Transsexualism

Causes of Transsexualism

Violation of the differentiation of brain structures responsible for sexual behavior (hypothalamus), possibly associated with hormonal effects during pregnancy.

Symptoms of Transsexualism

Features of behavior are noticeable from early childhood. The desire for toys characteristic of the opposite sex, the structure of relationships and the style of behavior of the opposite sex. For example, boys like to play with dolls, embroider and prefer quiet games to mother-daughter, girls, respectively, active and aggressive games, boyish companies, weapons. Transsexualism as a whole is a violation of behavior due to the desire to live and be accepted as a person of the opposite sex, combined with a feeling of inadequacy or discomfort from its anatomical gender and the desire to receive hormonal and surgical treatment in order to make your body as suitable as possible for the chosen gender. Due to social problems and the fact that the attraction of these individuals is directed physiologically to their gender with a different psychological sexual consciousness, depression and a high risk of suicide are frequent. A diagnosis of transsexualism is sufficient to permit prompt sex change in most countries. Sometimes transsexual experiences are unstable.

Diagnosis of Transsexualism

Transsexual experiences may occur with paranoid schizophrenia in the structure of delirium obsession, but in this case, other symptoms characteristic of schizophrenia should also be present.

Transsexualism Treatment

With “nuclear” transsexualism, sex change is indicated with surgical correction and subsequent hormonal and behavioral therapy.

Stuttering

What is Stuttering?

Characteristic features – frequent repetition or prolongation of sounds, syllables or words; or frequent stops, indecision in speech with violations of its smoothness and rhythmic flow.

Causes of Stuttering

The exact etiological factors are not known. Put forward a number of theories:

  • The theory of “block stuttering” (genetic, psychogenic, semantogennaya). The basis of the theory is cerebral dominance of speech centers with constitutional predisposition to the development of stuttering due to stress factors.
  • Theories of the beginning (include the theory of failure, the theory of needs and the theory of anticipation).
  • The theory of learning is based on an explanation of the principles of the nature of reinforcement.
  • Cybernetic theory (speech is an automatic process of the type of feedback. Stuttering is explained by the breakdown of feedback).
  • Theory of changes in the functional state of the brain. Stuttering is a consequence of incomplete specialization and lateralization of language functions.

Recent studies suggest that stuttering is a genetically inherited neurological disorder.

Prevalence

Stuttering suffers from 5 to 8% of children. The disorder is 3 times more common in boys than in girls. In boys, it is more stable.

Symptoms of Stuttering

Stuttering usually begins before the age of 12 years, in most cases there are two acute periods – between 2-4 and 5-7 years. It usually develops over several weeks or months, starting with repeating the initial consonants or whole words that are the beginning of a sentence. As the disorder progresses, repetitions become more frequent with stuttering on more important words and phrases. Sometimes it may be absent when reading aloud, singing, talking to pets or inanimate objects. The diagnosis is made when the duration of the disorder is at least 3 months.

Clonic-tonic stuttering (disturbed rhythm, tempo, fluency of speech) – in the form of a repetition of initial sounds or syllables (logos), at the beginning of speech clonic convulsions with the transition to tonic.

Tonic-clonic stuttering is characterized by a rhythm disturbance, smoothness of speech in the form of hesitations and stops with frequent vocal enhancement and pronounced breathing disorders associated with speech. There are additional movements in the muscles of the face, neck and limbs.

During stuttering, there are:

  • Phase 1 – preschool period. The disorder appears sporadically with long periods of normal speech. After this period, recovery may occur. During this phase, stuttering occurs when children are agitated, distressed, or when they need to talk a lot.
  • Phase 2 occurs in primary school. The disorder is chronic with very short periods of normal speech. Children are aware and painfully experiencing their disadvantage. Stuttering concerns the main parts of speech – nouns, verbs, adjectives and adverbs.
  • Phase 3 occurs after 8-9 years and lasts until adolescence. Stuttering occurs or increases only in certain situations (call to the board, buying in a store, talking on the phone, etc.). Some words and sounds are more difficult than others.
  • Phase 4 occurs in late adolescence and in adults. Expressed fear of stuttering. Typical are word substitutions and bouts of wordiness. Such children avoid situations that require verbal communication.

The course of stuttering is usually chronic, with periods of partial remission. From 50 to 80% of children with stuttering, especially in mild cases, recover.

Complications of the disorder include a decline in school performance due to shyness, fear of speech disorders; restrictions in the choice of profession. For those suffering from chronic stuttering, frustration, anxiety, and depression are typical.

Diagnosis of Stuttering

Spastic dysphonia is a speech disorder similar to stuttering, but is characterized by the presence of a pathological breathing pattern.

Unclear speech, in contrast to stuttering, is characterized by erratic and disrhythmic speech patterns in the form of quick and sharp flashes of words and phrases. When speech is unclear, there is no awareness of his lack, while those who stutter are acutely aware of their speech disorders.

Stuttering Treatment

Includes several directions. The most typical is distraction, suggestion and relaxation. Stutterers are taught to speak simultaneously with the rhythmic movements of the arms and fingers, or in a slow and monotonous manner. The effect is usually temporary.

Classical psychoanalysis, psychotherapeutic methods are not effective in the treatment of stuttering. Modern methods are based on the point of view that stuttering is a form of learned behavior that is not associated with neurotic manifestations or neurological pathology. Within these approaches, it is recommended to minimize the factors that increase stuttering, reduce secondary disturbances, convince the stutterer to talk, even with stuttering, freely, without constraint and fear, in order to avoid secondary blocks.

An effective method of self-therapy based on the premise that stuttering is a specific behavior that can be changed. This approach includes desensitization, reducing emotional reactions, fear of stuttering. Since stuttering is what a person does, and a person can learn to change what he does.

Drug treatment is of an auxiliary nature and is aimed at alleviating the symptoms of anxiety, expressed fear, depressive manifestations, and facilitating communicative interactions. Soothing, sedative, fortifying agents (valerian, motherwort, aloe vera, multivitamins and B vitamins, magnesium preparations) are applicable. In the presence of spastic forms, antispasmodics are used: mydocalm, sirdalud, myelostane, diafene, amisyl, theofedrin. Tranquilizers are used with caution, mebikar 450-900 mg / day is recommended, with short courses. Significant effect is brought by courses of dehydration.

Alternative options for drug treatment:

  • In the clonic form of stuttering, pantogam is used from 0.25 to 0.75 – 3 g / day., Courses lasting 1-4 months.
  • Carbamazepines (predominantly tegretol, timonyl, or finlepsin retird) with 0.1 g / day. up to 0.4 g / day. within 3-4 weeks, with a gradual reduction of the dose to 0.1 g / day. as a supportive treatment, with a duration of up to 1.5 – 2 months.

Complex treatment of stuttering also includes physiotherapeutic procedures, courses of general and specialized speech therapy massage, speech therapy, psychotherapy using the suggestive method.

Specific School Skills Disorders

What are School-specific Developmental Disorders?

These disorders arise due to violations in the processing of cognitive information, which largely occurs as a result of biological dysfunction. Characteristically, the normal acquisition of skills is impaired from the early stages of development. They are not the result of adverse learning conditions and are not related to brain injury or illness. It is necessary to evaluate not the level of education, but school achievements, taking into account the dynamics of development, since the severity and lag in reading for 1 year at 7 years old has a completely different meaning than for 1 year at 14 years old.

The type of manifestation of the disorder usually changes with age – the delay in speech in preschool years disappears in colloquial speech, but is replaced by a specific delay in reading, which in turn decreases in adolescence, and in youth these are violations of spelling / writing. That is, the condition is equal in all respects, but the dynamics of growing up are taken into account. School skills are not only a function of biological maturation, they must be taught and mastered. Specific violations of school skills cover groups of disorders manifested by a specific and significant deficiency in teaching school skills in a given age group, class, population, and school.

These disorders are not a direct result of other conditions – mental retardation, gross neurological defects, emotional or gnostic disorders. Often combined with hyperactivity disorder and attention deficit, specific disorders of motor functions. It doesn’t mean at all that these are children with a delay in skills, and “will catch up with their peers over time” – such violations are observed in adolescence and in further education. They are associated with the appearance of secondary disorders in the form of a lack of interest in learning, a poor educational program, and emotional disorders.

Diagnosing Specific School Skills Disorders

Diagnostic Requirements

There should be the most clinically significant degree of violation of a skill:

  • the presence of delays or deviations in the development of speech in the preschool period;
  • associated problems – inattention or increased activity, emotional disturbances or disturbances in behavior;
  • the presence of qualitative violations – a clear difference from the norm;
  • inadequate response to therapy (lack of effect with increased care at home and / or school).

The violation is more strictly specific and does not depend on mental retardation or on a general decrease in the intellectual level. Diagnosis of violations is based on psychological and pedagogical testing. Violation should be present from the first years of training, and not acquired during education. Violations should not be due to untreated or uncorrected visual or auditory disorders.

Specific impairments to school skills include:

  • specific violation of reading skills “dyslexia”;
  • specific violation of writing skills “dysgraphia”;
  • specific violation of arithmetic skills “dyscalculia”;
  • a mixed disorder of school skills “learning difficulties”.

Treatment of Specific School Skills Disorders

The preferred treatment is corrective training therapy. Emotional reactions are more important than certain teaching methods. An effective neuropsychological correction with an integrative approach to mastering phonetic combinations and the spatial structure of words. Concomitant emotional and behavioral disorders should be treated with appropriate medication and psychotherapeutic methods. A good effect is provided by family counseling.

Specific Personality Disorders

What are Specific Personality Disorders?

Personality disorders – persistent character anomalies, consisting of a combination of genetic and acquired properties that lead to social maladaptation. According to Gannushkin P.B., they are characterized by a violation of adaptation, the totality of the defeat of the psyche and low reversibility. Personality disorders are usually noticeable since childhood as special disharmonies and disproportionate development of the psyche. In dynamics, the phases of compensation and decompensation alternate. S.S. Korsakov pointed out that “The psychopathic constitution is a persistent painful disorder that is firmly connected with the characteristics of the mental warehouse, which already constitutes its fundamental weakness, becomes its characteristic property forever or for a rather long time.” O.V. Kerbikov divided psychopathy (the former name of specific personality disorders) into marginal, developing mainly under the influence of social factors, and nuclear, due to biological, constitutionally hereditary factors. M.O. Gurevich added organic psychopathies to these groups – the consequences of exogenous-organic harmfulness, manifested in anomalies of characterological development. An anomaly of personality grows in prepubertal from patho-characterological reactions, patho-characteristic development, therefore, the diagnosis of personality disorder is made from 16 to 17 years. They are related to borderline mental disorders. The exaggerated development of one of the character traits is considered accentuation (K. Leonhard, 1964), which is a variant of the norm.

E. Kretschmer considered character anomalies to be the result of development asynchrony, in which some character traits develop tremendously in connection with compensating for the insufficient development of other mental functions. J. Price believed that character anomalies are the result of a distorted development of the dominance function in the hierarchy system – this is the result of an incorrect awareness of one’s biological rank.

It is possible to distinguish constitutional genetic, organic and psychodynamic factors leading to the development of character anomalies. The contribution of genetic factors to the development of personality traits is up to 60%, most of the abnormal personality traits are transmitted according to a recessive or polygenic type. Theories of the late 19th century considered mental degeneration in families to be the cause of character anomalies. Long-term somatic and neurological disorders in childhood, pre-, postnatal pathology, traumatic brain injuries contribute to the formation of an abnormal nature. A significant role is played by upbringing in an abnormal and asymmetric family, the frequent background of which is the use by parents of psychoactive substances. Nevertheless, there are facts of the development of completely harmonious personalities even in the presence of all adverse circumstances, as well as facts of the development of abnormal personalities in outwardly harmonious and genetically prosperous families. Part of the abnormal personality traits develops as a kind of hypercompensation of mental deficiency (inferiority complex). From an analytical point of view, most personality abnormalities are associated with developmental delay and distortion of the stages of psychosexuality, while acquired abnormal features are more often the result of regression.

Symptoms of Specific Personality Disorders

General diagnostic guidelines for personality abnormalities are defined as conditions that cannot be directly explained by extensive brain damage or illness or other mental disorder. They must meet the following criteria:

  • disharmony in personal positions and behavior, usually involving several areas of functioning, for example, affectiveness, excitability, control of motives, processes of perception and thinking, as well as the style of attitude towards other people;
  • the chronic nature of the abnormal style of behavior that has arisen for a long time and is not limited to episodes of mental illness;
  • an abnormal style of behavior is comprehensive and clearly violates adaptation to a wide range of personal and social situations;
  • the aforementioned manifestations always arise in childhood or adolescence and continue to exist in the period of maturity, often sharpening of personality traits is noted at a later age;
  • the disorder leads to significant personality distress, but this can only become apparent in the later stages of the course;
  • usually, but not always, the disorder is accompanied by a significant deterioration in professional and social productivity.

Social Phobias

What are Social Phobias?

Social phobias are characterized by an obsessive fear of experiencing the attention of others in relatively small groups of people (as opposed to crowds), which leads to avoiding social situations. Unlike most other phobias, social phobias are equally common in men and women. Social phobias can be isolated and lie in the specific nature of fear – in public speaking, eating, meeting with the opposite sex. If phobic experiences extend to all situations outside the family circle, they talk about the diffuse nature of social phobia. Fear of vomiting in society may be important. In some cultures, direct eye-to-eye contact may be especially frightening. Avoidance of these situations is often pronounced, which in extreme cases can lead to almost complete social isolation.

Causes of Social Phobias

In premorbid, strict evaluation education in childhood, lack of encouragement from parents, forming a low level of self-esteem. The desire by any means to win the interest and recognition of others.

Pathogenesis during Social Phobias

The onset is more common in adolescence with a fear of an answer at the blackboard or in any other evaluative situation that is fixed reflexively.

Symptoms of Social Phobias

Fear of being the center of attention of others – the fear of public speaking is combined with reduced self-esteem and fear of criticism.

Patients complain of redness of the face, a feeling of a coma in the throat, palpitations, dry mouth, weakness in the legs, inability to concentrate on the action.

Diagnosis of Social Phobias

Diagnostics. The presence of anxiety, limited to social situations that are avoided, and being primary.

To establish a reliable diagnosis, all of the following criteria must be met:

  • psychological, behavioral or autonomic symptoms should be a manifestation of anxiety primarily, and not be secondary to other symptoms, such as delirium or obsessive thoughts;
  • anxiety should be limited only or mainly to certain social situations;
  • avoidance of phobic situations should be a pronounced sign.

Differential diagnosis. It should be differentiated from anthropophobia in a depressive episode, in this case other criteria for depression are taken into account. Secondary anthropophobia can also be with delirium.

Often expressed and agoraphobia and depressive disorders, and they can contribute to the fact that the patient becomes confined to the house. If the differentiation of social phobia and agoraphobia is difficult, agoraphobia should be encoded primarily as a major disorder; should not be diagnosed with depression, unless a complete depressive syndrome is detected.

Social Phobia Treatment

Psychoanalysis, psychodrama, gestalt therapy, group psychotherapy.

Sleepwalking (Somnambulism)

What is Sleepwalking (Somnambulism)?

The greatest prevalence in boys is in prepubertal.

Causes of Sleepwalking (Somnambulism)

The reason is the emergence of a functional focus of wakefulness, which invades the stage of deep sleep.

Symptoms of Sleepwalking (Somnambulism)

A state of altered consciousness in which the phenomena of sleep and wakefulness are combined. During the first third of sleep, the patient gets up at night with his eyes open, tries to go somewhere, often to the balcony, to the door, sometimes takes a pillow and a blanket with him, changes the location of the bed. He reacts negatively to an attempt to wake up, his eyes are open, and often there is no blinking. After awakening – amnesia, there are no signs of paroxysmal activity on the EEG.

Diagnosis of Sleepwalking (Somnambulism)

Diagnostic symptoms:

  1. The episodes of lifting and walking in the first third of night sleep.
  2. During the episode, a distant facial expression with a steady gaze, lack of reaction to attempts to make contact or wake up are noted.
  3. Amnesia about the episode.
  4. Restoring mental activity and behavior a few minutes after waking up.
  5. Lack of dementia and epilepsy.

Differential diagnosis

It should be differentiated from epileptic somnambulism, in which paroxysmal activity on the EEG is detected and there are other paroxysmal signs.

Treatment for Sleepwalking (Somnambulism)

Treatment consists in deepening sleep with benzodiazepines or amitriptyline.

Dissociative (Conversion) Disorders

What is Dissociative (Conversion) Disorders?

Dissociative (conversion) disorders (the old name is conversion hysteria) are disorders that result in partial or complete loss of conscious control over memory and sensations, on the one hand, and control of body movements on the other. Usually there is a significant degree of conscious control over memory and sensations that can be selected for immediate attention, and over the movements that need to be performed. It is assumed that in dissociative disorders this conscious and selective control is disturbed to such an extent that it can vary from day to day and even from hour to hour. The degree of loss of function under conscious control is usually difficult to assess.

The term “conversion” is widely used for some of these disorders, and implies an unpleasant affect caused by problems and conflicts that an individual cannot resolve, and transfected into symptoms. Patients with dissociative disorders usually deny problems and difficulties that are obvious to others. Any problems that are recognized by them are attributed to patients with dissociative symptoms.

Disorders are characterized by a close relationship in time with traumatic events, intractable and unbearable events or broken relationships. An increase in the number of disorders is characteristic of a period of wars and conflicts or natural disasters. They are more typical for women than for men, and for youth and adolescence, than for middle age.

The following main varieties are distinguished from dssociative disorders:

  • Dissociative amnesia
  • Dissociative fugue
  • Dissociative fugue
  • Trans and obsession
  • Dissociative movement disorders
  • Dissociative convulsions
  • Dissociative anesthesia or loss of sensory perception

Causes of Dissociative (Conversion) Disorders

In the origin of the disorders, biological, psychological and social factors play a role:

biological factors include the value of heredity and constitutional personality traits. The transferred diseases matter, more often frustration falls on the crisis periods, age of a prepubertal and puberty, and also on the climacteric period;

psychological factors include demonstrative traits in premorbid, mental traumas and deprivations suffered in childhood, increased suggestibility and sexual disharmonies of a married couple. In addition, the psychology of dissociative disorders includes the mechanism of conditional amenity and desirability of the symptom – a person gains some gain due to his illness. Thus, a symptom contributes, for example, to keeping a love object nearby;

social factors include dissociated upbringing, including the conflicting demands of the mother and father for the child, as well as the desire of the individual for a rental installation.

Pathogenesis during Dissociative (Conversion) Disorders

The beginning and end of dissociative states are often sudden, but they are rarely observed with the exception of specially designed modes of interaction or procedures, such as hypnosis. The change or disappearance of the dissociative state may be limited by the duration of these procedures.

All types of dissociative disorders tend to remit after a few weeks or months, especially if their occurrence was associated with a traumatic life event. Sometimes it can develop more gradually and more chronic disorders, especially paralysis and anesthesia, if the onset is associated with intractable problems or frustrated interpersonal relationships. Dissociative states that persisted for 1-2 years before going to a psychiatrist are often resistant to therapy.

Symptoms of Dissociative (Conversion) Disorders

Each of the individual disorders is characterized by its own list of clinical signs, among which the most common are partial or complete loss of memory for recent important events, accompanied by confusion, loss or sharp decrease in voluntary movements, loss of sensations and sensory perception, loss of a sense of personal identity and awareness of the environment.

Diagnosis of Dissociative (Conversion) Disorders

For a reliable diagnosis should be:

  • the presence of clinical signs set forth for individual disorders;
  • the absence of any physical or neurological impairment with which the identified symptoms could be associated;
  • the presence of psychogenic conditionality in the form of a clear connection with time with stressful events or problems or a broken relationship (even if it is denied to the sick).

Convincing evidence of psychological conditioning can be difficult to find, even if they are reasonably suspected. In the presence of known disorders of the central or peripheral nervous system, the diagnosis of dissociative disorder must be established with great care. In the absence of data on psychological conditioning, the diagnosis should be temporary, and the study of the physical and psychological aspects should continue.

It should be noted that all disorders of this rubric during their persistence, lack of connection with psychogenic influences, compliance with the characteristics of “catatonia under the mask of hysteria” (persistent mutism, stupor), identifying signs of increasing asthenia and / or personality changes of schizoid type should be classified within the pseudo-psychopathic (psychopathic) schizophrenia.

Differential diagnosis: Dissociative disorders must be distinguished from many somatic diseases that produce similar symptoms. Sometimes an unrecognized somatic disease can be a source of a nonspecific stimulus for the development of a dissociative disorder.

Depersonalization and derealization are not included here, since they usually violate only limited aspects of personal identity, and there is no loss of productivity in sensations, memory or movements.

Treatment of Dissociative (Conversion) Disorders

Treatment of dissociative disorders should be complex, including both psychotherapy and pharmacotherapy, in fact psychotherapy and pharmacotherapy in many cases occupy an equal place in the correction of disorders. Unlike some types of psychotherapy (cognitive, behavioral), psychopharmacotherapy has a predominantly symptomatic, partly pathogenetic, but not etiotropic effect. At the same time, a transient medicinal improvement may turn into stable remission due to the therapeutic effect of the time factor. Pharmacotherapy of disorders includes all classes of psychopharmacological agents – neuroleptics, tranquilizers, antidepressants, psychostimulants, nootropics, timoleptics. The most widely used are tranquilizers and antidepressants, which divide the first and second places by significance among the classes of psychopharmacological agents in the treatment of dissociative disorders.

Geller’s Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

What is Geller’s Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)?

Rapidly progressing dementia in young children (after a period of normal development) with a distinct loss of acquired skills over the course of several months, with the appearance of anomalies in social, communicative or behavioral functioning.

Causes of Geller Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

The causes of the disorder are not clarified. The prevailing idea is the presence of the organic nature of the disease.

Symptoms of Geller’s Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

After a period of normal development up to 2-3 years for 6-12 months. total dementia is formed. Often there is a prodromal period of an obscure disease: the child becomes wayward, irritable, anxious and hyperactive. Speech becomes impoverished and then disintegrates. Previously acquired behavioral, gaming and social skills are lost. Losing control of bowel and bladder function. Interest in the environment is lost, stereotypic motor actions are characteristic. The deterioration over the course of several months is followed by a plateau state, then a slight improvement can occur. The disorder is often combined with a progressive neurological condition, which is usually encoded separately.

The prognosis of the disease is unfavorable. Most patients remain with severe mental retardation.

Diagnosis of Geller Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

The disorder resembles adult dementia, but differs in 3 aspects: 1) there is no evidence of recognized organic disease or damage; 2) the loss of acquired skills may be accompanied by a certain degree of recovery and restoration of functions; 3) communication disorders are of a nature similar to autism, and not with intellectual decline.

Differential diagnosis

Carried out with autism, early childhood schizophrenia. Geller’s syndrome is characterized by general mental devastation.

Treatment of Geller’s Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

Mostly symptomatic. It includes three areas: treatment of behavioral disorders and neurological disorders; social and educational services activities; family assistance and family therapy.

There is no data on the effectiveness of any form of drug therapy, with the exception of short-term treatment of behavioral disorders. (There are reports that the disorder is caused by a “filtering virus”, and the specificity of the clinic is related to the age characteristics of the lesion)

Sexual Aversion and Lack of Sexual Satisfaction

Reasons for Sexual Aversion and Lack of Sexual Satisfaction

Sexual disgust and lack of sexual satisfaction is due to the fact that sexual intercourse with a partner causes unconscious anxiety and fear, which is caused by negative feelings for a sexual partner.

Symptoms of Sexual Aversion and Lack of Sexual Satisfaction

Upcoming sexual intercourse with a partner causes disgust, fear or anxiety, is avoided, and if it occurs, it is combined with a strong sense of guilt, which blocks subsequent sexual intercourse with this partner.

In the absence of sexual satisfaction, the genital reaction is “automatic in nature” and is not accompanied by a sense of pleasure.

Diagnosis of Sexual Aversion and Lack of Sexual Satisfaction

F52.10 – Sexual Aversion

Upcoming sexual intercourse with a partner causes strong negative feelings, fear or anxiety, which are sufficient to lead to sexual avoidance.

F52.11 – Lack of sexual satisfaction

Normal sexual reactions occur, an orgasm is experienced, but there is no adequate pleasure, more often observed in women.

Differential diagnosis

The problem is to identify the primary and secondary causes of sexual dysfunction. Neurotic disorders, delirium, should also be assumed behind the facade of sexual aversion.

Treatment for Sexual Aversion and Lack of Sexual Satisfaction

Psychotherapy and family therapy. Behavioral Therapy.

Recurrent Depressive Disorder

What is Recurrent Depressive Disorder?

Recurrent depressive disorder is a disorder characterized by repeated depressive episodes of mild, moderate or severe degree, without anamnestic data on individual episodes of high spirits, hyperactivity that could meet the criteria for mania. However, this category can be used if there is evidence of short episodes of mild high spirits and hyperactivity that meet the criteria for hypomania that follow immediately after a depressive episode (sometimes they can be triggered by the treatment of depression).

The prevalence in the population is quite high and according to various sources ranges from 0.5 to 2%

Causes of Recurrent Depressive Disorder

As a rule, it is rather difficult to identify the exact cause of recurrent depressive disorder, among the main etiological factors there are: endogenous (genetically determined predisposition), psychogenic (depression is the most typical human reaction to mental trauma) and organic (residual-organic inferiority, the consequences of neuroinfections, intoxication, head injuries, etc.). The first episodes of recurrent depressive disorder are usually caused by external provocation (often by traumatic circumstances), however, factors unrelated to external circumstances predominate in the occurrence and development of repeated phases.

Pathogenesis during Recurrent Depressive Disorder

The first episode occurs later than with bipolar disorder, at the age of about 40 years, although often the disease begins much later. The duration of the episodes is 3-12 months (average duration of about 6 months). The period between attacks is at least 2 months, during which no significant affective symptoms are observed. Although recovery is usually complete in between attacks, a small proportion of patients exhibit chronic depression, especially in old age. Usually, late seizure lengthening is noted. An individual or seasonal rhythm is quite distinct. The structure and typology of seizures correspond to endogenous depressions. Additional stress can alter the severity of depression. Individual episodes of any severity are often provoked by a stressful situation and, in many cultural conditions, are observed 2 times more often in women than in men.

Symptoms of Recurrent Depressive Disorder

Main symptoms

  • depressed mood;
  • a decrease in interest or pleasure from activities that were previously pleasant to the patient;
  • decreased energy and increased fatigue.

Additional symptoms

  • decreased self-esteem and self-confidence;
  • unreasonable sense of self-condemnation and guilt;
  • ideas or actions aimed at self-harm or suicide;
  • decreased ability to focus and attention;
  • a gloomy and pessimistic vision of the future;
  • sleep disturbance;
  • change in appetite.

Diagnosing Recurrent Depressive Disorder

The main symptom of recurrent depressive disorder is the presence of recurring depressive episodes (at least 2 episodes should last at least 2 weeks and should be separated by an interval of several months without any significant mood disorders). The possibility of a manic episode in a patient with recurrent depressive disorder cannot be completely excluded, no matter how many depressive episodes in the past. If an episode of mania occurs, the diagnosis should be changed to bipolar affective disorder.

Recurrent depressive disorder can be subdivided by designating the type of current episode, and then (if there is sufficient information) the prevailing type of previous episodes into mild, moderate or severe.

  • Mild recurrent depressive disorder is characterized by the presence of at least two main symptoms and two additional symptoms. Subdivided into:
    – Mild recurrent depressive disorder without somatic symptoms (there are, but not necessarily, only some somatic symptoms)
    – Mild recurrent depressive disorder with somatic symptoms (there are 4 or more somatic symptoms, or only 2 or 3, but quite severe)
  • Moderate recurrent depressive disorder is characterized by the presence of at least two main symptoms and three to four additional symptoms. Subdivided into:
    – Moderate recurrent depressive disorder without somatic symptoms (only some are present or are absent)
    – Moderate recurrent depressive disorder with somatic symptoms (there are 4 or more somatic symptoms, or only 2 or 3, but an unusually severe degree)
  • Severe recurrent depressive disorder is characterized by the presence of all the main symptoms and four or more additional symptoms. Subdivided into:
    – Severe recurrent depressive disorder without psychotic symptoms (no psychotic symptoms)
    – Recurrent depressive disorder, current severe episode with psychotic symptoms (delusions, hallucinations, depressive stupor should be present). Delusions and hallucinations can be classified as appropriate or not appropriate for mood.

Differential diagnosis

Recurrent depressive disorder should be differentiated from schizoaffective disorder and organic affective disorder. In schizoaffective disorders, the structure of productive experiences contains schizophrenia symptoms, and in organic affective disorders, the symptoms of depression accompany the underlying disease (endocrine, brain tumor, consequences of encephalitis).

Treating Recurrent Depressive Disorder

The treatment takes into account exacerbation therapy (antidepressants, electroconvulsive therapy, sleep deprivation, benzodiazepines and antipsychotics), psychotherapy (cognitive and group therapy) and maintenance therapy (lithium, carbamazepine or sodium valproate).