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8/12/2019 [Psihiatrie]Neurotic Disorders
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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