Neurotic, Stress-related And Somatoform Disorders

Chapter 8 neurotic, stress-related and somatoform disorders

Classifications • • • • •

F40. Phobic anxiety disorders恐怖性焦虑障碍 F41. Other anxiety disorders焦虑症 F42. Obsessive-compulsive disorder强迫性障碍 F43.Reaction to severe stress & adjustment disorders F44. Dissociative disorders分离性障碍 , 精神型癔 症 • F45. Somatoform disorders躯体病样精神障碍 • F48. Other neurotic disorders神经症性障碍

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

Anxiety disorders • • • • • •

Normal & pathological one Trait anxiety State anxiety generalized anxiety disorder panic disorder phobic anxiety disorders phobic anxiety disorders

phobic anxiety disorders 恐怖性 • specific phobia • social phobia • social phobia

Generalized anxiety disorder • generalized & persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances (i.e. it is "freefloating"). • persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness& epigastric discomfort. Fears • Anxiety: . neurosis . reaction Excludes: neurasthenia

Panic disorder • 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

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 器质性焦虑障碍

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.”