Neurotic , Stress-related And Somatoform Disorders

Chapter 8 Neurotic , stress-related and somatoform disorders

NEUROSIS • a class of functional mental disorder associated with distress but not delusions or hallucinations, where behavior is not outside socially acceptable norms. psychoneurosis or neurotic disorder. • be employed in psychoanalytic theory & practice.

Classifications • • • • • • •

F40. Phobic anxiety disorders 怕 F41. Other anxiety disorders F42. Obsessive-compulsive disorder F43.Reaction to severe stress & adjustment disorders F44. Dissociative disorders F45. Somatoform disorders F48. Other neurotic disorders

Phobic anxiety disorders • dread. • palpitations or feeling faint & secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. • Phobic anxiety & depression coexist.

phobic anxiety disorders • specific phobia • social phobia • social phobia

Anxiety disorders • • • • •

Normal & pathological one Trait anxiety 特征性 State anxiety generalized anxiety disorder panic disorder

anxiety symptoms • Physical motoric symptoms tremors 震颤 automomic & visceral symptoms Psychological cognitive symptoms perceptual sympotms derealization depersonalization affective symptoms others symptoms

Common anxiety symptoms • • • •

Body Chest Emotions (see mood) Fears

Fears • • • • • • • • • • • •

what people think of you being trapped in a place with no exits Constant feeling of being overwhelmed. Fear of being in public dying losing control impending doom悬空的不幸 mistakes or fool passing out 不省人事 losing your mind irrational things, objects, circumstances, or situations crazy, of dying, of impending doom, of normal things, unusual fee

• self awareness / self-consciousness • washrooms • to seat

• as headache, sweating, muscle spasms, palpitations, & hypertension, --- fatigue or even exhaustion.

Generalized anxiety disorder • generalized & persistent • persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness& epigastric discomfort. Fears • Anxiety: neurosis reaction • Excludes: neurasthenia / depressive disorder

Panic disorder

1.5~2% 惊恐急性

• recurrent attacks of severe anxiety (panic), • unpredictable sudden onset palpitations, chest pain, choking sensations, dizziness & feelings of unreality (depersonalization or derealization). • secondary fear of dying, losing control, or going mad. depressive disorder • secondary to depression. Panic: attack . state Excludes: panic disorder with agoraphobia 广场

Etiolgoy • • • •

Psychodynamic theory signal anxiety Behavioral theory Congnitive behavioral theory(CBT) selective Biological theory

genetic evidence chemically induced anxiety states lactate infusion GABA-benzodiaizepine R. γ- aminobutyric acid Other neurotransmitters Neuroanatomical basis locus ceruleus ,limbic system Organic anxiety disorder 器质性焦虑障碍

Biological theory •

genetic evidence chemically induced anxiety states lactate infusion GABA-benzodiaizepine R. γ- aminobutyric acid Other neurotransmitters Neuroanatomical basis locus ceruleus ,limbic system

Organic anxiety disorder

Therapy • • • •

Psychotherapy Relaxation techniques Other behavior therapies Drug treatment talk therapy, meditation, biofeedback, hypnosis& acupuncture.

A friend invites you to a big party. • #1:The party sounds like a lot of fun. I love going out & meeting new people! Happy, excited #2:Parties aren’t my thing. I’d much rather stay in & watch a movie. Neutral #3: I never know what to say or do at parties. I’ll make a fool of myself if I go. Anxious, sad

Thought challenging in cognitive behavioral therapy • Identifying your negative thoughts. • Challenging your negative thoughts. • Replacing negative thoughts with realistic thoughts.

Challenging Negative Thoughts • Negative thought What if I pass out on the subway? • Cognitive distortion • realistic thought Predicting the worstI’ve never passed out before, so it’s unlikely that I will on the subway.If I pass out, it will be terrible! Blowing things out of proportionIf I faint, I’ll come to in a few moments. That’s not so terrible.People will think I’m crazy.Jumping to conclusionsPeople are more likely to be concerned if I’m okay.

Systematic desensitization • Learning relaxation skills • Creating a step-by-step list. • Working through the steps

Facing a Fear of Flying • • • • • • • • • •

Step 1: photos Step 2: video. Step 3: real planes take off. Step 4: plane ticket. Step 5: Pack for your flight. Step 6: Drive to the airport. Step 7: Check in for your flight. Step 8: Wait for boarding. Step 9: Get on the plane. Step 10: Take the flight.

Anti-anxiety drugs

Anti-anxiety drugs tranquilizers, slowing down the CNS. relaxing & calming sleeping pills & muscle relaxants.

Benzodiazepines • • • •

Xanax (alprazolam) Klonopin (clonazepam) Valium (diazepam) Ativan (lorazepam) fast acting—30~1h depression. doses -- depressive symptoms & suicidal thoughts & feelings. emotional blunting or numbness. feelings of pleasure or pain.

Common side-effects of benzodiazepines or tranquilizers

• • • • • • • • • •

Drowsiness, lack of energy Clumsiness, slow reflexes Slurred speech Confusion & disorientation Depression Dizziness, lightheadedness Impaired thinking & judgement Memory loss, forgetfulness Nausea, stomach upset Blurred or double vision

Paradoxical effects of anti-anxiety drugs • sedating properties-- paradoxical excitement. increased anxiety, irritability& agitation. • Mania • Hostility & rage • Aggressive or impulsive behavior • Hallucinations • children, the elderly& people with developmental disabilities.

• Taking anti-anxiety medication with alcohol, prescription painkillers, or sleeping pills can be deadly. • antihistamines • Antidepressants -- Prozac & Zoloft

People over 65. • confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Anti-anxiety drug use in the elderly is associated with an increased risk of falls, broken hips and legs, and car accidents.

Pregnant women. • Placenta-- dependence : baby--withdrawal : muscle weakness, irritability, sleep & breathing problems& trembling. breast milk

People - substance abuse. • alcohol or drugs • benzodiazepines –quickly, addictiveabuse • alcohol or other illicit drugs.

Anti-anxiety drug dependence &withdrawal • benzodiazepines - Xanax, Klonopin, Valium, & Ativan - short-term use • physically dependent • Psychological dependence

dependent on benzodiazepines if: • ≥4 months • cope 克服 • ill or anxious or others . • effect ↓ • extra pill during a stressful time. • could not sleep a wink. • increased dose. • increased alcohol • interfering --sick days off work, family or relationship problems, difficulty coping, memory . • never run out of your pills. • You carry your pills with you “just in case.”