Anxiety Disorders

Anxiety disorder is a vague, subjective and non-specific feeling of uneasiness, apprehension, tension, fears and a sense of impending doom, irrational avoidance of objects or situations and anxiety attack. Anxiety disorders are the most common of all psychiatric illness and result in considerable functional impairment and distress.

Signs and symptoms of anxiety

• Excessive anxiety and worry about a number of events or activities.
• The person finds it difficult to control the worry.
• Restlessness.
• Being easily fatigued.
• Difficulty concentrating or mind going blank.
• Irritability.
• Muscle tension.
• Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).

Psychoses

Psychoses are a group of severe mental illnesses characterised by loss of reality contact (where the patient cannot differentiate between reality and their imagination), delusions and/or hallucinations. This leaves affected people vulnerable to strange and potentially very distressing experiences, such as hearing voices or seeing things which others around them cannot. They may also express these delusions in a way that may disturb others.

For instance, they may insist that they are God, or complain that there is someone else inside them giving them orders. Psychotic illnesses make sufferers personally distressed and also cause distress to others in their family and neighbourhood. The level of distress (the risk of permanent disability) is increased by the duration and severity of the symptoms.

Global research and studies in Ethiopia show that psychoses affect between 1 and 2% of the population. Psychoses are among the most serious mental health problems that you will have to deal with in your community. They are serious for patients because they can result in serious functional and social impairments and may leave them coping with severe long-term disabilities. They are serious for the families of patients because of the negative impact on family stability and finances, often resulting in conflict and poverty for other family members.

Recognition of psychoses

Suspect possible psychosis if someone is:

• talking and acting strangely or in a manner that you and others consider being abnormal.
• showing self-neglect (e.g. dirty, untidy appearance).
• claiming to hear voices or see things that other people don't.
• being very suspicious, perhaps claiming that other people are trying to harm them.
• talking alone, says meaningless words or speaks in a strange language, talks very fast.
• behaving strangely e.g. running out of the house, running naked.
• neglecting or has difficulties in carrying out usual work, school, domestic or social activities.

Management of psychoses

Early identification is crucial in the management of psychoses. This is because (as you discovered earlier) treatment can be highly effective if it is provided before the condition has time to deteriorate further. For example, the early identification and treatment of patients with acute psychosis often results in complete recovery.

Medication is one central component of treatment for a range of psychoses and is often highly effective in reducing the patient's difficulties and providing emotional stability. Here, you should seek to gain the support of the family (or others close to the patient) to ensure their adherence to treatment and to guard against relapse.

Adherence means agreeing to and following the advice and treatment prescribed by the health professionals. As a health worker, your responsibility in this area is to reassure the family or the caregivers and refer the patient to the next nearby health facility.

What to tell the person and their family about psychosis?

Reassure them:

• Psychosis is not caused by possession or a curse.
• It is not the person's fault and the family is not to blame.
• Most people with psychosis get better after some time if they have the right help.
• They will probably take medicine for several months, sometimes longer.
• There is a lot that the family can do to help someone with psychosis
• If the person is upset or confused, try to calm them in a place where there are no noises and no danger.

Referring a person with possible psychosis

Always refer a person with a possible psychosis! If someone with early psychosis gets specialist treatment quickly, there is a better chance of complete recovery.

URGENT referral if:

• The person has been chained or tied up by the family.
• He or she is aggressive, violent towards others or harming themselves.
• He or she seems confused