[Psihiatrie]Neurotic Disorders

8/12/2019 [Psihiatrie]Neurotic Disorders

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Phobic anxiety disorders

a group of disorders

anxiety is evoked only, or predominantly, incertain well-defined situations that are notcurrently dangerous

these situations are avoided or endured withdread

palpitations, feeling faint, fears of dying, losing

control, or going mad anticipatory anxiety

phobic anxiety and depression


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Agoraphobia

fears of leaving home, entering shops, crowdsand public places, or travelling alone in trains,buses or planes

Panic disorder is a frequent feature of bothpresent and past episodes

Depressive and obsessional symptoms and

social phobias are also commonly present assubsidiary features

Avoidance of the phobic situation


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Social phobias

Fear of scrutiny by other people leading to

avoidance of social situations

low self-esteem and fear of criticism

blushing, hand tremor, nausea, or urgency of

micturition

Symptoms may progress to panic attacks. Anthropophobia

Social neurosis


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Specific (isolated) phobias

phobias restricted to highly specific situations

particular animals, heights, thunder, darkness,flying, closed spaces, urinating or defecating inpublic toilets, eating certain foods, dentistry, orthe sight of blood or injury

panic as in agoraphobia or social phobia.

Acrophobia

Animal phobiasClaustrophobiaSimple phobia


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Other anxiety disorders

Disorders in which manifestation of anxiety

is the major symptom

not restricted to any particular

environmental situation

Depressive and obsessional symptomsmay also be present


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Panic disorder [episodic

paroxysmal anxiety]

The essential feature is recurrent attacks of severeanxiety (panic)

not restricted to any particular situation (unpredictable)

sudden onset of palpitations, chest pain, chokingsensations, dizziness, and feelings of unreality(depersonalization or derealization), fear of dying, losingcontrol, or going mad

Panic: attack state


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Generalized anxiety disorder

Anxiety that is generalized and persistent ("free-floating")

complaints of persistent nervousness, trembling,muscular tensions, sweating, lightheadedness,

palpitations, dizziness, and epigastric discomfort Fears that the patient or a relative will shortly become ill

or have an accident are often expressed.

Anxiety:

neurosis reaction state


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Mixed anxiety and depressive

disorder

symptoms of anxiety and depression are both

present, but neither is clearly predominant, and

neither type of symptom is present to the extentthat justifies a diagnosis if considered separately

when both anxiety and depressive symptoms

are present and severe enough to justify

individual diagnoses, both diagnoses should be

recorded and this category should not be used.


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Obsessive-compulsive disorder

The essential feature is recurrent obsessional thoughts orcompulsive acts

ideas, images, or impulses that enter the patient's mind again andagain in a stereotyped form

almost invariably distressing and the patient often tries,unsuccessfully, to resist them

Compulsive acts or rituals are stereotyped behaviours that arerepeated again and again

this behaviour is recognized by the patient as pointless or ineffectualand repeated attempts are made to resist. Anxiety is almost

invariably present. If compulsive acts are resisted the anxiety getsworse.

Includes:

anankastic neurosisobsessive-compulsive neurosis


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Predominantly obsessional

thoughts or ruminations

These may take the form of ideas, mental images, orimpulses to act, which are nearly always distressing tothe subject. Sometimes the ideas are an indecisive,

endless consideration of alternatives, associated with aninability to make trivial but necessary decisions in day-to-day living. The relationship between obsessionalruminations and depression is particularly close and adiagnosis of obsessive-compulsive disorder should be

preferred only if ruminations arise or persist in theabsence of a depressive episode.


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Predominantly compulsive acts

[obsessional rituals]

The majority of compulsive acts are concerned

with cleaning (particularly handwashing),

repeated checking to ensure that a potentiallydangerous situation has not been allowed to

develop, or orderliness and tidiness. Underlying

the overt behaviour is a fear, usually of danger

either to or caused by the patient, and the ritualis an ineffectual or symbolic attempt to avert that

danger.


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Reaction to severe stress, and

adjustment disorders

an exceptionally stressful life event or

a significant life change leading to continued unpleasantcircumstances

depend on individual, often idiosyncratic, vulnerability

the disorder would not have occurred without theirimpact

The disorders can be regarded as maladaptive

responses to severe or continued stress they interfere with successful coping mechanisms and

therefore lead to problems of social functioning.


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Acute stress reaction

a transient disorder - two to three days (often hours)

an individual without any other apparent mental disorder

within hours or days

an initial state of "daze, constriction of the field of consciousness,narrowing of attention, disorientation

signs of panic anxiety (tachycardia, sweating, flushing)

Partial or complete amnesia

If the symptoms persist, a change in diagnosis should be considered.

Acute: crisis reaction

reaction to stress

combat fatigue

crisis state

psychic shock


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Post-traumatic stress disorder

a delayed or protracted response to a stressful event

an exceptionally threatening or catastrophic nature (cause pervasivedistress in almost anyone)

Typical features: episodes of repeated reliving of the trauma ("flashbacks")

dreams or nightmares detachment from other people

Anhedonia

avoidance of activities and situations reminiscent of the trauma

hyperarousal with hypervigilance

insomnia

anxiety and depression are commonly associated suicidal ideation is not infrequent

latency period that may range from a few weeks to months

recovery can be expected in the majority of cases


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Adjustment disorders

arising in the period of adaptation to a significant life change or astressful life event

bereavement, separation experiences, migration, refugee status,going to school, becoming a parent, failure to attain a cherishedpersonal goal, retirement

Individual predisposition or vulnerability plays an important role

depressed mood, anxiety, a feeling of inability to cope, plan ahead,or continue in the present situation

conduct disorders - particularly in adolescentsCulture shock

Grief reactionHospitalism in children


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Dissociative [conversion]

disorders

a partial or complete loss of the normal integration betweenmemories of the past, awareness of identity and immediatesensations, and control of bodily movements

they are presumed to be psychogenic in origin, being associatedclosely in time with traumatic events, insoluble and intolerableproblems, or disturbed relationships

medical examination and investigation do not reveal the presence ofany known physical or neurological disorder

the possibility of the later appearance of serious physical orpsychiatric disorders should always be kept in mind.

Includes:ConversionHysteria


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Dissociative amnesia

The main feature is loss of memory

The amnesia is usually centred ontraumatic events, such as accidents orunexpected bereavements

It is usually partial and selective

The diagnosis should not be made in thepresence of organic brain disorders,intoxication, or excessive fatigue.


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Dissociative fugue

all the features of dissociative amnesia

+ purposeful travel beyond the usual everyday

range amnesia for the period of the fugue

the patient's behaviour during this time mayappear completely normal to independent

observers Excludes:

postictal fugue in epilepsy


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Dissociative stupor

a profound diminution / absence ofvoluntary movement and normal

responsiveness to external stimuli (light,noise, and touch)

no evidence of a physical cause

positive evidence of psychogeniccausation - recent stressful events orproblems.


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Trance and possession

disorders

a temporary loss of the sense of personal

identity and full awareness of the

surroundings

only trance states that are involuntary or

unwanted

outside religious or culturally accepted

situations


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Dissociative motor disorders

loss of ability to move the whole or a part of a limb orlimbs

resemblance to almost any variety of ataxia, apraxia,

akinesia, aphonia, dysarthria, dyskinesia, seizures, orparalysis.

Dissociative convulsions

mimic epileptic seizures very closely in terms of

movements no tongue-biting, bruising due to falling, and

incontinence of urine

consciousness is maintained or replaced by a state ofstupor or trance.


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Dissociative anaesthesia and

sensory loss

anaesthetic areas of skin

associated with the patient's ideas aboutbodily functions

sensory loss may be accompanied by

complaints of paraesthesia

loss of vision and hearing are rarely total

Psychogenic deafness


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Somatoform disorders

The main feature is repeated presentation

of physical symptoms

persistent requests for medical

investigations

if any physical disorders are present, they

do not explain the nature and extent of the

symptoms


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Somatization disorder

multiple, recurrent and frequently changing physicalsymptoms of at least two years' duration

a long and complicated history of contact with both

primary and specialist medical care services symptoms may be referred to any part or system of the

body

chronic and fluctuating

Briquet's disorderMultiple psychosomatic disorder


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Hypochondriacal disorder

persistent preoccupation with the possibility of having one or moreserious and progressive physical disorders

persistent somatic complaints

persistent preoccupation with their physical appearance

Normal or commonplace sensations and appearances are ofteninterpreted

Marked depression and anxiety are often present, and may justifyadditional diagnoses.

Body dysmorphic disorderDysmorphophobia (nondelusional)

Hypochondriacal neurosisHypochondriasisNosophobia


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Somatoform autonomic

dysfunction cardiovascular, gastrointestinal, respiratory and

urogenital systems

two types of symptoms:

objective signs of autonomic arousal (palpitations,

sweating, flushing, tremor) subjective complaints (pains, sensations of burning,

heaviness, tightness, bloated or distended)

Cardiac neurosis

Da Costa's syndromeGastric neurosisNeurocirculatory astheniaPsychogenic forms of aerophagy, cough, diarrhoea, dyspepsia, dysuria, flatulence,hiccough, hyperventilation, increased frequency of micturition, irritable bowelsyndrome, pylorospasm


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Persistent somatoform pain

disorder

The predominant complaint is of persistent, severe, and distressingpain

cannot be explained fully by a physiological process or a physicaldisorder

association with emotional conflict or psychosocial problems a marked increase in support and attention, either personal ormedical

PsychalgiaPsychogenic:

backache headacheSomatoform pain disorder


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Other neurotic disorders


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Neurasthenia

two main types

a complaint of increased fatigue after mental effort

feelings of bodily or physical weakness and exhaustion

after only minimal effort, accompanied by a feeling ofmuscular aches and pains and inability to relax.

worry about decreasing mental and bodily well-being

irritability

anhedonia depression, anxiety

insomnia


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Depersonalization-derealization

syndrome

rare disorder

mental activity, body, and surroundings are changed intheir quality

unreal, remote, or automatized loss of emotions and feelings of estrangement or

detachment from their thinking, their body, or the realworld

the patient is aware of the unreality of the change differential diagnosis - schizophrenic, depressive,

phobic, or obsessive-compulsive disorder

[Psihiatrie]Neurotic Disorders

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