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).

Adaptive Reaction Disorder

What is an Adaptive Reaction Disorder?

An upset of adaptive reactions is a condition of subjective distress and emotional disturbance that usually interferes with social functioning and productivity and occurs during the period of adaptation to a significant change in life or stressful life event (including the presence or possibility of a serious physical illness). The stress factor can affect the integrity of the patient’s social network (loss of loved ones, experience of separation), a wider system of social support and social values ​​(migration, refugee status). A stressor (stress factor) can affect an individual or also his microsocial environment.

Causes of Adaptive Reaction Disorders

An individual predisposition or vulnerability plays a more important role than other reactions to stress in the risk of occurrence and formation of manifestations of adaptive disorders, but nevertheless it is believed that the condition would not have arisen without a stress factor.

Pathogenesis during an Adaptive Reaction Disorder

The onset is usually within a month after a stressful event or change in life, and the duration of symptoms usually does not exceed 6 months (except for a prolonged depressive reaction due to an adaptation disorder).

Symptoms of Adaptive Reaction Disorders

Manifestations are different and include depressive mood, anxiety, anxiety (or a mixture of them); a feeling of inability to cope, plan or stay in the present situation; as well as some degree of decline in productivity in daily activities. An individual may feel prone to dramatic behavior and outbursts of aggressiveness, but they are rare. However, in addition, especially in adolescents, behavioral disorders (e.g., aggressive or dissocial behavior) may occur.

None of the symptoms is so significant or predominant as to indicate a more specific diagnosis. Regressive phenomena in children, such as enuresis or children’s speech or finger sucking, are often part of the symptoms.

Diagnosing Adaptive Reaction Disorders

The diagnosis depends on a careful assessment of the relationship between:

  • the form, content and severity of the symptoms;
  • anamnestic data and personality;
  • stressful event, situation and life crisis.

The presence of the third factor should be clearly established and there should be strong, although perhaps suggestive evidence that the disorder would not have appeared without it. If the stressor is relatively small and if a temporary relationship (less than 3 months) cannot be established, the disorder should be classified differently according to the available symptoms.

Dissociative Fugue

What is a Dissociative Fugue?

Dissociative fugue is characterized by loss of memory, usually on recent important events, in conjunction with externally targeted travel, during which the patient supports self-care. In some cases, a new identity is accepted, usually for several days, but sometimes for long periods and with an amazing degree of completeness. Organized travel can be in places previously known and emotionally significant. Although the period of the fugue is amnesized, the behavior of the patient at this time for independent observers may seem completely normal.

Causes of Dissociative Fugue

The main role in the development of the disorder is assigned to psychogenic factors, since the occurrence of this state is a protective mechanism for getting rid of emotionally painful experiences.

Symptoms of Dissociative Fugue

Dissociative amnesia combined with externally targeted actions, travel, often within a few days. Behavior seems completely normal. Sometimes there is a new identity. The fugue period is amnesized.

Diagnosis of Dissociative Fugue

For a reliable diagnosis should be:

  • signs of dissociative amnesia;
  • a purposeful journey beyond the limits of ordinary everyday life (the differentiation between travel and wandering must be carried out taking into account local specifics);
  • maintenance of personal care (food, washing, etc.) and simple social interaction with strangers (for example, patients buy tickets or gasoline, ask how to drive, order food).

Differential diagnosis: Differentiation with postictal pug, which is observed mainly after temporal epilepsy, usually presents no difficulty in taking into account epilepsy in history, absence of stressful events or problems and less focused and more fragmented activity and travel in patients with epilepsy.

As with dissociative amnesia, differentiation with consciously simulating a fugue can be very difficult.

Treatment of Dissociative Fugue

Psychoanalysis, caffeine-amitic disinhibition, hypnosis.

Disorders of Sexual Preference

Causes of Sexual Preference Disorders

The causes of disorders of sexual preference are distortions of the stages of development of psychosexuality in ontogenesis. Most of them are normal, however, these disorders are more often observed with hormonal, chromosomal abnormalities and gene abnormalities. Disorders should only be considered in a specific cultural context, as some of them are ritualized and considered acceptable in some cultures. A whole series of sexual preference disorders are successfully exploited by the modern sex industry, in particular, we are talking about sets for sado-masochism, peep shows for voyeurs, attributes of transsexualism, etc.

Symptoms of Sexual Preference Disorders

Periodic fantasies defining acts in the field of sexual behavior. These actions, in connection with the inconsistency with current cultural standards, cause maladaptation and neuroticism of the individual. Attractions are seen as necessary to relieve increasing stress or anxiety. The consequences of abnormal acts can themselves be a source of stress. However, they can only be a symptom in the syndromic structure of personality abnormalities or schizophrenia. It is also important to consider that patients carefully conceal some socially unacceptable traits of attraction, therefore observation of behavior is of particular importance in diagnosis.

Diagnosis of Sexual Preference Disorders

The diagnosis is made on the basis of the fact that the patient has periodic intense sexual drives and fantasies, including unusual objects or actions. At the same time, he either does as drives dictate, or in the fight against them experiences significant distress. This preference is observed for at least 6 months. Multiple disorders of sexual preference are possible (F65.6), when different abnormal, sexual preferences are combined in one individual more often than might be expected based on a simple statistical probability. The most common is a combination of fetishism, transvestism and bdsm, pedophilia and sadism, masochism and voyeurism.

Differential diagnosis

Disorders can be considered as monosymptoms and as inclusions in other mental disorders.

Treatment for Sexual Preference Disorders

When it comes to monosymptoms, they use methods of psychotherapy and psychoanalysis, as well as behavioral therapy in combination with substances that help control impulses: lithium, carbamazepine, beta-blockers and calcium channel antagonists.

Mental and Behavioral Disorders Due to Tobacco Use

What are Mental and Behavioral Disorders Due to Tobacco Use?

About 30% of the population smokes cigarettes, mainly between the ages of 20 and 45, men are more likely than women. Smokers are considered to smoke more than 20 cigarettes per day.

Causes of Mental and Behavioral Disorders Due to Tobacco Use

The main mechanism of the psychoactive effect of nicotine is its binding to cholinergic and nicotinic receptors in the central nervous system, adrenal medulla, neuromuscular synapses and autonomic ganglia.

Symptoms of Mental and Behavioral Disorders Due to Tobacco Use

Acute intoxication
Nausea and vomiting, increased irritability, relaxation under stress, decreased hunger, increased insomnia, tremors, relaxation of skeletal muscles, improved short-term memory.

Harmful use
Somatic changes in the form of reduced coronary blood flow and blood pressure, temperature, vasoconstriction, accelerated menopause and depletion of catecholamines, osteoporosis, cough, high risk of neoplastic processes and somatoform disorders.

Addiction syndrome
Physical dependence and mental dependence.

Withdrawal syndrome
Dizziness, hyperosmia, irritability and anxiety, decreased short-term memory, cough, change in blood pressure.

Psychotic Disorder and Amnestic Syndrome
Not typical.

Residual state and psychotic disorder with delayed debut
Resumption of anxiety, irritability and sleep disturbances in the residual period.

Diagnosing Mental and Behavioral Disorders Due to Tobacco Use

Diagnosis based on history.

Mental and Behavioral Treatment for Tobacco Use

Behavioral therapy, group therapy and psychotherapy. Nicotine replacement therapy: nicotine chewing gums and transdermal nicotine patches, clonidine.