Psychiatric problem is one of the major problems that an individual can face. How an individual affected by psychiatry problem? One individual can get affected by psychiatric problem through genetics, childhood trauma, current life stressors, environmental factors and traumatic accidents. By any one of the factor can lead to any psychiatric problems likes schizophrenia, depression, anxiety etc. Here the individual suffers a lot along with the individual his/her family members are also getting affected.
In a family if a person is diagnosed with psychiatric illness that will affect the whole family and the next generation too. Many researchers were investigating the care giver burden in many aspects in the area related to psychiatric problems. Most of the researchers were concluding that the family members are affecting in a large number. Before marriage of individual either his/her parents will take care of all the medical necessaries. If he/she got married his/her spouses has to manage all the medical necessaries. If old person gets affected then their son/daughter will take care of them. So it is a process the family members involvement is needed in a positive side and in the negative side they are also getting affected by the individuals in both physically and emotionally.
Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviours (compulsions) that he or she feels the urge to repeat over and over. (National Institute Of Mental Health, 2016)

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Obsessions are repeated and intrusive thoughts, urges, or mental images that cause a person to feel anxious. Common symptoms include:
• Fear of contamination
• Unwanted forbidden or taboo thoughts involving sex, religion, and harm
• Aggressive thoughts towards others or self
• Having things symmetrical or in a perfect order
Compulsions are repetitive behaviours that a person has feels the urge to do in response to an obsessive thought. Common compulsions include:
• Excessive cleaning and/or hand washing
• Ordering and arranging things in a particular, precise way
• Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
• Compulsive counting
A person with OCD generally:
• Can’t control his or her thoughts or behaviours, even when those thoughts or behaviours are recognized as excessive
• Spends at least 1 hour a day on these thoughts or behaviours
• Doesn’t get pleasure when performing the behaviours or rituals, but may feel brief relief from the anxiety the thoughts cause
• Experiences significant problems in their daily life due to these thoughts or behaviours
For the causes of OCD differs from person to person. Risk factors include:
Available research data on OCD supports that there is a significant involvement of genetic component. First degree relatives like parent, sibling or children who have OCD they have a higher risk of developing OCD and it has been proven in twin and family studies. The risk is higher when the first degree relative developed OCD as a child or teen. Early prevention is better for future living. And the onset of OCD in men is 19 years that is earlier than in women 22 years. Studies of the concordance for the disorder show that the higher risk in the monozygotic twins than dizygotic twins
Brain Imaging Studies
In brain imaging study it has been evident that the neuro circuitry between orbito frontal cortex, caudate and thalamus. In PET positron Emission Tomography shows that increased activity in frontal lobe and basal ganglia.
The individual who was undergone a physical or sexual abuse in childhood or any other trauma is in higher risk of developing OCD. In some cases the individual takes the behaviour which maximises their anxiety level and they maintain to calm and safe guard the anxiety.
There is a disorder called PANDAS – Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Children may develop OCD or OCD symptoms by streptococcal infections. Streptococcal Infection caused by streptococcal bacteria highly contagious which they can spread through airborne droplets when someone with the infection coughs or sneezes or through shared food or drinks.
According to ICD – 10 the following criteria should fixed to diagnose OCD
For a definite diagnosis, obsessional symptoms or compulsive acts, or both, must be present on most days for at least 2 successive weeks and be a source of distress or interference with activities.
The obsessional symptoms should have the following characteristics:
(a) They must be recognized as the individual’s own thoughts or impulses;
(b) There must be at least one thought or act that is still resisted unsuccessfully, even though others may be present which the sufferer no longer resists;
(c) The thought of carrying out the act must not in itself be pleasurable (simple relief of tension or anxiety is not regarded as pleasure in this sense);
(d) The thoughts, images, or impulses must be unpleasantly repetitive. (The ICD – 10 Classifications of Mental and Behavioural Disorders, World Health Organisation GENEVA)

Anxiety Disorders
Anxiety disorders are a group of mental disorders characterized by significant feelings of anxiety and fear. Anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. Generalised Anxiety Disorder (GAD), specific phobia, social anxiety disorder, panic disorder and selective mutism are the types of disorders which come under anxiety disorders. (Diagnostic ; Statistical Manual for Mental Disorder 5)
The cause of anxiety disorders is a combination of genetic and environmental factors. Risk factors include a history of child abuse, family history of mental disorders, and poverty. Anxiety disorders often occur with other mental disorders, particularly major depressive disorder, personality disorder, and substance use disorder. To be diagnosed symptoms typically need to be present for at least six months, be more than would be expected for the situation, and decrease functioning.
About 12% of people are affected by an anxiety disorder in a given year and between 5-30% are affected at some point in their life. They occur about twice as often in females as males, and generally begin before the age of 25.The most common are specific phobia which affects nearly 12% and social anxiety disorder which affects 10% at some point in their life. They affect those between the ages of 15 and 35 the most and become less common after the age of 55.
Generalized Anxiety Disorder
People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms. Generalized anxiety disorder symptoms include:
• Restlessness or feeling wound-up or on edge
• Being easily fatigued
• Difficulty concentrating or having their minds go blank
• Irritability
• Muscle tension
• Difficulty controlling the worry
• Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)

GAD may run in families, although as with all mental-health issues, the causes are typically a combination of biological and environmental factors.”It is likely due to a combination of stress and environmental factors that contribute to the expression of genes in individuals who are born with the risk/vulnerability to develop the condition,” said Dr. Andrew Gilbert, a psychiatrist and medical director at the Hallowell Center in New York. “Since GAD can emerge in adolescence, there are some interesting developmental/pediatric studies suggesting that individuals born with particular temperaments and/or wiring in their brains may be more vulnerable to develop GAD.”
An imbalance of naturally occurring brain chemicals — such as serotonin, dopamine and norepinephrine — is often seen in people with GAD and could be an indicator of a propensity to develop the disorder,
Connection to addiction
Many GAD sufferers use alcohol, tranquilizers or other drugs to calm their nerves and provide them some relief, according to the Anxiety and Depression Association of America (ADAA). Those with anxiety disorders are two to three times more likely than the general population to abuse alcohol or other substances at some point in their lives, according to the ADAA. About 20 percent of Americans with an anxiety or mood disorder, such as depression, have an alcohol or other substance-abuse disorder, according to the ADAA.
Typically, those suffering from GAD and other anxiety disorders have low self-esteem, which is a factor in substance abuse. Many GAD sufferers also abuse prescription drugs, the ADAA noted. Many GAD sufferers build up a tolerance to some of the drugs they have been given to treat their physical symptoms, leading them to visit multiple doctors for prescriptions.
According to ICD – 10 the individual has to meet the criteria to diagnosis GAD
The sufferer must have primary symptoms of anxiety most days for at least several weeks at a time, and usually for several months. These symptoms should usually involve elements of:
(a) Apprehension (worries about future misfortunes, feeling “on edge”, difficulty in concentrating, etc.);
(b) Motor tension (restless fidgeting, tension headaches, trembling, inability to relax); and
(c) Autonomic over activity (light headedness, sweating, tachycardia or tachypnoea, epigastric discomfort, dizziness, dry mouth, etc.).
In children, frequent need for reassurance and recurrent somatic complaints may be prominent. (The ICD – 10 Classifications of Mental and Behavioural Disorders, World Health Organisation GENEVA)
Agoraphobia usually involves fear of places that would be difficult to leave or find help if a panic attack occurs. This includes crowds, bridges, or places like planes, trains, or malls.
Other symptoms of agoraphobia include:
• fear of being alone
• fear of losing control in public
• a feeling of detachment from others
• feeling helpless
• feeling that your body or the environment is not real
• rarely leaving home
Causes a Panic Attack with Agoraphobia?
The specific cause of panic attacks is unknown. However, some evidence suggests that there may be a genetic aspect involved. Some people diagnosed with the disorder do not have other family members with the disorder, but many do.
Stress may also play a role in bringing on the disorder. Many people first experience attacks while going through intensely stressful periods. This could include:
• the death of a loved one
• divorce
• job loss
• another circumstance that causes your normal life to be disrupted
Development of Attacks
Panic attacks tend to come on with no warning. As more attacks occur, the person tends to avoid situations they view as potential triggers. A person with a panic disorder will feel anxious if they think they are in a situation that could cause a panic attack.
Diagnostic Criteria for Panic Attack – ICD 10
Panic attack that occurs in an established phobic situation is regarded as an expression of the severity of the phobia, which should be given diagnostic precedence. Panic disorder should be the main diagnosis only in the absence of any of the phobias. For a definite diagnosis, several severe attacks of autonomic anxiety should have occurred within a period of about 1 month:
(a) In circumstances where there is no objective danger;
(b) Without being confined to known or predictable situations; and
(c) With comparative freedom from anxiety symptoms between attacks (although anticipatory anxiety is common).
Social Anxiety Disorder (Social Phobia)
People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others. Social anxiety disorder symptoms include:
• Feeling highly anxious about being with other people and having a hard time talking to them
• Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
• Being very afraid that other people will judge them
• Worrying for days or weeks before an event where other people will be
• Staying away from places where there are other people
• Having a hard time making friends and keeping friends
• Blushing, sweating, or trembling around other people
• Feeling nauseous or sick to your stomach when other people are around
Evaluation for an anxiety disorder often begins with a visit to a primary care provider. Some physical health conditions, such as an overactive thyroid or low blood sugar, as well as taking certain medications, can imitate or worsen an anxiety disorder. A thorough mental health evaluation is also helpful, because anxiety disorders often co-exist with other related conditions, such as depression or obsessive-compulsive disorder.
Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of biological and environmental factors. Possible causes include
• Inherited traits. Anxiety disorders tend to run in families. However, it isn’t entirely clear how much of this may be due to genetics and how much is due to learned behavior.
• Brain structure. A structure in the brain called the amygdala (uh-MIG-duh-luh) may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
• Environment. Social anxiety disorder may be a learned behavior — some people may develop the condition after an unpleasant or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents who either model anxious behavior in social situations or are more controlling or overprotective of their children.
Risk factors
Several factors can increase the risk of developing social anxiety disorder, including:
• Family history. You’re more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
• Negative experiences. Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life, such as family conflict, trauma or abuse, may be associated with social anxiety disorder.
• Temperament. Children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk.
• New social or work demands. Social anxiety disorder symptoms typically start in the teenage years, but meeting new people, giving a speech in public or making an important work presentation may trigger symptoms for the first time.
• Having an appearance or condition that draws attention. For example, facial disfigurement, stuttering or tremors due to Parkinson’s disease can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.

Left untreated, social anxiety disorder can run your life. Anxieties can interfere with work, school, relationships or enjoyment of life. Social anxiety disorder can cause:
• Low self-esteem
• Trouble being assertive
• Negative self-talk
• Hypersensitivity to criticism
• Poor social skills
• Isolation and difficult social relationships
• Low academic and employment achievement
• Substance abuse, such as drinking too much alcohol
• Suicide or suicide attempts
Other anxiety disorders and certain other mental health disorders, particularly major depressive disorder and substance abuse problems, often occur with social anxiety disorder.

Diagnostic Criteria for Social Anxiety Disorder ICD 10
(a) The psychological, behavioural, or autonomic symptoms must be primarily manifestations of anxiety and not secondary to other symptoms such as delusions or obsession thoughts
(b) The anxiety must be restricted to or predominate in particular social situations; and
(c) The phobic situation is avoided whenever possible.

Perceived Stress
Perceived stress is the feelings or thoughts that an individual has about how much stress they are under at a given point in time or over a given time period. Perceived stress incorporates feelings about the uncontrollability and unpredictability of one’s life, how often one has to deal with irritating hassles, how much change is occurring in one’s life and confidence in one’s ability to deal with problems or difficulties. It is not measuring the types or frequencies of stressful events which have happened to a person, but rather how an individual feels about the general stressfulness of their life and their ability to handle such stress. Anna C. Phillips (2013)
Marital Adjustment
Marital Adjustment is the process during which partners in a marriage adapt and change to their new roles complementing each other acting as a team opposed to two separate units, it is also important to unify the following- interests and values, maintaining open line s of communication and encouraging the expression of each other’s communication.

Quality Of Life
Quality of life can be defined as to the extent certain desirable factors are attained or retained. These include such factors as well-being, interpersonal relations, opportunity for personal growth and development, ability to exercise human rights, self-determination and healthy participation in society. Enhancement of quality of life is particularly important for those who suffer from chronic disease or developmental or physical disability.
QUALITY OF LIFE: “A quality facility will always concentrate on quality of life issues for their residence and individuals.” (Nugent,PamM.S 2013)


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