0.5mg/day)

*Antidepressants:

• Clomipramine
• Fluoxetine
• Fluvoxamine

*Antipsychotic

• They can be used for the treatment of severe anxiety. They are used if there is a history of tics disorder.
• Haloperidol
• Risperidine

**ECT (Electro-Convulsive Therapy)

• ECT is used if there is severe depression with OCD and ECT is necessary when there is a risk of suicide or when other treatments fail.

*Self Help Group

• Maintain a healthy lifestyle and be aware of warning signs. Using relaxation techniques like yoga, meditation, massage etc.
• Psychotherapy •Psychodynamic psychotherapy • Cognitive Behavioral Therapy (CBT) • Supportive therapy

NURSING MANAGEMENT OF PATIENTS WITH OCD

(Nursing Management of Patients with OCD)

*Common nursing diagnoses of patients with OCD

• Severe Anxiety
• Impaired communication

•Altered coping abilities

• Impaired judgment

•Disturbed sleep patterns

•Lower self esteem

1.Severe Anxiety

*Objectives: Reduce patient anxiety and reduce compulsive behavior.

*Nursing intervention

-Anxiety level should be observed and relationship should be established with respect, warmth and empathy.

• Clean and comfortable environment should be provided.

-Encourage the patient to talk about his anxiety.

-Identifying anxiety producing situations and providing psychological support to the patient.

-Ask the patient to express his feelings and remove his fear.

-Discourage their compulsive behavior and give medication as per prescription.

2. Impaired communication

-Objectives: To improve communication and increase social interaction.

Nursing Interventions

-Trusting environment should be provided to the patient.

-Must help to develop effective relationship with patient.

• Source of anxiety should be discovered and other symptoms like rigidity, immobility etc should be observed.

-Encourage them to talk to other people.

-Speaking to the patient simply and briefly and teaching communication skills to the patient.

3. Altered Coping Ability

*Objectives : To improve coping ability and help in coping with obsessive compulsive behaviour.

Nursing Interventions

-The level of coping ability should be assessed.

-Establishing a warm and respectful relationship with the patient.

-Meet the patient’s dependency needs and provide positive reinforcement.

-The patient’s compulsive behavior should be accepted from the beginning.

• Gradually put limits on ritualistic behaviour.

-Do not punish the patient for his symptoms.

• To observe how many times the patient has gone for hand washing in the last one hour.

-Teaching new adaptation skills to deal with ritualistic behaviour.

-Using cognitive and modeling therapy to modify behavior.

CONVERSION DISORDERS

(Conversion Disorders)

*Conversion disorders are somatoform disorders in which anxiety is converted into physical symptoms.

*In this, the person shows his/her own anxiety/tension through physical movement.

*Paralysis, blindness, seizures, aphonia, amnesia, dementia, hallucinatory etc. are common examples of conversion symptoms.

CAUSES OF CONVERSION DISORDERS

(Causes of Conversion Disorders)

*Genetic factors

*Biochemical factors

*Psychological factors

*In tro

*Personality factors

*Family Dynamics

*Coping mechanism failure

*Psychosocial factor

*Neurobiological factors

CLINICAL MANIFESTATION

(Clinical Manifestation)

• Impaired balance

*Weakness or paralysis in limb and body

*Speech problems

*Dysphagia

• Hearing and vision impairment

*tremor (shaking)

• Sweating
• Diplopia (double vision)
• Sensation loss

*Gait problems (walking problems)

*Psychogenic non-epileptic seizure

*Fanting (dizziness)

TREATMENT OF CONVERSION DISORDERS

(Treatment of Conversion Disorder)

*Pharmacological treatment

•Antipsychotics: Haloperidol, Risperidol etc

•Antidepressants : Imipramine, Doxeparin

*ECT (Electro Convulsive Therapy)

• ECT is used to treat conversion disorder.
• Psychotherapy

•Cognitive Behavioral Therapy (CBT)

•Individual psychotherapy

•Group therapy

-Rehabilitation therapy

-Relaxation therapy

NURSING INTERVENTION

(Nursing Intervention)

• Comfortable environment should be provided to the patient.

*Develop a therapeutic relationship and seizure or

Observe and record the fits.

• Supervise the personal hygiene of each patient and provide them with psychological support.

*Listen and pay attention to the patient appropriately and evaluate the patient’s physical symptoms.

*The patient should be helped to identify his own situation.

• Administer medication to patients as per prescription and provide supportive psychotherapy.

DYSTHEMIA (Persistent Depressive Neurosis)

*Dysthymia, also known as persistent depressive disorder (PDD), is a chronic form of depression characterized by prolonged low mood and loss of interest and pleasure in daily activities. It is less severe than major depression but still causes daily May affect function more. Their duration is more than 2 years.

*The exact causes of depressive neurosis are not known but it can be caused by some factors.

•Genetic factor

•Biological factor

•Environmental factors

•Psychological factor

*Patients who have a history of depression are more likely to develop dysthymia.

SIGNS AND SYMPTOMS OF DYSTHEMIA

(Signs and Symptoms of Dysthymia)

• sad or irritable mood
• Anhedonia (loss of pleasure from any activity)
• Appetite or weight changes

-Sleep disturbance

• Fatigue and low energy
• Feel guilty.

-Problems in concentration and making decisions.

-Suicidal thought

-Anxiety

TREATMENT

(treatment)

*Pharmacological treatment

Antidepressants:

-Shertraline

• Fluvoxamine
• Fluoxetine
• Citalopram

*Psychological therapy

-Group therapy

-CBT (Cognitive Behavioral Therapy)

-Supportive psychotherapy

-Psychodynamic psychotherapy

NURSING INTERVENTION

(Nursing Intervention)

-Intervention

•Assess the patient’s daily life activities including bath, diet intake, cloth and hair care etc.

• To educate the patient to maintain their personal hygiene and provide health education.
• The patient should be asked to take a bath every day and should be encouraged to do nail and hair care.
• Make a plan for various activities of daily life according to the condition of the patient and increase him to actively participate in daily activities.
• Teach behavior change techniques and encourage them to follow through, providing help whenever needed.
• An opportunity should be given to discuss his disorder and his need for medication and other therapy and his feelings towards them.

DISSOCIATIVE DISORDERS

(Dissociative Disorders)

• Dissociation means that a person gets separated from himself and the surrounding environment.

*Dissociation is a mental process where a person becomes disconnected from their thoughts, feelings, memory or sense of identity. Dissociative disorders include dissociative amnesia, dissociative fuse, depersonalization disorder, and dissociative identity disorder.

TYPES OF DISSOCIATIVE DISORDERS

(Types of dissociative disorders.)

1.Dissociative Amnesia

2.Dissociative Fugue

3. Depersonalization Disorder
4. Dissociative Identity Disorder (Dissociative Identity)

1.Dissociative Amnesia

*Dissociative amnesia is when a person cannot remember the details of a traumatic or stressful event, even though they realize they are experiencing memory loss. A person also forgets his personal information. This is also known as psychogenic amnesia. This type of amnesia can last from a few days to a year or more. Dissociative amnesia can be associated with other disorders such as anxiety disorders.

2.Dissociative Fugue

*Dissociative fuse is also known as psychogenic fuse. The person suddenly, and without any warning, cannot remember who they are and has no memory of their past. They do not realize that they are losing their memory. Typically, a person travels sometimes thousands of kilometers from home, while in a fuse, which can last for hours and months. A person does not remember his traveling.

*When a person emerges from their dissociative fuse, they are usually in confusion with no memory of the ‘new life’ they have created for themselves.

3. Depersonalization Disorder

*In depersonalization, a person feels separated from his own life, a person forgets his identity.

*People with depersonalization disorder feel distant and emotionally disconnected, as if they are watching a character in a boring movie. Other typical symptoms include comprehension and memory problems. They may perceive their body as having a different shape or size than normal; In severe cases, they cannot even recognize themselves in the mirror.

4. Dissociative Identity Disorder (Dissociative Identity)

• This is the most severe dissociative disorder. A person with this disorder has two or more personalities or identities, that is, a person has different identities at different times.
• When different personality states influence a person’s behavior, the person is usually not aware of these personality states and experiences it as a memory lapse. A person with dissociative identity disorder almost always has dissociative amnesia.

CAUSES OF DISSOCIATIVE DISORDERS

(Causes of Dissociative Disorder)

• The root cause of dissociative disorder is chronic trauma in childhood. Examples of infidelity often include physical or sexual abuse, emotional abuse, or neglect.

*Even if the family environment is not right, it can cause the child to disconnect from reality during times of stress.

*Severity of dissociative disorders during adulthood is directly related to childhood stress.

*Traumatic events occurring during adulthood can also cause dissociative disorders. Such events include going through war, torture or a natural disaster causing a dissociative disorder.

SIGNS AND SYMPTOMS OF DISSOCIATIVE DISORDERS

(Signs and Symptoms of Dissociative Disorder)

*Disconnected from yourself (feeling disconnected from yourself).

*Problems in controlling intense emotions.

*sudden mood changes (becomes very depressed for no reason).

*Anxiety problems

*Derealization (feeling like the world is not real)

*Memory problems that are not linked to a physical injury or medical condition.

*Concentration problems (not paying attention)

• Forgetting important personal information.

*Fear of identity confusion

Long term memory poor

*Don’t have eye contact

*Negative thinking

*Judgment Impaired

*Limited insight

• Impaired social function

*fear

TREATMENT OF DISSOCIATIVE DISORDERS

(Treatment of Dissociative Disorders)

• Safe environment : which will help the person feel safe and relaxed which is enough to trigger memory recall in some people with dissociative disorder.
• Psychiatric drugs: barbiturates and other disorder treatment – ​​Usually, a person with dissociative disorder may have other mental health problems such as depression or anxiety, their treatment involves the use of antidepressants or anti-anxiety medicines to reduce the symptoms of dissociative disorder.
• Hypnosis: Can help to retrieve repressed memory.

Psychotherapy: Which is usually required for long term. Cognitive therapy, group therapy, psychoanalysis etc.

Stress management: Because stress can trigger symptoms.

NURSING MANAGEMENT OF PATIENTS WITH DISSOCIATIVE DISORDERS

(Nursing Management of Patients with Dissociative Disorders)

*Provide safety and security to the patient and identify stressors that produce severe anxiety.

*Helping the patient develop healthy coping behaviors.

• Look at the feelings felt by the patient as a response to stress and encourage the patient to participate in different therapies.
• Develop coping methods so that the patient can cope with stress and ask him to develop his hobbies and interests.
• Helping the patient identify his positive points and asking him to express feelings and emotions.

*Enhancing their sense of self by paying attention, empowering the patient to engage in activities that he can do confidently.

*Anchor the client for positive physical habits and ask the patient to remain cool and calm.

*Do not put the patient in a difficult decision-making condition and relatives should also support the patient.

• Making a suitable schedule plan for the patient which includes physical activity, exercise, meditation
• Administering medication as per prescription and checking for potential side effects of medication.

PSYCHOSOMATIC DISORDERS

(Psychosomatic Disorders)

*Psychosomatic means mind and body, ie

Both mind and body are involved in psychosomatic disorders.

*Psychosomatic disorders are conditions in which psychological factors such as stress, anxiety or emotional distress cause physical symptoms or illness.

LIST OF PSYCHOSMATIC DISORDERS

(List of Psychosomatic Disorders)

*GI system disorders

IBS (Irritable Bowel Syndrome)

• Peptic ulcer
• Ulcerative colitis

*Respiratory system disorder

• Asthma

•Rhinitis

*Heart disorder

• CAD (Coronary Artery Disease)
• Hypertension

*Skin disorder

• Psoriasis
• Eczema

•Pritis

• Endocrine system disorder

•Cushing’s syndrome

• Diabetes mellitus

•Hyperthyroidism

*Other disorders

• Obesity

•Anorexia and bulimia nervosa

RA (Rheumatoid Arthritis)

• Menstrual disorder

TREATMENT OF PSYCHOSOMATIC DISORDERS

*Medication:

•Medications are prescribed to manage the symptoms of anxiety, depression, pain.

*Psychotherapy:

•CBT (Cognitive Behavioral Therapy)

•Psychodynamic therapy

*Stress Management: Relaxation techniques, meditation, stress reduction strategies are effective in dealing with stress.

Alternative therapy:

Acupuncture, yoga, massage therapy can help reduce psychosomatic symptoms.

NURSING CARE OF PSYCHOSOMATIC DISORDERS

(Nursing Care of Psychosomatic Disorders)

*Physical symptoms and psychosocial factors of the patient should be assessed.

*Having therapeutic communication with the patient so as to remove their anxiety and fear and developing rapport with the patient.

*Giving information about psychosomatic disorders to patients and teaching relaxation techniques.

*Encouraging the patient to talk about his own stressful situation and feelings and emotions.

• Teaching coping skills to the patient to deal with stressful conditions.

*Family members should also be involved in the patient’s therapy.

*Giving medicine as per prescription and checking its side effects.

*Providing emotional support and counseling to patients. Provide positive reinforcement to the patient.

*Physical exercise, yoga, meditation, stress reduction strategies are effective in coping with stress and are necessary to reduce the symptoms of stress.

PTSD (Post Traumatic Stress Disorders)

PTSD (Post Traumatic Stress Disorders)

*PTSD is a severe anxiety disorder that develops after exposure to any event that results in psychological trauma. Earthquakes, floods, war, rape, tsunamis and serious physical assaults can cause PTSD.

ETIOLOGY OF PTSD

Causes of PTSD)

Stressors:

*Stressors are the prime causative factor for PTSD.

• Fear and stress can occur as a response to a traumatic event.

Biological Factors:

*Genetics factor – PTSD is also likely to be caused by heredity.

*More likely to occur in monozygotic twins than dizygotic.

•Cognitive Behavioral Factor:

*The cognitive model of PTSD posits that the affected person cannot process the beliefs that are responsible for causing the disorder.

• Neuro-endocrine factors:

*Decreased cortisol secretion.

• Brain and body chemical changes occur.

*Hypothalamic pituitary adrenal (HPA) axis

*Catecholamine level imbalance

Psychodynamic factors:

*PTSD is caused by physical and psychological trauma.

*Physical, emotional or sexual abuse

*Physical assault, drug addiction, illness and medical complications.

*Symptoms of PTSD can be seen due to events like war, rape and tsunami.

CLINICAL FEATURES

(Clinical Features)

*Intrusive memory of a traumatic event

•Recurring memories of the event

•Flashback

• Nightmare

•Physical reaction : Rapid breathing, Nozia, Vomiting, Sweating.

*Avoidance and Numbing.

• Avoid activities, places, feelings and thoughts that trigger memory of the event.

•Difficulty in remembering important aspects of tro.

• Loss of interest in activities.
• Feeling detached from people and emotionally numb.

*Negative thought

•Helplessness

•Worthlessness

• Anhedonia

*Emotional arousal and increased anxiety

•Sleep disturbance

• Irritability (restlessness)

Anger

•Concentration problems

*Other symptoms

• feel guilty

•Substance abuse

•fear

• Depression
• Suicidal thoughts

•Physical pain

TREATMENT OF PTSD

(Treatment of PTSD)

*Pharmacological therapy

-Antidepressants Medicine:

•SSRIs : Sertraline and Fluoxetine

•TCAs : Imipramine

-Antiangiolytic:

•Lorazepam

• Diazepam

-Antihypertensive

•Beta Blocker : Propranolol

• Mood Stabilizer : Lithium Carbonate

-Anticonvulsant : Clonidine, Sodium Valporate

• Psychosocial therapy

•CBT (Cognitive Behavioral Therapy)

• Exposure therapy (taking the person back to where the traumatic event occurred.)

•Cognitive restructuring therapy (necessary to improve the patient’s thought pattern.

• Family therapy (Family therapy can help PTSD patients improve communication and improve relationships.

•Group Psychotherapy (Group psychotherapy will make the patient confident and develop trust.

•EMDR-Eye Movement Desensitization and Reprocessing (is a psychotherapy treatment that addresses distress associated with traumatic memory).

NURSING MANAGEMENT OF PATIENT WITH PTSD

*Develop a therapeutic nurse-patient relationship.

• Provide clean and calm environment and do not leave the patient alone.

*Observe the patient for suicidal tendencies and suicidal thoughts.

*Providing support to the patient and family members and providing support to the patient for the rehabilitation process.

• Supervise the personal hygiene of each patient and provide them with psychological support.

*Listen and pay attention to the patient appropriately and evaluate the patient’s physical symptoms.

*The patient should be helped to identify his own situation. *Giving medicine as per prescription and assessing its side effects