NEUROSIS
Dr. Najat M. Al-SaffarThe word neurosis is a convenient collective -Term for a group of psychiatric disorders which however sever do not involve hallucinations, delusions and loss of insight. - Neurosis are functional disorders , that is disorder with no organic pathology. - Neurosis are common and frequently encountered by doctors working in general practice and general hospitals.
The Basic classifications of Neurosis 1. Generalized anxiety states. القلق النفسي Dissociation and conversion disorder. الحالات التحولية او الانقلابية Obsessive-compulsive disorder داء الحصر القهري Phobic disorders الخوف Depersonalization disorder and derealization.Hypochondriasis داء المراق
Generalized Anxiety states حالات القلق النفسي As the name suggest the main clinical features of anxiety disorders are the mental and physical symptoms of anxiety Gerenralized Anxiety states are classified as follow :-Generalized anxiety disorders : in which symptoms are persistent , varying little from one situation to another.Phobic disorder : in which symptoms are episodic and associated with defined circumstances. Panic disorder: in which symptoms are episodic but not associated with defined circumstances. Post traumatic stress disorder . Substance induced anxiety and medical conditions
Aetiology 1. Genetic factors :- - Childhood up brining play a role . - Generalized anxity disorder is not expressed by any single personality type , people with all kinds of personality can develop this disorder 2. Stressful events particularly those threaten the person. 3. Maintaining factors, by the persistance of stressful events.
Generalized anxiety disorders
The symptoms of generalized anxiety disorder Psychological Fearful anticipation Irritability Sensitivity to noises Restlesness Poor concentration Worrying thoughts . Physical :- Gastrointestinal : Dry mouth Difficulty in swallowing Epigastric discomfort Excessive wind Frequency in loose motions
Tremor Prickling sensations Tinitns Dizziness Headach Aching muscles
NeuromuscularFrequency or urgent micturition Failure of evertion Menstrual discomfort Aminorrhea
Genitourinary
Palpitation Discomfort in the chest
Cardiovascular
Constriction in the chest Over breathing
Respiratory
Hyperventilation Syndrome The breathing usually rapid and shallow that result in fall in the concentration of Co2 in the blood which result the following symptoms Dizziness Tinnitus Headache Preacordial discomfort Weakness Faintness Numbness and tingling in the extremities Carpopedal spasm.
Sleep disturbance Insomnia Night terror Other symptoms Depression Obsession Depersonalization
Treatment 1. Physical method –used in selected cases by giving anxiolytic like diazepam 5-10 mg tds.2. Psychotherape – is often effective 3.Beheaviour therapy – by giving balon and teach the patient to rebreath his expired air to balance the alkalosis , the symptom releived .
Differential diagnosis of Hyperventilation :-
Febril illness Hyperparathyroidism Brain Tumors Encephalitis Cardiovasular disease Asthma
Differential Diagnosis of Generalized Anxiety Disorder
G.A.D. Has to distinguished from :- 1. Psychiatric disorders . 2. Physical disorder. In depression anxiety is a common symptoms. In schizophrenia pt. some time complain of anxiety . In semile and prasenile dementia any complain of A. Dependence on drugs or Alcohol Physical illnesses Thrytoxicosis Phaeochromocytoma Hypoglycaemia Serious physical illness may causes anxiety .Prognosis
The diagnosis of G anxiety disorder the symptoms must have been present for more than 6 months, 80% of pt. recovery is slow without treatment . Prognosis is worse who the symptoms is severe and when there is a agitation, restlessness, conversion, suicidal ideas, depression.Treatment
Psychological and social treatment. Treatment plane for G.A.D. Initial treatment: cognitive therapy started by:- Exclude concomitant depressive disorder. Explain nature and cause of symptoms. Reasure about specific concern. If anxiety sever short term Bezodiazepine Give help in solving stressful problem . Further treatment Relaxation training Continue problem solving If anxiety still sever, consider antidepressant drugs. Monoamino oxidase inhibitors should be use for on occational Beta-adrenergic antagonist has limited nees for palpitations.