Introduction

Anxiety is an alerting signal, which enables a person to become prepared to deal with a threat. Every person experiences anxiety during stressful situations in life. Normal anxiety is a diffuse, unpleasant vague sense of apprehension, which subsides easily. But anxiety becomes pathological, when it interferes with day to day activities of an individual, or necessitates treatment
Panic disorder is a common anxiety disorder. Life time prevalence is 1.5 to 5%. It is twice more common in women than in men.

Significance of Panic disorder in Pregnancy

Several studies have shown that the intrauterine environment can be altered by maternal anxiety which will affect the fetal growth and development. The sympathetic activation and elevated cortisol level during panic attacks will contribute to increased uterine artery resistance. The elevated maternal cortisol during anxiety can also have a direct adverse effect on the development of fetal brain. The antenatal panic disorder is also associated with an amplification of physical symptoms in pregnancy. Panic disorder in pregnancy if not managed at the earliest will have adverse consequences not only for the mother’s health, but also for the developing fetus. Later the mother child interactions will also be negatively influenced.

Aetiology and Pathogenesis of Panic disorder

The major neurotransmitter systems implicated are those for norepinephrine, serotonin and GABA. The limbic system, the prefrontal cortex as well as the noradrenergic neurons of locus ceruleus and the serotonergic neurons of the median raphe nucleus are responsible for the generation of panic attacks. The autonomic nervous system of patients with panic disorder has been reported to exhibit increased sympathetic tone and to respond excessively to emotional stimuli.
Psychoanalytic theories conceptualize panic attacks as arising from an unsuccessful defense against anxiety provoking impulses. Psychodynamic exploration of patients with panic disorder frequently reveals a clear psychological trigger for the panic attacks. The pathogenesis of panic attacks is related to neurophysiologic factors triggered by the emotional problems.

Clinical Features and Diagnosis of Panic Disorder

Panic attack is a discrete period of intense fear or discomfort in which four or more of the following symptoms develop abruptly and reach the peak with in 10 minutes.
• Palpitation
• Sweating
• Trembling
• Sensation of shortness of breath
• Feeling of choking
• Chest pain or chest discomfort
• Nausea or abdominal distress
• Feeling dizzy or unsteady
• Derealisation or depersonalization.
• Fear of losing control
• Fear of dying
• Chills or hot flushes
Panic disorder is diagnosed when a person develops recurrent unexpected panic attacks and has persistent concern about having additional attacks.

Course and Prognosis of Panic disorder

Panic disorder has its onset during late adolescence. If not managed at the earliest it can have a chronic relapsing course. Patient with good premorbid functioning and a brief duration of symptoms tend to have good prognosis.

Treatment of Panic Disorder

Pharmacotherapy can have adverse effect on fetal growth. Hence the preferred treatment for panic disorder in pregnancy is psychological therapy. Several studies have shown that cognitive behavior therapy is effective in producing long lasting remission of symptoms in panic disorder. Relaxation therapy, insight oriented psychotherapy and family therapy are also effectively used in the management of panic disorder in pregnancy. Early diagnosis and management will also help in preventing further panic attacks. Through Life Skills Training to manage the emotional stressors of pregnant women, we can improve maternal health which in turn will lead to better mother child bonding in future life.

Conclusion

Women are at increased risk for panic disorder. Pregnancy contributes to the preponderance of vulnerability to panic disorder. Untreated panic disorder will have far reaching detrimental effects on maternal and child health. Hence panic disorder in pregnancy should be diagnosed and managed scientifically at the earliest. Psychological therapies have an important role in the management of panic disorder in pregnant women.

Adolescence is the most fascinating period in life during which considerable biological, cognitive, moral as well as social development occurs. It is a period of heightened emotionality and it is also considered as a period of stress and storm.

Parents have great responsibility in supporting adolescence in making an easy transition from a dependent child to an independent successful adult. Ensure an environment of appreciation, love and understanding at home. Share mutually enjoyable activities. Be firm but empathetic with teenagers. Remain always connected with adolescents by maintaining good communicating skills. Set reasonable limits, set clear and reasonable, mutually acceptable rules, infuse hope trust and confidence in teenagers.
Monitor the peer group of teenagers without being too intrusive. Allow some privacy and promote talents.

Do not be too authoritative, don’t be autocratic, do not be too much permissive, do not criticise unnecessarily, don’t be overambitious and avoid undue comparisons.

When conflicts arise: listen and discuss the problems, use appropriate problem solving strategies, identify the best solution and implement it.

Use professional help from experts in adolescent guidance, when: disagreement develops with teenagers which is difficult to solve, adolescents do not open up, deterioration of scholastic performance occurs,
emotional or behavioural problems occurs, sleep disturbance occurs and
there is inability to concentrate in studies.

Parents have a major role in the personality development of adolescents. Through proper parenting techniques, we can make adolescence the most beautiful and enjoyble period in life of our childern. We can also guide them towards a successful and happy adulthood.

Adolescence is the most crucial stage in the life of an individual. According to World Health Organization, adolescence covers 10 to 19 years of life. Adolescents form significant proportion of the population of any nation, and the care of adolescents is the need of the hour. The word ‘adolescence’ originated from the Latin word – ‘Adolescere’ which means – ‘to grow to maturity’.

Definition

Adolescence refers to the long transitional developmental period between childhood and adulthood, and to a maturational developmental process involving major physical, psychological and social transformations.

 Significance of Adolescence

 • Personality development is completed during this peiod

• It is the time for the deciding the future profession

• An adolescent is under lots of pressure from parents, teachers, peer group and the society

• Normal adolescence is viewed as a period of turmoil and stress.

• About to 10 to 20 % of normal adolescents experience severe emotional reactivity and disruptions in family relationships.

• Adolescence represents high risk period in human life cycle and hence requires special attention by everyone involved in health care.

Stress in Adolescence

Stress is a normal universal human experience . ‘Stress’ is either an external event or an internal drive which threatens the normal functioning of an individual, resulting in impaired health or altered behaviour. Since adolescence is considered as a stage of ‘stress and storm’, proper management of stress in adolescents is highly essential for success in adulthood.

Common causes of stress

Academic stress – Learning disability, Scholastic backwardness due to other causes, Failure in examinations.

Personal stress – Disappointment in love affairs, Sexual abuse, Low self esteem

Family related stress -Marital discord among parents, Conflicts among family members, Overambitious parents, Comparisons by parents, Sibling rivalry, Unempathetic attitude of family members

School related stress – Conflicts with teachers, Frequent school changes, Peer group pressures.

For adolescents with low coping skills, demands from society and even the daily hassles of life can cause significant stress.

Symptoms of Stress

Physical symptoms – (Investigations will be normal)

• Pain disorder – Stress will lower the pain threshold and the individual under stress can experience severe distressing pain anywhere in the body. The common symptoms are headache, backache, chest pain and abdominal pain.

• Somatoform autonomic dysfunction – Individual presents with varying physical symptoms related to cardiovascular, gastrointestinal, genitourinary or respiratory systems.

• Conversion disorders – Present with neurological symptoms like pseudoseizures, weakness of limbs, movement disorders, sensory disturbance etc.

Emotional responses to stress

• Deliberate self harm

• Forgetfulness

• Lack of concentration / deterioration in scholastic performance 

• Anxiety 

• Low mood

• Reduced sleep and appetite

Behavioural symptoms of stress

• Irritability

• Restlessness / Occasional aggressiveness

• Withdrawal from usual activities

• Substance use

Prevention of stress related problems – Role of parents

• Provide peaceful and happy environment at home. 

• Be empathetic with the adolescents and give love and support

• Be a role model and friend 

• Avoid undue criticisms and comparisons 

• Motivate to improve scholastic performance

• Provide encouragement to promote the talents

• Be firm, but allow some privacy

• Listen and discuss the problems of the adolescent and help to solve the conflicts

Management of Stress

An adolescent presenting with unexplained physical symptoms as well as with emotional or behavioural symptoms need immediate and individualized detailed evaluation by experts in adolescent guidance to find out the underlying stress. They need counseling to improve self esteem and motivation. Relaxation therapy helps to relieve stress. Through cognitive behaviour therapy the negative stressful thoughts can be restructured towards a positive outlook in life. After cognitive restructuring, stress is relieved and the physical symptoms related to stress will subside. Family therapy will be required in managing stress in family.

For Excellence – Role of Professionals in Adolescent Guidance

• Training to improve the emotional quotient (EQ) of the adolescent. ‘The inner beauty’ of an individual gets maximised on acquiring high emotional intelligence.

• Life skills training to improve the personality and increase the skills needed to deal effectively with demands and challenges of everyday life.

• Career guidance to enable the adolescent to choose the profession according to the aptitude and skills.

• Study skills training to improve academic performance and for success in examinations.

• Premarital counseling to prepare the adolescent for happy family life.

• Social skills training and communication skills training to improve the social performance.

Conclusion

Adolescence is the most fascinating as well as the most critical period in the life of an individual. Early and scientific management of stress in adolescents is necessary to improve the quality of life. Through professional guidance, we can maximise the talents and potentials of the adolescents, so as to lead them towards excellence in life.