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Neurotic
Disorders
Neurotic Disorders
• Neurotic, stress-related, and somatoform disorders have
common historical origin with the concept of neurosis and
association of a substantial proportion of these disorders with
psychological causation.
• Mixtures of symptoms, especially anxiety and depressive ones
are common in these disorders
• About one fourth of the population in developed countries will
suffer from neurotic disorders during its lifetime course.
• With the exception of social phobia their frequency is higher in
women than in men.
Phobic Anxiety Disorders
• In agoraphobia, social and specific phobias, anxiety is
evoked predominantly by certain well-defined situations or
objects, which are external to the individual and are not
currently dangerous.
• As a result, these situations or objects are characteristically
avoided or endured with dread.
• Phobic anxiety fluctuates from mild uneasy to terror. The
individual’s concern may focus on individual symptoms
such as palpitations or feeling faint and is often associated
with secondary fears of dying, losing control, or going
mad.
• The anxiety is not relieved by the knowledge that other
people do not regard the situation in question as dangerous
or threatening.
Agoraphobia
• „Agoraphobia“ - the fear from marketplace.
• Agoraphobia includes various phobias embracing fears of leaving
home: fears of entering shops, crowds, and public places, or of
traveling alone in trains, buses, underground or planes.
• The lack of an immediately available exit is one of the key features
of many agoraphobic situations.
• The avoidance behaviour causes sometimes that the sufferer
becomes completely housebound.
• Most sufferers are women. Onset - early adult life.
• The lifetime prevalence - between 5—7%.
• High co-morbidity with panic disorder; depressive and obsessional
symptoms and social phobias may be also present.
Social Phobias
• Clinical picture - fear of scrutiny by other people in
comparatively small groups leading to avoidance of social
situations
• The fears may be
• discrete - restricted to eating in public, to be introduced to other
people, to public speaking, or to encounters with the opposite sex
• diffuse - social situations outside the family circle.
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Direct eye-to-eye confrontation may be stressful.
Low self-esteem and fear of criticism.
Symptoms may progress to panic attacks.
Avoidance - almost complete social isolation.
Usually start in childhood or adolescence.
Estimation of lifetime prevalence - between 10-13 %.
It is equally common in both sexes.
Secondary alcoholism.
Specific (Isolated) Phobias
1. Fears of proximity to particular animals
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spiders (arachnophobia)
insects (entomophobia)
snakes (ophidiophobia)
2. Fears of specific situations such as
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heights (acrophobia)
thunder (keraunophobia)
darkness (nyctophobia)
closed spaces (claustrophobia)
3. Fears of diseases, injuries or medical examinations
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visiting a dentist
the sight of blood (hemophobia) or injury (pain —odynophobia)
the fear of exposure to venereal diseases (syphilidophobia) or AIDS-phobia.
Usually arise in childhood or early adult life and can persist for
decades if they remain untreated.
Lifetime prevalence - between 10-20%.
Other Anxiety Disorders
• Manifestations of anxiety are also the major
symptoms of these disorders, however, it is not
restricted to any particular environmental
situation.
Panic Disorder
• The essential features are recurrent attacks of severe anxiety
(panic attacks) which are not restricted to any particular situation
or set of circumstances.
• Typical symptoms are palpitations, chest pain, choking
sensations, dizziness, and feelings of unreality (depersonalisation
or derealization).
• Individual attacks usually last for minutes only. The frequency of
attacks varies substantially.
• Frequent and predictable panic attacks produce fear of being
alone or going into public places.
• The afflicted persons used to think that they got a serious somatic
disease.
• The course of panic disorder is long-lasting and is complicated
with various comorbidities, in half of the cases with agoraphobia.
• The estimation of lifetime prevalence moves between 1-3%.
General Anxiety Disorder
• The essential feature is anxiety lasting more than 6 months, which is generalized
and persistent but not restricted to, or even strongly predominating in, any
particular environmental circumstances.
• Symptoms: continuous feelings of nervousness, trembling, muscular tension,
sweating, lightheadedness, palpitations, dizziness, and stomach discomfort.
• Fears that the person or a relative will shortly become ill or have an accident are
often expressed, together with a variety of other worries and forebodings.
• The estimation of lifetime prevalence moves between 4-6 %.
• This disorder is more common in women, and often related to chronic
environmental stress.
• Its course uses to be fluctuating and chronic connected with symptoms of
frustration, sadness and complicated with abuse of alcohol and other illicit
drugs.
Obsessive-Compulsive Disorder
• Obsessional thought are ideas, images or impulses that enter the
individual’s mind again and again in a stereotyped form.
• They are recognized as the individual’s own thoughts, even
though they are involuntary and often repugnant. Common
obsessions include fears of contamination, of harming other
persons or sinning against God.
• Compulsions are repetitive, purposeful, and intentional
behaviours or mental acts performed in response to obsessions or
according to certain rule that must be applied rigidly.
Compulsions are meant to neutralize or reduce discomfort or to
prevent a dreaded event or situation.
• Autonomic anxiety symptoms are often present.
• There is very frequent comorbidity with depression (about 80%)
- suicidal thoughts. Obsessive-compulsory symptoms may appear
in early stages of schizophrenia.
• The life time prevalence: 2 - 3%. Equally common in men and
women. The course is variable and more likely to be chronic.
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The Lifetime Prevalence
(%)
Prevalence
30
28.7
25
20
15
13.3
11.3
10
7.6
5.3
5
0
All Anxiety
Disorders
Social
Phobias
Specific
Phobias
PTSD
5.1
Agorafobia
without
Panic
GAD
3.5
Panic
Disorders
Kessler et al., 1995
Dissociative Amnesia
• The main feature is loss of memory, usually of
important recent event, which is not due to organic
mental disorder and is too extensive to be explained
by ordinary forgetfulness or fatigue.
• The amnesia is usually centered on traumatic events,
such as accidents, combat experiences, or
unexpected bereavements, and used to be partial and
selective.
• The amnesia typically develops suddenly and can
last from minutes to days.
• Differential diagnosis: complicated; it is necessary
to rule out all organic brain disorders as well as
various intoxications. The most difficult
differentiation is from conscious simulation malingering.
Dissociative Stupor
• The individual suffers from diminution or absence of voluntary
movement and normal responsiveness to external stimuli such as
light, noise, and touch.
• The person lies or sits largely motionless for long periods of time.
• Speech and spontaneous and purposeful movement are completely
absent.
• Muscle tone, posture, breathing, and sometimes eye-opening and
coordinated eye movements are such that it is clear that the
individual is neither asleep nor unconscious.
• Positive evidence of psychogenic causation in the form of either
recent stressful events or prominent interpersonal or social
problems.
Reaction to Severe Stress, and
Adjustment Disorders
• This category differs from others in that it includes disorders
identifiable not only on grounds of symptomatology and course
but also on the basis of one or other of two
• Causative influences:
• an exceptionally stressful life event (e.g. natural or man-made disaster,
combat, serious accident, witnessing the violent death of others, or being the
victim of torture, terrorism, rape, or other crime) producing an acute stress
reaction
• significant life change leading to continued unpleasant circumstances that
result in an adjustment disorder
• Stressful event is thought to be the primary and overriding causal
factor, and the disorder would not have occurred without its
impact.
Acute Stress Reaction
• A transient disorder of significant severity, which develops in an individual
without any previous mental disorder in response to exceptional physical and/or
psychological stress.
• Not all people exposed to the same stressful event develop the disorder.
• The symptoms: an initial state of „daze”, with some constriction of the field of
consciousness and narrowing of attention, inability to comprehend stimuli, and
disorientation. This state may be followed either by further withdrawal from the
surrounding situation (extreme variant - dissociative stupor), or by agitation and
overactivity.
• Autonomic signs - tachycardia, sweating or flushing, as well as other anxiety or
depressive symptoms.
• The symptoms usually appear within minutes of the impact of the stressful event,
and disappear within several hours, maximally 2—3 days.
Post-traumatic Stress Disorder
(PTSD)
http://www.youtube.com/watch?v=LM_nw5N3n-I
• PTSD is a delayed and/or protracted response to a stressful event of an
exceptionally threatening or catastrophic nature.
• The three major elements of PTSD include
1) reexperiencing the trauma through dreams or recurrent and intrusive thoughts
(“flashbacks”)
2) showing emotional numbing such as feeling detached from others
3) having symptoms of autonomic hyperarousal such as irritability and exaggerated
startle response, insomnia
• Commonly there is fear and avoidance of cues that remind the sufferer of the
original trauma. Anxiety and depression are commonly associated with the
above symptoms. Excessive use of alcohol and drugs may be a complicating
factor.
• The onset follows the trauma with a latency period, which may range from
several weeks to months, but rarely more than half a year.
• The lifetime prevalence is estimated at about 0.5% in men and 1.2% in women.
Hypochondriacal Disorder
• The disorder is characterized by a persistent preoccupation and a
fear of developing or having one or more serious and progressive
physical disorders.
• Patients persistently complain of physical problems or are
persistently preoccupied with their physical appearance.
• The fear is based on the misinterpretation of physical signs and
sensations.
• Physician physical examination does not reveal any physical
disorder, but the fear and convictions persist despite the
reassurance.
Persistent Somatoform Pain
Disorder
• The predominant symptom is a persistent severe and
distressing pain that cannot be explained fully by a
physiological process of physical illness.
• Pain occurs in association with emotional conflicts or
psychosocial problems.
• The expression of chronic pain may vary with different
personalities and cultures.
• The patient is not malingering and the complaints about
the intensity of the pain are to be believed.