Post-traumatic Disorder

What is Post Traumatic Disorder?

Post-traumatic disorders are disorders that occur during an extremely severe stressful life event or a significant change in life, leading to persisting unpleasant circumstances, resulting in an adaptation disorder. An important point is the relative nature of the trauma, that is, it is important to consider individual, often particular vulnerability

Causes of Post Traumatic Disorder

It develops in people who have experienced emotional or physical stress (military operations, disasters, bandit attacks, rape, house fire).

Symptoms of Post-Traumatic Disorder

The experience of injury again and again in a dream, thoughts and waking state, while in the imagination the picture of the injury can be objective and lively. Characterized by emotional deafness to all other experiences in life, including relationships with other people, concomitant symptoms in the form of vegetative lability, depression and cognitive impairment. Lack of pleasure from life and its manifestations (anhedonia).

Children and old people suffer harder stress. The duration of the disorder is more than 1 month.

Treatment for Post Traumatic Disorder

Antidepressants, sleeping pills, if necessary antipsychotics. Group and family psychotherapy.

Pathological Addiction to Gambling (Human Addiction)

Causes of Pathological Addiction to Gambling (Human Addiction)

Unknown. Increases during stress and is compulsive.

Symptoms of a Pathological Addiction to Gambling (Human Addiction)

Frequent repeated episodes of participation in gambling, leading to a decrease in professional, material and family values. Patients risk their work, make big debts, break the law in order to raise money or to avoid paying debts. Pathological addiction to computer games with a symbolic win. Lyudomania often, although not always, contributes to the formation of a dependent personality disorder, which is characterized by redirecting most of the problems to the object of the game or person, subordinating their needs to the game or dominant personality, and the formation of mental dependence. In loneliness or outside the game, addicted individuals have a feeling of helplessness and fear of an independent decision, as well as a fear of being abandoned, no free decisions can be made. With lyudomania, a pathological propensity for gambling, vivid violent ideas about the game are described, which take possession of the person especially at the time of stress. As a result of long-term (more than 7 hours a day) work at the computer, a special professional behavior modification and a peculiar coloration of neurosis and psychosis arise. Professional modification of behavior, in particular, is expressed in simplifying speech turns, looking over the interlocutor’s head, automatic gestures resembling typing on the dashboard before falling asleep and waking up, hypnagogic computer images when falling asleep, changing the structure of communication and dreams. In case of sudden problems (erasing information, computer failure), the so-called “absence” effects are revealed, which are expressed in psychogenic freezing in front of the screen, confusion and asthenia, and sometimes anxiety and restless fussiness.

Treatment of Pathological Addiction to Gambling (Human Addiction)

Neuro-linguistic programming, transactional analysis, computer psychotherapy.

Paranoid Personality Disorder

Causes of Paranoid Personality Disorder

Features of education and early development, forming a basic distrust of others. Distrust develops in early childhood as a result of the child’s distance from the mother; as a result, he develops a diffuse fear, which later turns into a wary and distrustful attitude towards others. A pronounced protective mechanism of projection is characteristic.

Symptoms of Paranoid Personality Disorder

Starting from adolescence, there has been a persistent tendency to interpret the actions of other people as suspicious, degrading the patient’s dignity and causing his fear, distrust and the need to protect themselves from them in a strictly defined way. Patients believe that those around them exploit, wanting to take away their acquired benefits, social prestige or economic success, harm them, often behave in such a way as to discredit or humiliate the patient. Often they are pathologically jealous, demanding without reason evidence of loyalty to their spouse or sexual partner. At the same time, they consider observance of personal fidelity completely optional. Externalizing their own emotions, they use protection in the form of a projection, attributing to others their own unconscious traits, intentions, motives, motives. By virtue of affective flatness, they seem unemotional, devoid of heat, they are impressed only by the strength and power that they worship and obey. In social terms, paranoid personalities look businesslike and constructive, but their tendency to intrigue to identify fidelity or infidelity subordinates often cause fear and create conflict. They constantly protect the basic desire to experience their increased importance and usefulness, and each time they attribute everything that happens to their own account, they are overly sensitive to failures and failures. Patients with paranoid personality disorders are predisposed to chronic delusional disorders, induced delusional disorders and paranoid schizophrenia.

Diagnosis of Paranoid Personality Disorder

It should be distinguished from chronic delusional disorders in which the development of paranoid monoids is possible. However, with personality disorders, suspicion and a tendency to overvalued formations are noted already from childhood.

Treatment for Paranoid Personality Disorder

Individual psychotherapy, anxiolytics and small doses of antipsychotics.

Lack of Genital Reaction

Reasons for the Lack of Genital Reaction

Sexual disharmony or psychogeny. Equivalent to psychogenic impotence.

Symptoms of a Lack of Genital Reaction

If there are signs of sexual dysfunction in men, a full erection occurs in the early stages of sexual intercourse, but disappears during intercourse, so an erection is present, but not during intercourse. Partial erection is sometimes possible.

In the presence of signs of sexual dysfunction in women, stimulation of erogenous zones does not lead to the disappearance of vaginal dryness for psychogenic reasons (disharmony) or as a result of menopause, the addition of an infectious lesion of the bartholin glands.

Diagnosis of the Absence of a Genital Reaction

In men, erectile dysfunction is characterized in that the erection persists during sleep, masturbation, or with another partner. In women, vaginal dryness, psychogenic or pathological (infection, menopause).

Differential diagnosis

It should be differentiated with other disorders of the erection component, for example, with organic damage to the brain, vascular lesions of the cavernous bodies, cerebrospinal disorders.

Treatment of the Absence of a Genital Reaction

Psychotherapy, behavioral therapy, including sex therapy. Erectotherapy and treatment with local negative pressure.

Acute Polymorphic Psychotic Disorder with Symptoms of Schizophrenia

Symptoms of Acute Polymorphic Psychotic Disorder with Symptoms of Schizophrenia

This diagnosis is considered not only as the first with a schizophrenic manifest, but also in cases of a favorable course of the disease, for example, with prolonged remissions and spontaneous exits from psychosis, it is advisable to attribute each subsequent psychosis to this group, and not to schizophrenia or schizoaffective disorder. In the clinic of acute psychosis of this group, there are productive symptoms of the first rank characteristic of schizophrenia, but there are no negative emotional-volitional disorders. The affect of anxiety, expansion, confusion. Motor activity is increased up to excitement.

Diagnosis of Acute Polymorphic Psychotic Disorder with Symptoms of Schizophrenia

  1. Rapid changes in the symptoms of delirium, including delirium exposure, delusional interpretation and delusional perception characteristic of schizophrenia.
  2. Hallucinations, including auditory commentators, contradictory and mutually exclusive, imperative truths and pseudo-hallucinations, somatic hallucinations and a symptom of open thoughts, sounding of one’s own thoughts related to symptoms of the first rank in schizophrenia.
  3. Symptoms of emotional disorders: fear, anxiety, irritability, confusion.
  4. Motor excitement.
  5. The above productive symptoms of schizophrenia are noted for no more than a month.

Differential diagnosis

It should be differentiated from schizoaffective disorder, psychotic schizophrenia-like disorders in dependence on psychoactive substances. This psychosis differs from the clinic of schizoaffective disorder in that the period of affective disorders is shorter than the productive one, and productive symptoms of the first rank characteristic of schizophrenia are noted. Schizophrenia-like psychoses in addiction diseases and organic schizophrenia-like psychoses can be delimited using additional research methods (laboratory, somatic, neurological, neurophysiological) and on the basis of anamnesis.

Treatment of Acute Polymorphic Psychotic Disorder with Symptoms of Schizophrenia

In the treatment it is necessary to use detoxification therapy, antipsychotics in medium and sometimes in maximum doses. You should always prescribe supportive treatment with prolongations or conduct episodic short-term courses of therapy due to the risk of developing schizophrenia, and also insist on outpatient monitoring of the patient for at least one year. Pay attention to periods of sleep disturbances, emotional disturbances (episodes of anxiety), suspiciousness. It is these symptoms that can precede exacerbations, and therefore they are a signal for preventive therapy.

Organic Emotionally Labile (Asthenic) Disorder

What is Organic Emotionally Labile (Asthenic) Disorder?

Almost all severe somatic and infectious diseases result in convalescence with asthenia.

Causes of Organic Emotionally Labile (Asthenic) Disorder

More often occurs in connection with cerebrovascular diseases, the so-called discirculatory encephalopathy, as well as in the long term (after a year) of craniocerebral injuries. Asthenia is also noted in the follow-up of individuals who have committed suicide attempts, after prolonged anesthesia, encephalitis, and all prolonged and severe somatic and infectious diseases, with brain tumors.

Symptoms of Organic Emotionally Labile (Asthenic) Disorder

The basis of the clinic is asthenic syndrome, which is characterized by: weakness, hypersensitivity (hypealgesia, hyperesthesia, hyperacusis, often photophobia), dizziness, decreased motor activity, rapid fatigability, irritability, impaired concentration, and tearfulness.

Diagnosis of Organic Emotionally Labile (Asthenic) Disorder

Based on the identification of a history of probable causes of emotional lability.

Differential diagnosis

More often it should be differentiated from neurotic disorders (neurasthenia, other specific neurotic disorders), in which there is no characteristic history and which are associated with psychological causes and stress. Significant physical and intellectual stress can lead to a clinic of neurasthenia, which can be distinguished from organic asthenia only after identifying the causes of the disorder.

Treatment of Organic Emotionally Labile (Asthenic) Disorder

It consists in taking non-specific stimulants (aloe, ginseng, fibs, eleutherococcus), nootropics (nootropil, phenibut, glutamic acid, encephabol, aminalon) for several courses of vitamin therapy with large doses, physiotherapy.

Organic Delusional (Schizophrenia-like) Disorder

What is Organic Delusional (Schizophrenia-like) Disorder?

Approximately 5% of patients with epilepsy may have psychosis if the underlying disease lasts up to 6 years. The question of periodic organic delusional psychosis is controversial, although all such cases are verified by objective research.

Causes of Organic Crazy (Schizophrenia-like) Disorders

The most common etiology is temporal epilepsy, as well as focal disorders of the temporal and parietal regions as a result of transferred encephalitis. This group includes epileptic psychosis without impairment of consciousness, or “schizoepilepsy.” With the defeat of the frontal and temporal divisions, hallucinatory-delusional attacks are possible, which are accompanied by episodes of unmotivated actions and loss of control over impulses of aggressiveness and other forms of instinctive behavior. It is not clear what caused the specificity of such psychosis – bilateral hereditary burden (epilepsy and schizophrenia) or damage to specific brain structures. Schizophrenia-like patterns of psychosis are also found in endocrine pathology (diffuse toxic goiter, after thyroidectomy).

Symptoms of Organic Crazy (Schizophrenia-like) Disorders

Chronic and recurrent organic delusional disorders are possible. They are united by the fact that in both cases negative organic personality changes are typologically similar to epileptic ones, that is, including bradifrenia, torpid, thorough thinking. Productive symptoms include hallucinatory-delusional pictures with the presence of visual, often religious hallucinations. Expansive paranoid states are characterized by ecstatic affect, while depressive paranoid states are dysphoric. At the height of psychosis, fragments of disturbances of consciousness are possible. Paranoiac psychosis proceeds according to the type of religious delirium, paraphrenia – with ecstasy, excitement and missionary utterances. Often, paranoid utterances are built on the basis of epilepsy-specific perceptual disorders of the type of interpretive delusion. It has been noticed that the onset of convulsive seizures can interrupt delirium, and their therapy resumes the clinical picture. There are clinical pictures of psychosis that contain symptoms of the first grade of schizophrenia. In endocrine pathology, psychosis is reminiscent of schizoaffective disorder, that is, with them, affective disorders coincide with schizophrenia-like disorders, but they last longer.

Diagnosing Organic Crazy (Schizophrenia-like) Disorders

Based on the identification of the main pathology (epilepsy or organic background), as well as specific emotional (dysphoria, ecstasy) color of paranoid experiences, the inclusion of visual hallucinations in the structure of hallucinatory-paranoid psychosis.

Differential diagnostics

Differential diagnoses are being conducted with paranoid schizophrenia, chronic delusional disorders, and schizophrenia-like psychotic disorders as a result of taking psychoactive substances, especially often amphetamines and cannabis.

In schizophrenia, along with productive symptoms of the first rank, there are also negative disorders, there are no exogenous components of psychosis and organic personality changes in the history.

In chronic delusional disorders, monothematic delirium may be the only persistent symptom, but it occurs on organically unchanged soil.

Psychotic schizophrenia-like disorders after taking psychoactive substances are characterized by the fact that they occur on the background of taking or canceling a substance, although psychotic episodes are also possible. Somato-vegetative status allows to identify the symptoms of intoxication or withdrawal, organic background is absent.

Treatment of Organic Crazy (Schizophrenia-like) Disorders

Includes treatment of the underlying disease. Effective use of aminazine, carbamazepine, depakina. The last two drugs can be used for maintenance therapy, since the risk of recurrence of psychosis is quite high. The use of antipsychotics for prolongation therapy is not recommended, as patients quickly develop intoxication symptoms.

Organic (Affective) Mood Disorders

What is Organic (Affective) Mood Disorders?

Affective disorders are observed in almost all endocrine diseases, and especially in patients who are treated with hormonal drugs during their withdrawal.

Causes of Organic (Affective) Mood Disorders

A frequent cause are endocrine disease (hyperthyroidism, Cushing’s disease – Cushing, thyroidectomy, premenstrual and menopausal syndromes), hormonal drugs in patients with bronchial asthma, rheumatoid arthritis, overdosage and poisoning vitamins and antihypertensives, craniocerebral trauma, tumors of the frontal lobes.

Symptoms of Organic (Affective) Mood Disorders

Affective disorders are manifested in the form of depression, mania, bipolar or mixed disorders. Indirectly, the organic background can be identified by a combination of these disorders with a decrease in activity up to a reduction in energy potential, asthenia, a change in craving (endocrine psycho-syndrome), as well as symptoms of cognitive deficit. In history you can find episodes of organic delirium. Manic episodes occur with euphoria and unproductive euphoria (moria), dysphoria is characteristic in the structure of depressions, daily mood swings are absent or distorted. By evening, mania can be exhausted, and in case of depression, asthenia increases in the evening. In bipolar disorders, affect is associated with the course of the underlying pathology, and seasonality is not characteristic.

Diagnosis of Organic (Affective) Mood Disorders

Based on the identification of the underlying disease and atypia of affective disorders. Affective disorders can usually be manic, depressive, bipolar, or mixed.

Differential diagnostics

Disorders should be differentiated from affective residual disorders due to dependence on psychoactive substances, with endogenous affective disorders, symptoms of frontal atrophy.

Affective residual disorders due to the use of psychoactive substances can be identified by history, the frequent presence of typical psychosis (delirium and affective disorders during abstinence) in history, a combination of affective disorders with a pseudo-paralysis clinic or Korsakov’s disorders.

Endogenous affective disorders are characterized by typical daily and seasonal dynamics, lack of organic neurological symptoms, although secondary endocrine disorders are possible (delayed menstruation, involution).

Symptoms of frontal atrophy are characterized by a combination of affective disorders with the symptoms of E. Robertson (see Pick’s disease).

Treatment of Organic (Affective) Mood Disorders

When treating organic affective disorders, it should be borne in mind that patients may react abnormally to psychoactive substances, that is, the trap should be cautious. In the treatment of depression should prefer Prozac, Lerivon and Zoloft. For the prevention of bipolar disorders – difenin, carbamazepine and depakin. For the treatment of manic states – carbamazepine, beta-blockers, tranquilizers and small doses of teasercine. All this therapy is considered symptomatic, attention should be paid to the treatment of the underlying disease. Of nootropics, phenibut and pantogams should be preferred, since other nootropics can increase anxiety and anxiety.

Inorganic Enuresis

What is Inorganic Enuresis?

It is characterized by involuntary urination during the day and / or night, which does not correspond to the child’s mental age. Not due to the lack of control over the function of the bladder due to neurological disorders, epileptic seizures, structural abnormalities of the urinary tract.

Causes of Inorganic Enuresis

Bladder control develops gradually, it is influenced by features of the neuromuscular system, cognitive functions, and, possibly, genetic factors. Violations of one of these components may contribute to the development of enuresis. Children suffering from enuresis are approximately twice as likely to have developmental delays. 75% of children with inorganic enuresis have close relatives suffering from enuresis, which confirms the role of genetic factors. Most children suffering from enuresis have an anatomically normal bladder, but it is functionally small. Psychological stress can increase enuresis. A big role is played by the birth of a sibling, the beginning of schooling, the breakup of a family, and the transfer to a new place of residence.

Prevalence

Enuresis affects more men than women, at any age. The disease occurs in 7% of boys and 3% of girls aged 5 years, 3% of boys and 2% of girls aged 10 and 1% of boys and is almost completely absent in girls aged 18 years. Daytime enuresis is less common than nocturnal, in about 2% of 5-year-olds. Unlike nocturnal, daytime enuresis occurs more often in girls. Mental disorders are present only in 20% of children with inorganic enuresis, most often they occur in girls or in children with day and night enuresis. In recent years, descriptions of rare forms of epilepsy appear more and more often in the literature: an epileptic variant of enuresis in children (5-12 years old).

Symptoms of Inorganic Enuresis

Inorganic enuresis can be observed from birth – “primary” (80%), or occur after a period of more than 1 year, acquired bladder control – “secondary”. Late onset is usually observed at the age of 5-7 years. Enuresis can be monosymptomatic or combined with other emotional or behavioral disorders, and is the primary diagnosis if involuntary urination is observed several times a week, or if other symptoms show a temporary connection with enuresis. Enuresis is not associated with any particular sleep phase or night time, more often it is observed in a random order. Sometimes it occurs when it is difficult to go from a slow phase of sleep to a fast one. Emotional and social problems that arise as a result of enuresis include low self-esteem, a sense of inferiority, social constraints, stiffness and family conflicts.

Diagnosis of Inorganic Enuresis

The minimum chronological age for diagnosis should be 5 years, and the minimum mental age should be 4 years.

  • Involuntary or arbitrary urination in bed or clothing can be observed during the day (F98.0) or overnight (F98.01) or observed during the night and day (F98.02).
  • At least two episodes per month for children aged 5-6 years and one event per month for older children.
  • The disorder is not associated with a physical illness (diabetes, urinary tract infections, seizures, mental retardation, schizophrenia and other mental illnesses).
  • The duration of the disorder is at least 3 months.

Differential diagnostics

It is necessary to exclude the possible organic causes of enuresis. Organic factors are most often found in children who have daytime and nocturnal enuresis, combined with frequent urination and an urgent need to empty the bladder. They include: 1) disorders of the genitourinary system – structural, neurological, infectious (uropathy, cystitis, hidden spina bifida, etc.); 2) organic disorders causing polyuria – diabetes mellitus or diabetes insipidus; 3) disorders of consciousness and sleep (intoxication, somnambulism, epileptic seizures), 4) side effects of treatment with certain antipsychotic drugs (thioridazine, etc.).

Treatment of Inorganic Enuresis

Due to the etiology of the disorder, various methods are used in treatment.

Hygiene requirements include training in using the toilet, limiting fluid intake 2 hours before bedtime, and sometimes a night waking to use the toilet.

Behavioral therapy. In the classic version – conditioning by a signal (bell, beep) the time of the onset of involuntary urination. The effect is observed in more than 50% of cases. This therapy uses hardware methods. It is reasonable to combine this treatment option with praise or reward for longer periods of abstinence.

Drug treatment

The use of Melipramine is recommended. Against the background of its administration, in 30% of patients, enuresis completely stops, and in 85% it weakens.

However, the effect is not always lasting. There are reports of the effectiveness of the use of Driptan (the active substance is oxybutrin), which has a direct antispasmodic effect on the bladder and a peripheral M-cholinolytic effect with a decrease in the hypertonus of the parasympathetic nervous system. Doses 5 – 25 mg / day.

Traditional variants of psychotherapy for enuresis in some cases are not effective.

Undifferentiated Somatoform Disorder

What is Undifferentiated Somatoform Disorder?

Undifferentiated somatoform disorder. This category should be used in cases where somatic complaints are multiple, variable and long-lasting, but at the same time, a complete and typical clinical picture of a somatized disorder is not detected. For example, the assertive and dramatic nature of the complaint may be absent, the latter may be relatively small in number, or there may be no violation of social and family functioning. The grounds for the assumption of psychological conditioning may or may not be present, but there should be no somatic basis for a psychiatric diagnosis.

Symptoms of Undifferentiated Somatoform Disorder

Symptoms resembling somatic disease, however, constant complaints despite excessive detail, vague, inaccurate and inconsistent in time. Somatic is framed by emotional instability, anxiety, low mood, not reaching the level of depression, decay of physical and mental strength, besides, irritability, a feeling of internal tension and dissatisfaction are often present. An exacerbation of the disease is provoked not by physical exertion or by changing weather conditions, but by emotionally significant stressful situations.

Diagnosis of Undifferentiated Somatoform Disorder

Criteria:

  • The presence of multiple, changing somatic symptoms in the absence of any somatic diseases that could explain these symptoms.
  • Constant concern about the symptom leads to prolonged suffering and repeated (3 or more) consultations and examinations in the outpatient clinic, and if counseling is unavailable for any reason, repeated visits to representatives of paramedicine.
  • Persistent refusal to accept a medical opinion on the absence of sufficient somatic causes of the existing symptoms or only a short-term agreement with it (up to several weeks).

Undifferentiated somatoform disorder can be diagnosed, when the minimum duration of symptoms is reduced to 6 months, criteria 1 and 3 are fully satisfied, criterion 2 can only be partially met

Important differentiation with the following disorders:

  • Somatic disorders. It is most difficult to differentiate somatoform disorder from some somatic diseases, such as multiple sclerosis, systemic lupus erythematosus, etc., beginning with nonspecific, transient manifestations. Here, the doctor needs to distinguish from a variety of clinical symptoms those that are characteristic of these diseases. Thus, multiple sclerosis often begins with transient motor, sensory (paresthesia) and visual disturbances. Hyperparathyroidism can be manifested by osteoporosis (loosening and tooth loss), and systemic lupus erythematosus often begins with polyarthritis, which is gradually joined by polyserositis.
    However, one should take into account the probability of the emergence of an independent somatic disorder in such patients, which is not lower than that of ordinary people at the same age. Particular attention in case of change of emphasis in the complaints of patients or their stability, when you need to continue surveys.
  • Affective (depressive) and anxiety disorders. Depression and anxiety of varying degrees are often accompanied by somatized disorders, but they should not be described separately unless they are sufficiently pronounced and stable to justify their own diagnosis. The appearance of multiple somatic symptoms after the age of 40 years may indicate a manifestation of primary depressive disorder.
  • Hypochondriacal Disorder. With somatisation disorder, the focus is on the symptoms themselves and their individual manifestation, while in hypochondriacal disorder, attention is directed more to the presence of the intended progressive and serious disease process, as well as its disabling consequences. In hypochondriacal disorder, the patient more often asks for examination in order to confirm the nature of the alleged disease, while a patient with somatisation disorder asks for treatment in order to remove the existing symptoms. With somatisation disorder, there is usually excessive use of drugs, whereas patients with hypochondriacal disorder are afraid of drugs, their side effects, and seek support and relief from frequent visits to various doctors.
  • Delusional disorders (such as schizophrenia with somatic delusions and depressive disorders with hypochondriacal ideas). Freakish features of ideas, combined with a smaller number of them and the more constant nature of somatic symptoms, are most typical of delusional disorders.

Longer (from 2 years) and more intense symptoms are diagnosed as somatoform disorder.

Treatment of Undifferentiated Somatoform Disorder

The main role in the treatment belongs to psychotherapy. Pharmacotherapy aims to create psychotherapy opportunities and is carried out to correct the accompanying symptoms. The choice of drugs in each case is determined by the characteristics of the symptoms and associated manifestations. The following groups of drugs are used for pharmacotherapy: drugs of the first choice are antidepressants (tricyclic and SSRI groups); second choice drugs are beta blockers and mood stabilizers; In the initial stages of treatment, a combination of antidepressant with benzodiazepine is possible; antipsychotics with sedative effect are also used as reserve medicines for severe anxiety, which can not be stopped by benzodiazepines. In addition, the treatment of somatoform disorders must be supplemented with vasoactive, nootropic drugs and vegetal stabilizers.