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neurotic disorder presentation in psychiatry.pptx
- 1. Neurotic, Stress RelatedDisorder And Somatoform Disorder Presented by :- Dr. Sajal Ashish Nag Assistant Professor (Psychiatry) RINPAS
- 2. NEUROTIC DISORDER • Neuroticdisorder (neurosis) is a less severe form of psychiatric disorder where, patient show either excessive or prolonged emotional reaction to any given stress. • These disorder are not caused by organic brain disease & however severe, do no involve hallucination and delusions.
- 3. Classification of NeuroticDisorder • Generalized anxiety disorder • Phobic anxiety disorder • Dissociative (conversion) disorder • Obsessive compulsive disorder • Psychosomatic disorders • Post traumatic stress disorder
- 5. Anxiety • Anxiety isa normal emotional response (e.g. Apprehension, tension, uneasiness) to anticipation of danger, the source of which is largely unknown or unrecognized. • Anxiety may be regarded as pathologic when it interferes with effectiveness in living, achievement of desired goals or satisfaction or reasonable emotional comfort. • Anxiety may vary in mild, moderate, severe and panic depending upon its severity.
- 6. Anxiety disorders • Arethe group of conditions that are vague, subjective, non specific feeling of uneasiness, tension, apprehension and sometimes dread or impending doom. • Anxiety disorders are classified as following:- • Generalized Anxiety Disorder • Phobic Anxiety Disorder • Panic Anxiety Disorder
- 7. Generalized anxiety disorder •This disorder is characterized by chronic, unrealistic, and excessive anxiety and worry. • The anxiety is generalized and persistent not restricted to any particular environmental circumstances (i.e. It is free floating). • The symptoms must have occurred more days for at least 6 months • It must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- 8. Epidemiology • Prevalence ofgad in general population: 3 to 8% • Women to men ratio: 2:1 • About 25% of patients have generalized anxiety disorder in anxiety disorder clinics • Onset: late adolescence or early adulthood
- 9. Etiology Generalized anxiety disorder Biophysiological Cognitivetheory Psychodynamic theory
- 10. Etiology contd. • Biophysiologicaltheory - Genetic evidence: about 15-20% of first degree relatives, monozygotic twins of patient is as high as 80% i.e. 4 times more than in dizygotic twins. - Biochemical: alteration in GABA and nor epinephrine level - Substance intoxication and withdrawal (e.g. Cocaine, alcohol. Marijuana, opioids)
- 11. Contd. • Psychodynamic theory:inability of ego to intervene when the conflict occurs between the id and super ego producing anxiety. • Cognitive theory: according to this theory anxiety is related to cognitive distortions, faulty or counterproductive thinking patterns accompany (negative automatic thoughts) or precede maladaptive behaviors and emotional disorders.
- 12. Sign and symptoms •Physical symptoms - Motor tension (restless fidgeting, tension, headache, trembling, twitching or feeling shaky, easy fatigability) - Autonomic and visceral symptoms: over activity, lightheadedness, sweating or cold calmy hands, palpitation, tachycardia, flushes, dyspnea, tachypnea or hyper ventilation, constriction in the chest or lump in throat, epigastric discomfort, nausea, abdominal distress, dizziness, dry mouth, frequency of micturition, diarrhea, mydriasis etc.
- 13. Contd. • Psychological symptoms -Cognitive symptoms: distractibility, hyper arousal, vigilance, negative automatic thoughts. - Perceptual symptoms: derealization, depersonalization - Affective symptoms: diffuse, unpleasant, vague sense of apprehension, fearfulness, inability to relax, irritability, feeling of impending doom (when severe) - Other symptoms: insomnia, increased sensitivity to noise, worries prolonged and difficult to control. - Tension in the form of headache, restlessness or tremors
- 14.
- 15. Phobia • Defined asan unreasonable fear of specific object, activity or situation. • Phobia is an illogical, intense, persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal life functioning.
- 16. TYPES • An irrationalfear of performing activities in the presence of other peoples or interacting with others. Person is afraid of his actions being viewed by others critically, resulting in embarrassment or humiliation. • E.g. Fear of blushing (erthrophobia), fear of participating in group works, interacting with others, speaking to authority figures, and urinating in a public lavatory (shy bladder). Social Phobia • Characterized by irrational fear of being in places away from the familiar setting of home, in crowds, or in situations. • E.g. fear of entering in shops, public places, travelling alone in trains, buses, planes. As agoraphobia increases in severity, there is gradual restriction in normal day to day activities. Agoraphobia • Irrational fear of a specific objects or stimulus, specified objects or situations. Simple phobia
- 17. Simple phobias • Acrophobia:fear of heights • Pteromerhanophobia: fear of flying • Claustrophobia: fear of enclosed spaces • Entomophobia: fear of insects • Ophidiophobia: fear of snakes • Cynophobia: fear of dogs • Astraphobia: fear of storms • Trypnophobia: fear of needles • Hematophobia: fear of sight of bloods.
- 18. Etiology • Biological theories •Psychodynamic theory • Behavioral theories
- 19. Contd. • Biological theories:all phobias are closely linked to panic disorders and so genetic factors are also linked to phobias • Psychodynamic theory: - focus on the inability of ego (primarily defense mechanisms) to intervene when the conflict occurs between the id and super ego producing anxiety. - In phobia secondary defense mechanisms of ego i.e. Displacement come into action. By using displacement, anxiety is transferred from a really dangerous or frightening object to a neutral object. These two objects are often connected by symbolic association. - Traumatic experiences in childhood, like loss of parents in childhood are susceptible to anxiety and fear in childhood and in later life.
- 20. Contd. • Behavioral theories:it explain phobia as a conditioned reflex. Initially, the anxiety provoked by a naturally frightening or dangerous object occurs in contiguity with a second neutral object. If this happens often enough, the neutral object becomes a conditioned stimulus for causing anxiety.
- 21. General clinical featuresof phobias • Presence of the fear of an object, situation or activity. • The fear is out of proportionate to the dangerousness perceived. • Patient recognized the fear as irrational and unjustified • Patient is unable to control the fear and is very distressed by it. • This leads to persistent avoidance of the particular object, situation, or activity. • Gradually the phobia and the phobic object becomes a preoccupation with the patient, resulting in marked distress and restriction of the freedom of mobility.
- 22. Panic Anxiety Disorder Panicdisorder is characterized by anxiety, which is intermittent and unrelated to particular circumstances (unlike phobic anxiety disorders where, though anxiety is intermittent, it occurs only in particular situations). The central feature is the occurrence of panic attacks, i.e. sudden attacks of anxiety in which physical symptoms predominate and are accompanied by fear of a serious consequence such as a heart attack. The lifetime prevalence of panic disorder is 1.5 to 2 percent. It is seen 2 to 3 times more often in females.
- 23. Autonomic Arousal Symptom •Palpitationsor pounding heart •Sweating •Trembling or Shaking •Dry mouth ( not due to medication or dehydration)
- 24. Symptoms concerning chestand abdomen • Difficulty breathing • Feeling of choking • Chest pain or discomfort • Nausea or abdominal distress (churning in stomach
- 25. Symptoms concerning Brainand Mind • Feeling dizzy, unsteady, faint or light headed • Fear of losing control • Going crazy or passing out • Fear of Dying
- 26. Management • Pharmacotherapy • Psychotherapy •Behavioral therapy
- 27. Pharmacotherapy • BENZODIAZEPINES AREMOST USEFUL WHEN A PATIENT REQUIRES RAPID CONTROL OF SEVERE ANXIETY SYMPTOMS. • SHORT-TERM BENZODIAZEPINE, LORAZEPAM OR ALPRAZOLAM, • FOR PANIC DISORDER, SSRIS OR THE SEROTONIN–NOREPINEPHRINE REUPTAKE • INHIBITOR (SNRI) VENLAFAXINE ARE FIRST-LINE OPTIONS. • MIRTAZAPINE, ARE SECOND-LINE OPTIONS.
- 28. Contd. • FOR GENERALIZEDANXIETY DISORDER, FIRST-LINE TREATMENTS ARE SSRIS AND • SNRIS. • FOR SOCIAL ANXIETY DISORDER, FIRST-LINE CHOICE ARE SSRIS AND SNRIS • Β-BLOCKERS PROPRANOLOL MAY BE USEFUL FOR PERFORMANCE ANXIETY.
- 29. Contd. • Cognitive behavioraltherapy Behavioral therapy - Relaxation technique - Hyperventilation control - Bio feedback Psychotherapy : goal of psychotherapy is to increase the patient’s anxiety tolerance, rather than to eliminate it by providing safe environment.
- 30. Contd. • Other psychologicaltherapies - Jacob’s progressive muscle relaxation technique, yoga, pranayama, meditation and self hypnosis - Supportive psychotherapy
- 31. Somatoform Disorder Somatoform disordersare mental illness characterized by the presentation of physical symptoms with no medical explanations . The symptoms are severe enough to interfere with the patients ability to function in social or occupational activities.
- 32. Somatisation Disorder Somatization disorderis characterized by the following clinical Features: • Multiple somatic symptoms in absence of any physical disorder. • The symptoms are recurrent and chronic (at least 2 year duration is needed for diagnosis).
- 33. Contd. • Patients withsomatisation disorders have multiple and recurrent or chronic bodily complaints. • A person exhibits vague and recurring physical/bodily symptoms such as pain, acidity, etc., without any organic cause. • These complaints are likely to be presented in a dramatic and exaggerated way. • Common complaints are headaches, fatigue, heart palpitations, fainting spells, vomiting, and allergies. • Patients with this disorder believe that they are sick, provide long and detailed histories of their illness, and take large quantities of medicine.
- 34. Conversion Disorder • Theperson suffers from a loss or impairment of motor or sensory function (e.g., paralysis, blindness, etc.) that has no physical cause but may be a response to stress and psychological problems. • The symptoms of conversion disorders are the reported loss of part or all of some basic body functions. • Paralysis, blindness, deafness and difficulty in walking are generally among the symptoms reported. • These symptoms often occur after a stressful experience and may be quite sudden.
- 35. Hypochondriasis is Disorder •Hypochondriasis is diagnosed if a person has a persistent belief that s/he has a serious illness, despite medical reassurance, lack of physical findings, and failure to develop the disease. • Hypochondriacs have an obsessive preoccupation and concern with the condition of their bodily organs, and they continually worry about their health. • A person interprets insignificant symptoms as signs of a serious illness despite repeated medical evaluation that point to no pathology/disease.