Nightmares

Causes of Nightmares

Deeply repressed phobias, complexes, aggression can be expressed in stereotypical horrors in a dream.

Symptoms of Nightmares

Terrible and disturbing, often stereotypically repeated dreams, the contents of which the patient remembers well. It seems the pursuit, the end of the world, the metamorphosis of objects. The patient is afraid to fall asleep, as this dream can see. In children, fragments of images of sleep can intrude into reality.

Diagnostics Nightmares

Dense and anxious dreams, which the patient remembers in great detail. Clinical signs:

  1. Awakening (in the second half of sleep) with detailed and lively reproduction of dreams of bright frightening content.
  2. When you wake up, you quickly reach a normal level of wakefulness and orientation.
  3. Disorders lead to marked distress.

Differential diagnostics

Nightmares may be present in the initial stages of depression, other endogenous psychosis, and chronic pain. Usually the type of dream suggests its symbolic significance.

Nightmare Treatment

Psychotherapy, psychoanalysis, deepening of sleep with antidepressants and tranquilizers, carbamazepine are used.

Hysterical Personality Disorder

Causes of Hysterical Personality Disorder

Disorder, associated with the education of the “idol of the family” type or as a result of cultivating demonstrative traits in families in which parents try to realize their own claims for leadership in children. More common in women.

Symptoms of Hysterical Personality Disorder

Since childhood, there is a desire to be in the center of attention of children and adults, the thirst for praise and evaluation. The refusal of adults to fulfill desires in a child meets a protest reaction with a demonstration of a fall, rolling of eyes, intermittent breathing. Character is marked by demonstrativeness, theatricality, extraverted behavior in excitable, emotional personalities. Patients are not able to maintain deep long-term affection. Characterized by frequent demonstrations of bouts of irritability, tears and accusations, if the person is not the center of attention or does not receive praise or approval. The suggestibility and orientation to authorities are enhanced, the influence of surrounding circumstances or circumstances is easily formed. Excessive physical preoccupation and constant manipulative behavior to meet their needs are typical. Facial expression is characterized by excessive vividness, paramimia are possible, an expansive gesture. Bright colors and extravagance prevail in clothes and cosmetics. The pursuit of occupations that satisfy the need for demonstration. High susceptibility to dissociative disorders, including motor and disorders of consciousness, as well as the use of alcohol and other psychoactive drugs. Many mental phenomena in hysterical individuals resemble paroxysmal, therefore they are close to the epileptic circle.

Diagnosis of Hysterical Personality Disorder

It should be distinguished from organic dissociative disorders characteristic of some endocrine diseases, in particular, thyrotoxicosis and organic disorders as a result of head injuries. These disorders are characterized, in addition to hysterical characteristics, by dysmnesic, dysphoric and asthenic states, as well as by typical data of additional methods of research (neurology, EEG, CT).

Treatment for Hysterical Personality Disorder

Psychoanalysis, focused on clarifying the internal sensations of the patient, pharmacotherapy. Therapy with antiparoxysmal agents, in particular diphenin and carbamazepine.

Dysthymia (Mood Decline)

What is Dysthymia (Mood Decline)?

Dysthymia is a chronic depressive mood.

Causes of Dysthymia (Mood Decline)

The types of personalities that have dysthymia, it would be correct to call constitutional depressive. These features in them are manifested in childhood and puberty as a reaction to any difficulty, and later on endogenously.

Symptoms of Dysthymia (Mood Decline)

They are tearful, pensive and not too sociable, pessimistic. Under the influence of insignificant stresses in postpuberty, for at least two years, they have periods of constant or periodic depressive mood. Intermediate periods of normal mood rarely last longer than several weeks, the whole mood of the person is colored by subdepression. However, the level of depression is lower than with mild recurrent disorder. It is possible to identify the following symptoms of subdepression:

  • reduced energy or activity;
  • violation of the rhythm of sleep and insomnia;
  • decrease in self-confidence or feeling of inferiority;
  • difficulty concentrating, and hence the subjectively perceived loss of memory;
  • frequent tearfulness and hypersensitivity;
  • decrease in interest or pleasure from sex, other earlier pleasant and instinctive forms of activity;
  • a sense of hopelessness or despair in connection with the realization of helplessness;
  • inability to cope with the routine duties of everyday life;
  • pessimistic attitude towards the future and a negative assessment of the past;
  • social isolation;
  • decrease in talkativeness and secondary deprivation.

Diagnosis of Dysthymia (Mood Decline)

  • At least two years of persistent or recurring depressive mood. Periods of normal mood rarely last longer than a few weeks.
  • The criteria do not correspond to a mild depressive episode, since suicidal thoughts are absent.
  • During periods of depression, at least three of the following symptoms should be present: a decrease in energy or activity; insomnia; decreased self-confidence or inferiority; difficulty concentrating; frequent tearfulness; decrease in interest or pleasure from sex, other pleasant kinds of activity; sense of hopelessness or despair; inability to cope with the routine duties of everyday life; pessimistic attitude towards the future and a negative assessment of the past; social exclusion; reduced need for communication.

Differential diagnostics

It should be differentiated from a mild depressive episode, the initial stage of Alzheimer’s disease. In a mild depressive episode, suicidal thoughts and ideas are present. In the initial stages of Alzheimer’s disease and other organic disorders of depression become protracted, organics can be identified neuropsychologically and with the help of other objective research methods.

Dysthymia Treatment (Mood Decline)

With a reduced mood, Prozac, sleep deprivation treatment and enotherapy are indicated. Sometimes 2-3 sessions of nitrous oxide, amytal-caffeine disinhibition and intravenous administration of novocaine, as well as nootropic therapy, give the effect.

Dissociative Seizures

What is Dissociative Seizures?

Dissociative seizures (pseudo-fits) are seizures that very accurately mimic an epileptic seizure, but without life-threatening manifestations (dangerous falls, biting of the tongue, loss of consciousness is absent and memory is kept for events of this period, stupor or trance may occur).

Causes of Dissociative Seizures

Situational conditionality

Symptoms of Dissociative Seizures

The main feature is sudden and unexpected jerky movements, for which stereotype is not observed and a certain theatricality is characteristic. Duration from minutes to hours. The demonstrative character emphasizes what happens in the presence of outside observers and disappears when they lose interest in the patient. More often abortive forms are encountered – fainting, tears or laughter, tremor of the whole body with external signs of loss of consciousness without actually losing it. In childhood, there is a protest reaction when adults refuse to fulfill the child’s demands.

Diagnosis of Dissociative Seizures

For a reliable diagnosis, the following criteria should be:

  • The absence of a physical disorder that could explain the symptoms that characterize the disorder (but there may be physical disorders that give rise to other symptoms).
  • There is a convincing link in time between the onset of symptoms of the disorder and stressful events, problems or needs.
  • Sudden and unexpected spastic movements, resembling any variants of epileptic seizures, but without subsequent loss of consciousness.
  • Convulsions are not accompanied by a bite of the tongue, serious bruises or injuries due to a fall or involuntary urination, loss of consciousness, pupillary reaction to light is maintained.

Differential diagnosis: Should be distinguished from epileptic seizures.

Treatment of Dissociative Seizures

Emotional stress psychotherapy, psychoanalysis.

Dissociative Disorders of Motility

Causes of Dissociative Motility Disorders

Psychological stress, avoidance of conflict by flight to the disease.

Symptoms of Dissociative Motility Disorders

Full or partial paralysis of the limb (mono-, those- and paraparesis and plegia), ataxia, astasia-abasia, apraxia, akinesia, aphonia, dysarthria, blepharospasm.

Evaluation of the patient’s mental state suggests that a decrease in productivity resulting from the loss of function helps him to avoid unpleasant conflict or to express his dependence or indignation indirectly. A significant factor is the behavior aimed at attracting attention.

Diagnosis of Dissociative Motility Disorders

With dissociative paralysis, there are no pyramidal signs, disturbance of trophism and tone, and sensitivity disorders vary.

Treatment of Dissociative Motility Disorders

Psychoanalysis, hypnosis, Amital-caffeine disinhibition, behavioral therapy.

Which doctors should be consulted if you have Dissociative Motility Disorders

Psychiatrist