sleep disturbances, including nightmares, reduction in efficiency, feeling fatigued and tired are also present.

something dreadful is going to happen are the commonest. Difficulty in concentration and forgetfulness, sleep disturbances, including nightmares, reduction in efficiency, feeling fatigued and tired are also present. TYPES: 1. Acute - also known as Panic Disorder. Autonomic disturbances are marked. Patients are restless and agitated, and have a fear of impending doom. Recurrence is common. 2. Chronic - Also known as Generalised Anxiety Disorder. Physical and psychological symptoms are marked, mild to moderate in severity and tend to run a chronic course, sometimes leading to a state of physical and mental tiredness or exhaustion (neurasthenia). Prognosis - Determined by: 1. Duration of illness - shorter duration carries better prognosis. 2. Personality - Well adjusted personalities recover more easily than the neurotic, maladjusted personalities. 3. Precipitating factors - Possibility of environmental manipulations to make the environment less stressful for the person ensures quicker and long lasting remission of symptoms. Management: 1. Hospitalization - in severe cases of panic disorder. 2. Drugs -Benzodiazepines are drugs of choice for rapid alleviation of symptoms. Diazepam 5-10 mg), alpra-zolam (0.5-1 mg), chlordiazepoxide (10-20 mg), lorazepam (1-2 mg), oxazepam (15-30 mg), clonazepam (0.5-2 mg), or clolazam (10-20 mg), by mouth, or diazepam 10 mg iv bring quick relief. Maintenance is best with tricyclic antidepressants e.g. imipramine (75-300 mg/day) or clomipramine (10-75 mg/day) or with selective serotonin re-uptake inhibitors like fluoxetine (20-60 mg/day) sertraline (50-200 mg/day) all orally. (b) Generalised Anxiety Disorder 3. Psychotherapy and case work - Supportive psychotherapy gives relief from troublesome symptoms in healthy and well adjusted personalities. Deep analytical psychotherapy may be needed for chronic maladjusted personalities since the modification of basic psychic structure is important to get any lasting benefit. 4. Behavioural therapy Deep muscle relaxation, yoga and other forms of meditation. 5. Biofeedback techniques - have been used with some success. I.I Phobic Disorder Definition: A disorder characterised by intense fears of an object or situation which the patient consciously recognises as posing no danger to him Etiology: 1. Age - The disorder usually begins in childhood, adolescence or early adulthood. 2. Sex - Equal incidence in both sexe. 3. Personality factors - Persons with anxious, obsessive and passive dependent personality traits are more likely to suffer from phobic neurosis. 4. Psychoanalytic theories - Failure of repression to prevent intrapsychic conflicts from seeking conscious representation leads to anxiety which alerts the ego to use additional defence mechanisms of displacement. In this way, anxiety is displaced or transferred from the original stimulus to a seemingly unimportant object or situation which symbolically represents the original stimulus, and which now has the property of evoking the same anxiety. 5 Learning theory - Anxiety that has been aroused by an intensely frightening stimulus occurs in contiguity with a second inherently neutral stimulus. As a result of the contiguity, the original neutral stimulus takes on the capacity of arousing anxiety by itself - it becomes a conditioned stimulus for anxiety. Clinical manifestations There are three main types of phobic disorders. 1. Simple phobias - are fears of specific objects (e. g. animals) or situations (heights, closed spaces). 2. Agoraphobia - marked fear of being alone or in public places (e. g. crowds, tunnels, public transports) .3. Social phobias -Situations provoking anxiety are social gatherings or meetings in which the person feels that he might be looked at critically. Management: 1. Drugs - Anxiolytics, as in the treatment of anxiety states. 2. Behaviour therapy - to eliminate the conditioned avoidance behaviour. This is done by a process of systematic desensitization, which involves a gradual exposure, either in imagination or reality, to the feared object or situation. III. Obsessive compulsive disorder Definition A disorder in which there is persistent intrusion of unwanted thoughts, urges or actions that the patient is unable to stop. Etiology 1 Heredity - Higher incidence in families of patients. This could be due to the upbringing rather than genetic factors per se. 2. Age - Majority under age of 40 years. 3. Sex - No significant sex differences .4. Intelligence - Incidence is higher in those with high intelligence levels. 5. Organic factors - Although obsessions and compulsions are known to occur in patients with temporal lobe lesions, encephalitis and head injury, there is no evidence yet of possible organic basis for this disorder. G. Psychoanalytical theories - Obsessions and compulsions are disguised selfreproaches in connection with incidents which have occurred during the early years. Conflicts between feelings of love and hate towards parental figures who are seen as interfering with the pursuit of pleasurable activities leads to states of doubt. There is a displacement of affect from these repressed conflicts onto the symptoms which thus act as substitutes. 7. Learning theory - According to this theory, the compulsive rituals are viewed as the equivalent of avoidance responses .8. Personality factors - Persons with obsessive traits are more likely to suffer from this disorde. Clinical