EVALUATION OF INTEGRATED APPROACH OF PSYCHO AND YOGA THERAPY IN MANAGEMENT OF ANXIETY NEUROSIS: A CASE STUDY

Case study of a 45-year-old male patient with sedentary life style, diagnosed with anxiety disorder (Neurosis) and other anxiety related problems since 2004. He undergone with integrated approach of psycho & yoga therapy (IAPYT) for 15 days at Psycho Clinic, Dev Sanskriti Vishwavidyalaya in Uttarakhand between September and October 2009. The results showed that reduction in anxiety symptoms. There was significant reduction of psychological parameter scores after 15 days of IAPYT intervention. The percentage change of trait anxiety was 60.42%% after Integrated Yoga Therapy. His anxiety symptoms minimized and blood pressure, respiratory rate, pulse rate came to normal condition at the time of discharge. There was improvement in feeling of wellness and overall functional health. This case report suggested that the yogic lifestyle and IAPYT intervention are beneficial in treating anxiety disorders.

Value of the Resting Electrocardiogram in Assessing Patients with Recent Onset Chest Pain A Study in Tertiary Care Hospital, Dhaka Bangladesh

Background: Chest pain or discomfort caused by acute coronary syndrome (ACS) or angina has a potentially poor prognosis, emphasizing the importance of prompt and accurate diagnosis. To evaluate a clinic set up specifically to assess patients with recent onset chest pain, particularly those presenting with a normal resting electrocargram.Method: The cross-sectional study was carried out from September 2016 to August 2017 in cardiology department of Shaheed Suhrawardy Medical College hospital, Sher-E-Bangla Nagar, Dhaka. Total 1000 consecutive patients with recent onset chest pain were evaluated within 24 hours of general practitioner referral, to find out the clinical diagnosis and management.Results: Total 1000 patients (535 men and 465women, mean age 51.5±11.4 years with range from 32 to 70 years) were assessed over 12 months. Most of the patients 844 (84.4%) had symptoms in duration of ≤30 days. Majority 433 (43.3%) patients had peptic ulcer disease (PUD), 317 (31.7%) patients had chronic stable angina (CSA), 94 (9.4%) had unstable angina (UA), 92 (9.2%) had anxiety neurosis (AN) and 64 (6.4%) had myocardial infarction (MI). Regarding outcome of the patients 525 (52.5%) [PUD: 433+ AN: 91] patients considered to have noncardiac pain and referred to medicine outpatient department (OPD) without further follow up. In a further 317 patients (31.7%, CSA) arrangements were made for outpatient review. Ninety four patients (9.4%, UA) were referred to National Institute of Cardiovascular diseases (NICVD) for admission out of them 61 patients were admitted for medical treatment & 33 patients were discharged from emergency department whose troponin-I were negative. Remaining 64 (6.4%) acute MI patients were admitted into Coronary Care Unit (CCU) of NICVD, out of them 41 patients received streptokinase injection, 23 patients received Enoxaparin injection, after conservative treatment all patients were advised to do coronary angiography within 3 to 4 weeks. Among these 43 patients underwent coronary angiography within 4 weeks, 23 patients had coronary angioplasty, eleven patients had coronary bypass surgery and nine patients refused any intervention and discharged with medicine.Conclusion: This experience highlights the inadequacy of a routine electrocardiogram reporting service in patients with recent onset of chest pain. Clinical diagnosis found were peptic ulcer disease (PUD), chronic stable angina (CSA), unstable angina (UA), anxiety neurosis and myocardial infarction (MI). Regarding outcome of the patients were coronary angiography followed by coronary angioplasty, coronary artery bypass surgery, discharged with medicine and referred to out patients department of medicine unit.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 65-68

The history of generalized anxiety disorder as a diagnostic category

From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included “pantophobia” and “anxiety neurosis.” Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state). Also, generalized anxiety was considered one of numerous symptoms of neurasthenia, a vaguely defined illness. Generalized anxiety disorder (GAD) appeared as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, when anxiety neurosis was split into GAD and panic disorder. The distinct responses these two disorders had to imipramine therapy was one reason to distinguish between the two. Since the revised DSM-III (DSM-III-R), worry about a number of life circumstances has been gradually emphasized as the distinctive symptom of GAD. Thus, a cognitive aspect of anxiety has become the core criterion of GAD. The validity of GAD as an independent category has been questioned from DSM-III up to preparation of DSM-5. Areas of concern have included the difficulty to establish clear boundaries between GAD and (i) personality dimensions, (ii) other anxiety-spectrum disorders, and (iii) nonbipolar depression. The National Institute of Mental Health has recently proposed the Research Domain Criteria (RDoC), a framework destined to facilitate biological research into the etiology of mental symptoms. Within the RDoC framework, generalized anxiety might be studied as a dimension denominated “anxious apprehension” that would typically fit into the research domain called “negative valence systems” and the more specific construct termed “potential threat.”

Progressive validation of psychiatric syndromes: The example of panic disorder

Prior validation approaches for psychiatric disorders, as used in DSM-IV and DSM-5, have been synchronic—snapshots of results typically taken out of temporal context. This chapter explores the advantages of a diachronic approach to validation. The discovery of juvenile-onset and adult-onset diabetes is explored as an example of a successful division of a broad biomedical syndrome into subtypes. This division has yielded fruitful insights into etiology and treatment. A psychiatric example, reviewed in detail, is the division of anxiety neurosis into panic disorder and generalized anxiety disorder. A range of etiologic and treatment studies have supported the distinction between these two forms of anxiety. These findings are interpreted in the context of Lakatos’s conceptual framework of a progressive versus degenerative scientific paradigm. The conclusion is that considering a diachronic or historical view of validity of psychiatric disorders adds a valuable perspective to the discipline and its nosology.