PSYCHIATRIC DISORDERS
PREPARED BY MR. ABHIJIT DAS
DEPRESSION
DEFINITION
Depression is a mental health disorder characterized
by persistent feelings of sadness, hopelessness, and loss of interest or
pleasure in activities that were once enjoyable. It is a common condition that affects
mood, thoughts, and behavior, and can have a significant impact on daily life.
ETIOPATHOGENESIS
The exact cause of depression is not known, but it
is believed to be the result of a combination of genetic, environmental, and
psychological factors. Some of the factors that may contribute to the
development of depression include:
1.
Genetics: There is evidence to suggest
that depression can run in families, indicating that there may be a genetic
component to the condition.
2.
Brain chemistry: Imbalances in certain
chemicals in the brain, such as serotonin and dopamine, may contribute to the
development of depression.
3.
Environmental factors: Stressful life
events, such as trauma, loss of a loved one, or financial difficulties, can
trigger the onset of depression.
4.
Medical conditions: Certain medical
conditions, such as chronic pain or chronic illness, may increase the risk of
developing depression.
5.
Substance abuse: Substance abuse,
including alcohol and drug use, can increase the risk of developing depression.
CLINICAL MANIFESTATIONS
1.
Persistent feelings of sadness or
emptiness
2.
Loss of interest or pleasure in
activities that were once enjoyable
3.
Changes in appetite or weight
4.
Sleep disturbances, including insomnia
or oversleeping
5.
Fatigue or loss of energy
6.
Difficulty concentrating, making
decisions, or remembering things
7.
Feelings of worthlessness or guilt
8.
Recurrent thoughts of death or suicide
NON-PHARMACOLOGICAL MANAGEMENT
1.
Psychotherapy: Talk therapy or
counseling with a mental health professional can help individuals with
depression to identify and address the underlying issues that may be
contributing to their condition.
2.
Exercise: Regular physical activity has
been shown to be beneficial for reducing symptoms of depression. Exercise can
help to improve mood, reduce stress, and increase self-esteem.
3.
Relaxation techniques: Practices such as
meditation, deep breathing, and yoga can help to reduce symptoms of depression
by promoting relaxation and reducing stress.
4.
Sleep hygiene: Improving sleep habits,
such as establishing a regular sleep schedule and avoiding caffeine and alcohol
before bedtime, can help to improve symptoms of depression.
5.
Social support: Building and maintaining
a strong support system, including friends and family members, can help
individuals with depression to feel less isolated and improve their overall
well-being.
6.
Nutrition: Eating a well-balanced and
nutritious diet can help to improve overall health and may also be beneficial
for reducing symptoms of depression.
PHARMACOLOGICAL MANAGEMENT
1.
Selective serotonin reuptake inhibitors
(SSRIs): SSRIs are a commonly used class of antidepressant medications that
work by increasing the levels of serotonin in the brain. Examples of SSRIs
include fluoxetine, sertraline, and escitalopram.
2.
Serotonin-norepinephrine reuptake
inhibitors (SNRIs): SNRIs are another class of antidepressant medications that
work by increasing the levels of both serotonin and norepinephrine in the
brain. Examples of SNRIs include venlafaxine and duloxetine.
3.
Tricyclic antidepressants (TCAs): TCAs
are an older class of antidepressant medications that work by increasing the
levels of serotonin and norepinephrine in the brain. Examples of TCAs include
amitriptyline and nortriptyline.
4.
Monoamine oxidase inhibitors (MAOIs):
MAOIs are another class of antidepressant medications that work by increasing
the levels of serotonin, norepinephrine, and dopamine in the brain. MAOIs are
generally used less frequently than other classes of antidepressants due to the
risk of serious side effects. Examples of MAOIs include phenelzine and
tranylcypromine.
ANXIETY
DEFINITION
Anxiety is a medical condition characterized by
excessive and persistent worry, fear, or nervousness about a particular
situation or event. This can manifest as physical symptoms such as rapid heart
rate, sweating, shaking, and difficulty breathing.
Anxiety can be a normal reaction to stress, but when
it becomes excessive and interferes with daily activities, it may require
medical treatment.
ETIOPATHOGENESIS
1.
Genetics: There is evidence to suggest
that anxiety disorders may have a genetic component, as studies have shown that
the risk of developing an anxiety disorder is higher in individuals with a
family history of the condition.
2.
Neurotransmitters: Neurotransmitters
such as serotonin, norepinephrine, and dopamine play a role in regulating mood
and anxiety levels. Imbalances or dysfunction in these neurotransmitters may
contribute to the development of anxiety disorders.
3.
Environmental factors: Trauma, abuse,
neglect, or other stressful life events can increase the risk of developing
anxiety disorders. Chronic stress, such as that experienced in an unhealthy
work or family environment, can also contribute to the development of anxiety.
4.
Medical conditions: Certain medical
conditions, such as thyroid disorders, cardiovascular disease, or respiratory
disorders, can cause symptoms of anxiety.
5.
Substance abuse: Substance abuse,
particularly of drugs such as caffeine, nicotine, and alcohol, can exacerbate
symptoms of anxiety and increase the risk of developing an anxiety disorder.
CLINICAL MANIFESTATIONS
1.
Psychological symptoms: These can
include excessive worry, fear, or nervousness, restlessness, irritability,
difficulty concentrating, and a sense of impending doom or danger.
2.
Behavioral symptoms: These can include
avoidance of certain situations, social isolation, compulsive behaviors, and
difficulty sleeping or staying asleep.
3.
Physical symptoms: These can include
rapid heartbeat, palpitations, sweating, shaking, shortness of breath, dizziness
or lightheadedness, chest pain or discomfort, nausea or gastrointestinal
distress, headaches, and muscle tension or aches.
4.
Panic attacks: Panic attacks are
intense, sudden episodes of anxiety that can be accompanied by a range of
physical symptoms such as chest pain, difficulty breathing, sweating, and
dizziness. Panic attacks can be a feature of panic disorder, but they can also
occur in other anxiety disorders.
5.
Phobias: Phobias are intense fears of
specific objects, situations, or activities that are generally not harmful.
Phobias can lead to avoidance of the feared object or situation, which can
interfere with daily life.
NON-PHARMACOLOGICAL MANAGEMENT
1.
Therapy: Psychotherapy, such as
cognitive-behavioral therapy (CBT), is an effective non-pharmacological
treatment for anxiety. Therapy can help individuals identify and change
negative thought patterns and develop coping strategies for managing anxiety.
2.
Mindfulness and meditation: Mindfulness
and meditation practices can help individuals manage anxiety by reducing stress
and promoting relaxation. Mindfulness involves focusing on the present moment
without judgment, while meditation involves calming the mind and body through
deep breathing and relaxation techniques.
3.
Exercise: Regular exercise can help reduce
symptoms of anxiety by releasing endorphins, improving mood, and reducing
stress levels. Exercise can also promote better sleep, which is essential for
good mental health.
4.
Dietary changes: Some dietary changes
may help reduce symptoms of anxiety, such as reducing caffeine intake, avoiding
alcohol, and eating a balanced diet with plenty of fruits, vegetables, and
whole grains.
5.
Relaxation techniques: Various
relaxation techniques, such as deep breathing, progressive muscle relaxation,
and guided imagery, can help reduce anxiety symptoms and promote relaxation.
PHARMACOLOGICAL MANAGEMENT
1.
Selective serotonin reuptake inhibitors
(SSRIs): SSRIs are a class of antidepressant medications that are also
effective for treating anxiety disorders. These medications work by increasing
the levels of serotonin in the brain, which can improve mood and reduce anxiety
symptoms.
2.
Benzodiazepines: Benzodiazepines are a
class of sedative medications that are effective for reducing anxiety symptoms
quickly. However, they can be habit-forming and have the potential for abuse,
so they are typically prescribed for short-term use only.
3.
Buspirone: Buspirone is an anti-anxiety
medication that works by binding to serotonin and dopamine receptors in the
brain. It is effective for reducing symptoms of generalized anxiety disorder
and does not have the potential for abuse like benzodiazepines.
4.
Beta blockers: Beta blockers are a class
of medications that are typically used to treat high blood pressure, but they
can also be effective for reducing physical symptoms of anxiety, such as rapid
heartbeat and shaking.
PSYCHOSIS
DEFINITION
Psychosis is a mental health condition characterized
by a loss of contact with reality. It is often associated with symptoms such as
delusions, hallucinations, disordered thinking, and abnormal behaviors. People
experiencing psychosis may have difficulty distinguishing what is real from
what is not real and may have trouble communicating and interacting with
others. Psychosis can be a symptom of several different mental health
disorders, including schizophrenia, bipolar disorder, and severe depression.
ETIOPATHOGENESIS
1.
Genetics: There is evidence that genetic
factors play a role in the development of psychotic disorders. People with a
family history of schizophrenia, for example, are at higher risk of developing
the disorder themselves.
2.
Neurobiological factors: Abnormalities
in the structure and function of the brain are believed to contribute to the
development of psychosis. For example, research has shown that people with
schizophrenia have differences in the size and activity of certain brain
regions compared to people without the disorder.
3.
Environmental factors: Exposure to
certain environmental factors, such as stress, trauma, substance abuse, and
infections, may increase the risk of developing psychosis. Early childhood
trauma, in particular, has been linked to an increased risk of developing
psychosis later in life.
4.
Developmental factors: There is evidence
that disruptions in brain development during childhood and adolescence may
contribute to the development of psychosis. For example, disruptions in the
development of the prefrontal cortex, which is involved in regulating emotions
and behaviors, may contribute to the development of psychotic disorders.
5.
Social factors: Social factors, such as
social isolation and poor social support, may contribute to the development of
psychosis. There is also evidence that social factors can affect the course of
psychotic disorders, with supportive social environments associated with better
outcomes.
CLINICAL MANIFESTATIONS
1.
Delusions: A delusion is a fixed, false
belief that is not based in reality. People experiencing psychosis may have
delusions that they are being followed or persecuted, that they have special
powers or abilities, or that they are receiving messages from an external
source.
2.
Hallucinations: A hallucination is a
sensory experience that is not based in reality. People experiencing psychosis
may have auditory hallucinations, in which they hear voices or other sounds
that are not present, or visual hallucinations, in which they see things that
are not there.
3.
Disordered thinking: Psychosis can cause
disordered thinking, which can manifest in several ways. People experiencing
psychosis may have difficulty organizing their thoughts, speaking coherently,
or making logical connections between ideas.
4.
Abnormal behaviors: Psychosis can cause
people to behave in ways that are not typical for them. They may become
agitated, aggressive, or withdrawn. They may also engage in repetitive or
compulsive behaviors.
5.
Emotional disturbances: Psychosis can
cause emotional disturbances, such as depression, anxiety, or apathy. People
experiencing psychosis may also have difficulty expressing emotions
appropriately.
6.
Cognitive impairments: Psychosis can
cause cognitive impairments, such as difficulties with memory, attention, and
problem-solving.
NON-PHARMACOLOGICAL MANAGEMENT
1.
Psychotherapy: Psychotherapy, such as
cognitive-behavioral therapy (CBT), can help people with psychosis manage their
symptoms, cope with stress, and improve their relationships. CBT can also help
people challenge their delusions and develop more realistic beliefs.
2.
Family therapy: Family therapy can help
improve communication and relationships between the person with psychosis and
their family members. This can help reduce stress and improve overall
functioning.
3.
Support groups: Joining a support group
for people with psychosis can provide a sense of community and support. It can
also be a place to share experiences and learn coping strategies.
4.
Exercise: Regular exercise can help
improve mood and reduce stress, which can help improve symptoms of psychosis.
It can also help improve overall physical health.
5.
Nutrition: Eating a healthy, balanced
diet can help improve overall health and reduce symptoms of psychosis. Avoiding
substances like caffeine, alcohol, and drugs can also be beneficial.
PHARMACOLOGICAL MANAGEMENT
1.
First-generation antipsychotics (FGAs):
FGAs, also known as typical antipsychotics, work by blocking dopamine receptors
in the brain. Examples include chlorpromazine, haloperidol, and fluphenazine.
2.
Second-generation antipsychotics (SGAs):
SGAs, also known as atypical antipsychotics, also work by blocking dopamine
receptors, but they also affect other neurotransmitters in the brain. Examples
include clozapine, olanzapine, risperidone, and quetiapine.
3.
Long-acting injectable antipsychotics:
These medications are administered by injection and provide a sustained release
of the medication over a period of several weeks. Examples include fluphenazine
decanoate, haloperidol decanoate, and risperidone microspheres.
4.
Mood stabilizers: Some mood stabilizers,
such as lithium and valproic acid, may be used in combination with
antipsychotic medications to help stabilize mood and reduce symptoms of
psychosis.
5.
Antidepressants: Antidepressants may be
used in combination with antipsychotic medications to help reduce symptoms of
depression and anxiety that may co-occur with psychosis.