In ICD-10, neurotic, stress-related and ICDstresssomatoform disorders have been classified in to the following types: 1.

Phobic anxiety disorder 2. Other anxiety disorders 3. Obsessive compulsive disorder 4. reaction to severe stress, and adjustment disorders 5. Dissociative disorders 6. other neurotic disorders.

F40 Phobic anxiety disorders

F40.0 Agoraphobia .00 without panic disorder .01 with panic disorder F40.1 Social phobias .2 specific phobias .8 other phobic anxiety disorders .9 phobic anxiety disorders, unspecified.

F41 Other anxiety disorders

F41.0 Panic disorder .1 Generalized anxiety disorder .2 mixed anxiety and depressive disorder .3 other mixed anxiety disorder .8 other specified anxiety disorders .9 anxiety disorder, unspecified

F42 Obsessive- compulsive Obsessivedisorder

F42.0 Predominantly obsessional thoughts or ruminations .1 Predominantly compulsive acts .2 mixed obsessional thoughts and acts .3 other Obsessive- compulsive disorder .4 Obsessive- compulsive disorder, unspecified

Anxiety disorders
is the commonest psychiatric symptom in the clinical practice and one of the commonest psychiatric disorders in general population Anxiety- is a normal phenomenon, which is characterized by a state of apprehension or unease arising out of anticipation of danger.

Neurosis
The presence of a symptom or group of symptoms which cause subjective distress to the patient. The symptom is recognized as undesirable. (i.e. insight is present) The personality and behavior are relatively preserved and not usually grossly disturbed. The contact with reality is preserved There is an absence of organic causative factors.

What are Anxiety Disorders?

Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder.

distinction between fear and anxiety

anxiety is a alerting signal: it warns of impending danger and enables a person to take measures to deal with a threat. fear is a response to a known, external, definite or nonconflictual threat; anxiety is a response to a threat that is unknown, internal, vague, or conflictual.

Normal anxiety becomes pathological when it causes significant subjective distress and or impairment in functioning of the individual

Two types
Trait anxiety: this is a habitual tendency to be anxious in general and is exemplified by I often feel anxious. State anxiety: this is the anxiety felt at the present moment exemplified by I feel anxious now. Persons with trait anxiety often have episodes of state anxiety.

Symptoms of anxiety

Symptoms of anxiety
1. Physical symptoms A. Motoric symptoms tremors, restlessness, muscle twitches, fearful facial expression B. Autonomic and Visceral symptoms palpitations, tachycardia, sweating, flushes, dysnea, hyperventilation, dry month, frequency and hesitancy of micturition, dizziness, diarrhoea, mydriasis

2. Psychic symptoms A. Cognitive symptoms poor concentration, distractibility, hyperarousal, vigilance B. Perceptual symptoms derealization and depersonalization

C. Affective symptoms unpleasant, vague sense of apprehension, fearfulness, inability to relax, irritability, feeling of impending doom (when severe) D. Other symptoms insomnia, exaggerated startle response

Generalized anxiety disorder

Generalized anxiety disorder is a common chronic disorder that affects twice as many women as men and can lead to considerable impairment As the name implies, generalized anxiety disorder is characterized by long-lasting anxiety that is not focused on any particular object or situation. In other words it is unspecific or free-floating.

 People with this disorder feel afraid of something but are unable to articulate the specific fear. They fret constantly and have a hard time controlling their worries. Because of persistent muscle tension and autonomic fear reactions, they may develop headaches, heart palpitations, dizziness, and insomnia. These physical symptoms, combined with the intense, long-term anxiety, make it difficult to cope with normal daily activities.

Panic disorder
Onset is usually in early 3rd decade with often a chronic course. It is characterized by discrete episodes of acute anxiety. The panic attacks occur recurrently every few days. There may or may not be an underlying generalized anxiety disorder.

 Episode is usually sudden in onset, last for 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.

 The life time prevalence is 1.5 -2%. It is seen 2-3 times more often in females. It can present either alone or with agoraphobia.

Etiology
The exact cause is not known. There are many theories of which more than one may be correct. 1. Psychodynamic theory: acc. To this theory anxiety is a signal that something is disturbing the internal psychological equilibrium. This is called as signal anxiety.

Signal anxiety This arouses ego to take defensive actionwhich is in the form of repression (primary defense mechanism) Repression fails other secondary defense mechanisms like conversion, isolation r called in to action.

 In anxiety, repression fails to function adequately and the secondary defense mechanisms are not activated. Hence anxiety comes to the forefront. 2. Behavioral theory: anxiety is viewed as unconditioned inherent response of the organism to painful or dangerous stimuli. Acc. to this theory anxiety is a conditioned response to specific environmental stimuli.

3. Biological theories: i. Genetic evidence: 15-20% of the first degree relatives of pts exhibit anxiety. Concordance rate in the monozygotic twins of pts-is as high as 80% ii. Chemically induced anxiety states: Infusion of sodium lactate, isoproterenal and caffeine, inhalation of 5% carbon dioxide can produce panic episodes in predisposed individuals.

 Oral administration of MAOs before lactate infusion protect the individual from panic attack. iii. GABA benzodiazepine receptors. alteration in GABA levels may lead to production of clinical anxiety. Benzodiazepines relieve anxiety. iv. Other transmitters: Norepinephrine, 5-HT, Dopamine, Opioid receptors and neuroendocrine dysfunction have also been implicated in the causation of anxiety disorders.

v. Neuroanatomical basis:

Locus ceruleus, limbic system, and prefrontal cortex VI. Organic anxiety disorders: anxiety secondary to the various medical disorders.

Treatment
Multi-modal. 1. Psychotherapy: Supportive Psychotherapy- mild anxiety OR in combination with drugs. 2. Relaxation techniques: Jacobsons progressive relaxation technique, yoga, pranayama, selfhypnosis and meditation

3. Other behavioral therapies: Cognitive behavioral therapy, biofeedback & hyperventilation control 4. Drug treatment: Benzodiazepines. For the treatment of panic disorders begin with small doses of antidepressants. Eg. Imipramine & Fluoxetine.

 Alprazolam- for both G.A.D. and panic disorder. Clonazepam B-blockers like propranolol & atenolol- for anticipatory anxiety Buspirone is a new anti anxiety drugpreferable for the long term mgt

Nursing management
Nursing diagnosis - goals - Nsg interventions Tips for client with anxiety disorders Communication tecniques Client and family education Ways to reduce anxiety & promote mental health