Obsessively phobic disorders are found at. What is obsessive phobic syndrome

A. V. Snezhnevsky (1983) The obsessive phenomena divides on the following forms: figurative, sensitive (often extremely heavy) and distracted (indifferent in their content). The figurative form includes obsessive memories, blasphemous thoughts (contrasting views), obsessive doubts, obsessive fears in the impossibility of performing primary actions, etc., to the abstract - obsessive reproduction in the memory of forgotten names, surnames, definitions, fruitless obsessive account, Ice ("mental Gum ") and others.

The obsessive states are separated on a motor (compulcia) of spheres, emotional (phobias) and obsessions in intellectual. This separation can be considered conditional, as in one degree or another in each obsessive phenomenon contains movement, and fears, and obsessive thoughts, closely interrelated. An example of this may serve as patients suffering from severe neurosis of obsessive states. In such patients, protective actions are sometimes produced (actions) various character in the form of so-called rituals.

The obsessive phenomena of the "mental chewing" type are manifested in obsessive doubts and thinking accompanying various patient classes. Based when performing various intellectual practices, they force patients to return to the same thoughts, many times check full work, recalculate, reread, bringing to the state of fatigue, fatigue.

Obsessive doubts can sometimes manifest as uncertainty in loyalty and the completion of different actions with a continuous desire to check their implementation. So, patients are checked many times, whether the iron is turned off, the door is locked, etc. At the same time, real (real) events attract their interest in much less.

The obsessive account (arrhythmomania) sometimes has in neurosis and independent, not dependent value, but still more often occurs in phobic syndrome, acquiring a security-ritual character. For example, the patient almost always recalculates any objects (steps, window bindings, produces counting operations, legs of chairs, etc. (obsessive phobic disorders)) so as not to get some dangerous disease (for example, cancer). To the noted, indifferent in its content, obsessive phenomena also refers to repetition in memory of various forgotten names, dates, obsessive names of names (onomomatomia).

The obsessive memories are usually expressed in an irresistible memories of the patient's memories, most often related to a fighter situation that was the basis of a neurotic breakdown, or any annoying events in the past.

Obsessing movements, or neurosis actions, sometimes meet independently either more often included in the complex structure of phobic syndrome and are issued as rituals. Intrusive character may have both light, simple movements (for example, tapping, etc.) and more complex movements, actions (strict sequence of anything, for example, a sequence in a certain order of things on a desk or exactly melted on the clock day t. d.). In cases of insensitive forms of neurosis, including neurosis of obsessive states, patients not only make ritual actions themselves, but also forced to make them and their loved ones, relatives.

Complex intrusive motor rituals often have the character of a "cleansing", a protective-protective act (for example, washing hands for misophobia).

Described in the group of obsessive movements of ticks in the form of stereotypically repeated involuntary muscle twitching, usually related to face muscles, and blefarpasm common in neurosis may have neurotic origin, but in some cases require thorough differential diagnosis with organic diseases of the central nervous system, local hyperkinosis of other origin et al. At the same time, in the opinion of many authors, strengthening clinical manifestations Hyperkinosis with emotional voltage, sometimes considered as proof of the neurotic nature of the symptom, as a rule, is observed in hyperkinosis of organic origin.

It should be noted that if in some cases the patient, contrary to the desire, forced to make certain logically not motivated movements and actions, as this leads to soothing, then in other cases all efforts are aimed at not to make any actions.

Along with more frequent obsessive phenomena in the form of obsessive actions in the clinic of neurosis there are symptoms, expressed in an obsessive fear of the inability to make any action. This kind of intrusive concern is characteristic of disabling syndromes. vegetative functionsshown in respiratory disorders, swallowing, urination. In the latter case, this, for example, the inability to perseve in the presence of outsiders.

Isolated obsessions

The obsessions in an isolated form in neurosis are relatively rare. The authors recognizing the neurosis of obsessive states as an independent form describe the obsessive phenomena more often within this neurosis. The same clinicians who do not distinguish the neurosis of obsession, consider obsessive symptoms are quite typical for patients with neurasthenia.

Patients with different forms "\u003e neuroses can occur with a wide variety of obsessive symptoms. For patients with neurasthenia, obsessive thoughts of hypochondriac content are characterized, whose fixation can be facilitated by various unpleasant somatic sensations. In an obsessive symptom complex with hysteria, more demonstration, care from difficulties," escapes to illness " than the actual experiences of obsessions. There is an emotional saturation of these states. A. M. Zapodyos (1982) proposes to refer to the hysterical only those obsessions, which are based on the mechanism of "conditional pleasantness or desirability of a painful symptom." Obsessive thoughts With hysteria, there are much less frequently. Sometimes patients with hysteria observed obsessive performances that reach brightness of hallucinations (usually visual and auditory).

The obsessive motor rituals often take place in patients with neurosis of obsessive states and hysteria, less often - with neurasthenia.

In most cases, obsessive manifestations in isolated form are found in psychopathies (psychostective or pineapple), as well as procedural diseases and organic lesions of the brain.

Diagnosis of disease

The differential diagnosis of obsessive states during neurosis and schizophrenia (especially the sluggish, neurosis-like form) is often significant difficulties.

D. S. Ozertekovsky (1950) believes that when schizophrenia should be distinguished by obsessive states carrying the undoubted emotional color (the presence of which, according to the author, is a consequence of a psycho-prey-mensive nature that detects in patients with schizophrenia), and obsessive states that are fundamentally They differ from the first lack of emotional colors and which should be regarded as schizophrenic symptoms.

E. K. Yakovlev, who studied in our clinic for many years, obsessive phenomena showed that in most cases developing in schizophrenic (as well as other neuropsychiatric diseases) obsessive states are not one of the components of the painful process, but only a consequence of complex Experiencers that have arisen from a person with psychos-beams, why they concern meaningful. As for the external manifestations of obsessions and the attitude towards them of patients, a certain originality of them for nervous and mental illness, E. K. Yakovlev considers them the result of the impact on the nervous activity of the main painful process and emphasizes (agreeing with D. S. Ozerkivovsky) that The diagnosis of schizophrenia in the presence of obsessive syndrome can be delivered only on the basis of psychopathological disorders specific for this disease and cannot be determined by one obsessive phenomena, no matter how they hit their unusual.

Most authors emphasize the following differential diagnostic signs of intrusiveness in schizophrenia: the lack of imagery, the pallor of emotional components, monotony, the presence of a monotonous stamp of obsessions, rigidity, abundance of rituals, tendency to systematization. Also emphasized the suddenness and non-motivation of their occurrence. In the deepening of the painful process, the accession of stereotypical motor and ideator rituals is often observed, which differ in meaninglessness and absurdity. Prognostically unfavorable and also testifying in favor of the obsession within the framework of sluggish schizophrenia are obsessive doubts arising in the complication of the syndrome. The severity of obsessions, their changes are usually independent of external factorsas it is observed in neurosis. When schizophrenia, obsessions are often combined with the symptoms of the derrania and depersonalization.

Relatively lower differential diagnosis There are such signs as the degree of critical attitude towards obsessive phenomena, the presence of combating them.

As E. S. Matveyeva (1975) notes, in the clinic of low-armred schizophrenia, patients at the beginning of the disease can detect a certain critical attitude towards the ideas of a obsessive nature and regard them as painful; Pathological ideas do not bear the nature of delusional conviction and are constantly questioned; Patients regard these phenomena as alien to their personalities; Patients tend to overcome them, opposing them a system of protective measures, characteristic of greencastic psychopaths. Significant importance in this regard is observing the dynamics of the development of psychopathological disorders. Under the intrusiveness of schizophrenia with the progression of the disease, there is a weakening of a critical attitude towards them, the disappearance of painful experiences of fruitless struggle against them. The "swelling" of an affective relationship towards these disorders, the emergence of other indicated signs of obsessive disorders (obsessive disorder), characteristic of procedural diseases, is also observed. A clearer identification of symptoms of another register.

In the case of manico-depressive psychosis, psychogenically determined obsessive states usually arise in the depressive phase; They are closely related to the beginning of the attack and disappear with the end of it.

Encephalitis

Many intrusive authors are described with encephalitis. These patients may have real obsessive states caused by the reaction of an anxious personality to the disease by encephalitis, as well as in connection with more complex psychogencies associated with organic disease. At the same time, actually obsessive formations in encephalitis are characterized by some features that are usually emphasized in the literature: violent overwhelming, dominance, stereotype, often - suddenness of the offensive; It is not more correct to attribute them to obsessive, but to violent phenomena.

Specific features are characterized by contrast obsessions in patients with organic brain diseases.

The component of the obsessive encouragement borders on them with violence.

A violent nature also bear motor acts in patients with post-ancephalitic parkingonism, nothing in common with obsessive compulsions (obsessive compulsive personality disorder).

Epilepsy

In patients with epilepsy, it is necessary to distinguish symptoms in the framework of special states that are associated with violations in the field of deposits and cannot be attributed to true obsessive states: Influes of thoughts, violent desires, violent attractions. They are characterized by a short-term, expressed affective saturation, almost violent overwhelming, lack of communication with mental traumatization.

M. Sh. Wolf (1974) notes in patients with epilepsy an obsessive need for moving, removing or destruction of individual objects, as well as the appearance of obsessive, often meaningless phrases, individual phrases, scraps of memories or painful doubts, the meaning and importance of which patients are poorly realized and not able to accurately convey.

At the same time, in patients with epilepsy, as in other, neuropsychiatric diseases, there may be obsessive phenomena, psychogenically determined, differing in the period of weakening nervous activity Special inhibitory.

Obsessive-phobic disorder

What is this - obsessive-phobic violation? This is a neurotic disorder, in which a person suffers from obsessive fears, thoughts, actions, memories.

If you want to know if you have it, you can take a test on the "obsessive-phobic disorder" scale in the article "Neose. What it is and how to reveal "on our website.

And there is a disorder if your indicator is lower than the coefficient of 1.28.

As a rule, the obsessive-phobic disorder may be accompanied by such fears (phobias):

• fear to get sick with a serious disease (AIDS, cancer, etc.);
• fear remain indoors in the elevator (claustrophobia);
• fear to go outside, on open prostations (Agarofobia).

Moreover, anxiety comes to such sizes that the person will avoid situations where these fears arise.

But, in addition to fears, this disorder has the following obsessions (obsessions):

• obsessive thoughts;
• obsessive memories;
• an obsessive invoice (the score of the steps of the stairs, cars of some color, the number of letters in words, etc.);
• obsessive hand washing;
• obsessive checks (whether the door is closed, whether iron, light, gas, etc. are removed.);
• rituals (in order to eliminate obsessive actions).

The person himself understands the unreasonableness of these actions, but can not get rid of them.

Is there a way to cure? There is!

This is cognitive behavioral therapy (CBT). In this therapy is very effective method It is the Jeffrey Schwartz program "4 steps".

And there is such a method of therapy as the EMDR, in which we work in traumatic experience, events that lead to the disorder. Read more about the method on our website in the "Methods" section.

Ossessive compulsive disorder - symptoms and treatment. Diagnosis of neurosis of obsessive states and test

Anxious state, fear of trouble, repeated hand washing - only a few signs of a dangerous obsessive-compulsive disease. The fault line between normal and obsessive states can turn into the abyss if it does not diagnose the OCR (from the lat. Obsessive is an obsession, siege, and compulsive - coercion).

What is obsessive compulsive disorder

A desire to check something all the time, a feeling of anxiety, fear has a different degree of severity. It is possible to talk about the presence of a disorder if the obsessions (from the lat. Obsessio - "presentations with a negative color") appear with a certain periodicity, provoking the occurrence of stereotypical actions called a compulcility. What is OCC in psychiatry? Scientific definitions are reduced to the interpretation, which is neurosis, obsessive state syndrome caused by neurotic or mental disorders.

The opposition-causing disorder for which fear is characteristic, obsession, depressive mood, lasts a long period of time. Such specifics of obsessive-compulsive malaise makes the diagnosis of complex and simple at the same time, but at the same time a certain criterion is taken into account. According to the adopted classification on Snezhnevsky, based on the participation of the flow features, the disorder is characterized by:

• one-time attack with a duration of the week to several years;
• cases of recurrence of a compulsive state, between which periods of complete recovery are recorded;
• continuous development dynamics with periodic amplification of symptoms.

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Contrast obsessions

Among the obsessive thoughts, there are alien to the true desires of the very person in a compulsive malaise. Fearing to make something that a person is not able to commit because of the character or upbringing, for example, blasphemy during religious service or a person thinks that he can harm his loved ones - these are signs of contrast obsession. The fear of causing harm with obsessive-compulsive violation leads to a diligent avoidance of the subject, which caused such thoughts.

Obsessive actions

At this stage, the obsessive disorder can be characterized as the need to make some actions that bring relief. Often senseless and irrational compulsices (obsessive actions) take one form or another, and such widespread variation makes it difficult to form a diagnosis. The emergence of actions are preceded by negative thoughts, impulsive actions.

Among the most common signs of obsessive-compulsive ailments are the following:

• frequent washing of hands, the adoption of the soul, often with the use of antibacterial agents - it causes fear of pollution;
• behavior when the fear of infection forces a person to avoid contact with door handles, toileties, sinks, money as potentially dangerous dirt peddles;
• multiple (compulsive) checking switches, sockets, door locks, when the disease doubt passes the line between thoughts and the need to act.

Obsessive phobic violations

Fear, albeit unreasonable, provokes the emergence of obsessive thoughts, actions that reach the absurdity. Anxious state in which the obsessive-phobic disorder reaches such sizes, is amenable to treatment, and rational therapy is considered to be the method of four steps of Jeffrey Schwarz or working as a traumatic event, experience (obverse therapy). Among phobias with an obsessive-compulsive violation of the most well-known claustrophobia (fear of a closed space).

Obsessive rituals

When negative thoughts or feelings arise, but compulsive malaise patient far from the diagnosis - bipolar affective disorderYou have to look for a way to neutralize obsessive syndrome. The psyche forms some obsessive rituals, which are expressed by meaningless acts or the need to perform repeated compulsive actions similar to superstition. Such rituals himself can be considered illogical, but the alarming disorder is forced to repeat everything first.

Ossessive-compulsive disorder - symptoms

Obsessive thoughts or actions that are perceived as incorrect or painful, can make harm to physical health. Symptoms of obsessive-compulsive disorder can be solitary, have a different degree of severity, but if you ignore the syndrome - the state will deteriorate. The obsessive-compulsive neurosis can accompany apathy, depression, so it is necessary to know the signs for which it will be possible to diagnose OCD (OCD):

• the emergence of unreasonable fear to get infected, fear of pollution or trouble;
• repeated obsessive actions;
• compulsive deeds (protective actions);
• excessive desire to observe order and symmetry, cycling, pedantry;
• "Jam" on thoughts.

Ossessive-compulsive disorder in children

It occurs less frequently than in adults, and when diagnosing, a compulsive disorder is often detected in adolescents, and only a small percentage is the children of 7 years of age. Belonging to the floor does not affect the appearance or development of the syndrome, while the obsessive-compulsive disorder in children does not differ from the main manifestations of neurosis in adults. If parents manage to notice the signs of the OCC, then it is necessary to contact the psychotherapist to select a treatment plan with the use of medicines and behavioral, group therapy.

Ossessive compulsive disorder - Causes

Comprehensive study of the syndrome, many studies have not been able to give a clear answer to the question of the nature of obsessive-compulssant violations. Influence the well-being of a person can psychological factors (transferred stress, problems, fatigue) or physiological (chemical imbalance in nerve cells).

If you dwell on factors, then the reasons for the OCR look like this:

1. stressful situation or traumatic event;
2. autoimmune reaction (consequence of streptococcal infection);
3. genetics (turret syndrome);
4. biochemistry violation of the brain (reduction of glutamate activity, serotonin).

Obsessive-compulsive disorder - treatment

Almost complete recovery is not excluded, but long-term therapy will be required to get rid of obsessive-compulsive neurosis. How to treat OCD? Treatment of obsessive-compulsive disorder is carried out comprehensively with a consistent or parallel application of techniques. Compulsive personality disorder in the severe form of OCC requires drug treatment or biological therapy, and when easy to use the following techniques. It:

• Psychotherapy. Psychoanalytic psychotherapy helps to cope with some aspects of a compulsive disorder: Correction of behavior in stress (method of exposure and warnings), training of relaxation technique. Psycho-formational therapy with an obsessive-compulsive violation should be aimed at deciphering actions, thoughts, identifying reasons, for which family therapy is sometimes prescribed.
• Lifestyle correction. Mandatory revision of the diet, especially if there is a compulsive disorder of feeding, getting rid of bad habits, social or professional adaptation.
• Physiotherapy at home. Hardening at any time of the year, bathing in seawater, warm baths with medium duration and subsequent wiping.

Medical treatment of OKR

Mandatory point for complex therapyrequiring an attentive approach from the specialist. The success of drug treatment of OCP is associated with the right choice of drugs, the duration of the reception and dosage during the exacerbation of the symptoms. Pharmacotherapy provides for the possibility of prescribing drugs for a particular group, and the most common example, which can be used by a psychotherapist for the recovery of the patient is:

• antidepressants (paroxetine, sertalin, cytitalopram, escitalopram, fluvoxamine, fluoxetine);
• atypical antipsychotics (risperidone);
• normatimics (normal, lithium carbonate);
• tranquilizers (diazepams, clonazepam).

Talk about alarming-phobic disorder

Alarming-phobic disorder - neurotic stateAt which there are obsessive fears (phobias), thoughts, memories. All these obsessions (obsessions) are unpleasant, alien to the patient, but they cannot get rid of them.

Anxious-phobic disorder, obsessive-phobic disorder, obsessiveness neurosis, obsessive-phobic neurosis is all different names The same disease. Let us dwell in more detail for the causes of the development of this disease, manifestations, as well as treatment.

Who has violations?

The predisposition to the development of obsessive-phobic neurosis is inherited.

Some personal qualities are a favorable soil for the development of an alarm-phobic disorder. These include anxiety, blitivity, caution, responsibility, pedanticity. Such people live with reason, and not emotions, they used to think everything in detail, weigh. Also, people suffering from obsessive-phobic neurosis are demanding of themselves, prone to self-analysis.

Practically, neurosis of obsessions does not happen in persons who can easily endure responsibility for the unpleasant situation on other, inclined to aggression, reaching their goal at any cost.

One of the options for psychopathy, psychstay, is a background for the development of anxiety-phobic disorder, constantly manifests itself with more or less pronounced obsessions.

In certain age periods, the risk of developing neurosis, including an alarming-phobic violation, increases. This is a teenage period, early maturity period (25-35 years old) and the time preceding the climacterid period.

Ossessive-phobic neurosis is approximately the same frequency of both men and women.

Causes of neurosis development

All neuroses, including anxious phobic disorder, arise, as a rule, with a combination of mental injury with excessively intense work and a lack of rest, chronic lack of sleep. Various infections, alcohol abuse, endocrine disorders, defective nutrition act as factors that weaken the organism.

Clinical picture

The main manifestations of the obsessive-phobic neurotic disorder include panic attacks, agoraphobia and hypochondriatic phobias.

Panic attacks

Panic attacks are manifested by the strongest fear and a sense of impending death, accompanied by vegetative symptoms (sweating, dizziness, sensation of air shortness, heartbeat, nausea). Such attacks can last from a few minutes to an hour. During panic attacks, the fear of going crazy, losing control over their behavior. Panic attacks are characteristic of panic disorder, I dedicated his detailed description by a separate article.

Some internal organs may cause the first panic attacks. This is gastritis, pancreatitis, osteochondrosis, heart disease, disorders of the thyroid gland.

Agoraphobia

Agorafobia is not only fear of open spaces, but also the fear of crowds, crowded places, fear of going out.

There are a number of obsessive fears similar to agoraphobia. Among them are claustrophobia (fear of closed spaces), transport phobias (fear moving on the train, plane, bus).

As a rule, panic attacks are the first manifestations of anxious and phobic disorders, agoraphobia appears after them.

With alarm phobias and obsessive fear appear not only in specific situations, and even when people remember such situations, represent them.

Typical for the development of phobic disorders is the expansion of situations causing fear. For example, during transport phobias, an obsessive fear appears to move in the subway, then the fear of public land transport, taxis joins. People suffering from obsessive-phobic neurotic disorders are afraid of not the transport itself, but situations that may arise in them. For example, fear of the fact that in the subway, due to a large distance between the stations, a person will not be able to provide medical care in time when an attack of panic attack occurs.

Hypochondriatic phobias

Hypochondriatic phobias are the fear of any serious illness. They are still different called nosophobia.

Most often found carcercofobia (fear of cancer), cardiophobia (obsessive fear of heart disease), strokemophobia (stroke fear), speedophobia and syphilophobia (Fear to infect AIDS or syphilis). Hypochondriatic phobias may also be manifestations of hypochondriac depression.

People suffering from phobias do everything to avoid the situation that causes them fear. With transport phobias, the face with anxious-phobic disorder is not used by an elevator, transport, everywhere walk on foot. Those who are pathologically afraid to get sick with cancer constantly turn to doctors so that they conduct careful surveys. But even good results of analyzes are for a while soothing patients. The first minor deviations in the work of the internal organs are immediately perceived as the emergence of a severe, incurable disease.

Social phobias

Phobic anxiety disorder may be accompanied by a number of social phobias.

Social phobias are fear of being the focus and concerns to earn a negative assessment by other people, while people will mostly avoid public situations.

The first signs of social phobias, as a rule, arise in adolescent or youthful age. Quite often, phobias provoke adverse psychological or social impacts. At first, the fear of being the focus on the spot affects only individual situations (for example, the answer at the board, appearance on stage) or contact with a certain group of people (local "elite" among students in school, representatives of the opposite sex). At the same time, communication with loved ones, in the circle of the family of fear does not cause.

Over time, social phobia can manifest itself only with relative restrictions in the field of public activity (fear of communicating with higher persons, fear of meals in in public places). If a person falls into a similar situation, then shyness, embarrassment, feeling of internal stiffness, trembling, sweating appear.

Some people may have a generalized social phobia. Such people in every way avoid public places, afraid to seem like funny, to detect signs of imaginary damage in humans. Everyone staying in public places, public speeches cause them a unfortunate feeling of shame.

Ossessive-phobic disorders may also manifest itself with specific phobias - obsessive fears related only to a specific situation. Such phobias refers fear of thunderstorms, heights, pets, visits to the dentist.

Options for the flow of disorders

The first option is the most rare. He manifests itself exclusively at the bosoms of panic attacks. The phenomena of agoraphobia and noosophobia arise rarely and close ties with rinic attacks do not form.

The second version of obsessive-phobic neurotic disorders Manifested by panic attacks and rack agoraphobia. A distinctive feature of panic attacks - they arise suddenly, among complete health, accompanied by severely disturbing and perceived by patients as a bodily catastrophe life-threatening. At the same time, vegetative symptoms are weakly expressed.

With a second embodiment of phobic alarm disorder very quickly, agoraphobia, obsessions and hypochondriac symptoms are attached to the attacks of panic. In this case, the entire lifestyle of patients subordinate to the elimination of the conditions for the occurrence of panic attacks. Patients can develop a whole range of protective measures to avoid the slightest opportunity to get sick or get into a situation accompanied by the appearance of phobia. Often, patients change their work or even dismissed, move into a more environmentally friendly terrain, lead the gentle lifestyle, avoid "dangerous" contacts.

The third option of obsessive-phobic neurosis is panic attacks developing in the type of vegetative crisis. Attimes, panic precedes not sharply expressed anxiety, a variety of pains around the body. In most cases, the attack of panic is psychogenically provoked. Its main symptoms are a rapid heartbeat, a feeling of lack of air, suffocation. Even after the attack of panic passes, the condition of complete well-being does not occur. Patients begin to scrupulously observe everyone, even the smallest, deviations from the work of the internal organs and consider them signs of serious pathology.

Features of treatment

Treatment of obsessive-phobic disorders should be comprehensive, including drug treatment along with psychotherapy.

Medical therapy

For the treatment of panic attacks, such an antidepressant is most often used as Anafranil (clomipramine). Help to cope with panic attacks and other manifestations of trial-phobic disorders Antidepressants Fluvoxamine, sertraline, fluoxetine, which are also used to treat depression. The preparation of choice for the treatment of social phobias is Moklobemid (Auroks).

In addition to antidepressants, tranquilizers (meepobamate, hydroxyzine) can also be applied to the treatment of phobic alarm disorder. These drugs have minimal side effects, their long-term use does not entail the development of drug addiction.

With acute forms of anxious-phobic disorders, benzodiazepine tranquilizers alprazolam and clonazepams are most effective. Also intramuscularly or in the form of droppers can be used diazepams, eleganium. However, these drugs can only be used briefly in order to avoid addiction to them.

With phobias, accompanied by a complex system of protective rituals (obsessive invoice, an obsessive decomposition of words), with a combination of intrinsic inclusions, neuroleptics can be assigned - triftatazine, haloperidol and others.

Psychotherapy

Psychotherapeutic impact is aimed at eliminating anxiety and correction of inadequate forms of behavior (avoidance for anxious-phobic disorders), patient training. Relaxation basics (relaxation). Care as group and individual methods of psychotherapy can be used.

If phobias predominate during the disorder, patients need psycho-emotional-supporting therapy, which allows to improve the psychological well-being of such people. Eliminate phobias helps behavioral therapy and hypnosis. During the sessions of patients, they are trained to resist the object causing fear, apply different kinds Relaxation.

Also, rational psychotherapy can be used to treat obsessive fears, while patients explains the true essence of the disease, an adequate understanding of the patient's manifestation of the disease is formed (so that the slightest shifts on the part of the internal organs are not perceived by the signs of a serious illness).

I was always afraid to speak in front of the public. It still started school. After I once forgot the words during the performance, in which I participated, I began to manitally be afraid of any speech, for this I found any causes, if only I did not need to go on the scene.

And now it has been more than 10 years old, I have graduated from the institute, I have a favorite job, I was raised by the head of the department, and now I need to periodically report to leadership before all employees of our numerous firm! But I'm just panicing! What should I do how to cope with excitement?

Antonina, I think you are a strong person and can overcome your fear to speak in front of the public.

Read the book Dale Carnegie "How to produce confidence and influence people, speaking publicly" and follow the recommendations described in it. I think this book will help you overcome your fear and become a good speaker, especially since this skill will be needed in your work.

I never thought that a panic could comprehend me. I am a calm, balanced, fighter in life by nature. Always sought the goals set, almost nothing was afraid.

And now I have a fear of the car. Driving experience is about 5 years. Always drove smoothly, carefully. A month ago, I got into an accident. I myself did not suffer at all, the car needs a little repair, but the problem is that I am now catastrophically afraid to sit behind the wheel, I'm afraid I'm afraid to get into an accident. I literally arises panic, you begin to shake hands, as soon as I sit down behind the wheel, and I can't do anything with it, calm down. What should I do?

Lisa, I know from the experience of some of my friendly drivers, that after you get into an accident, even if you were not driving, fear may arise in front of the car.

What is best to do in this case? You need to believe again in your strength, perhaps a little rush. The best way for this is to use the driving instructor services. When you sit in the car and you will know that a professional is sitting nearby, who will inspect you in any minute, you will be easier to overcome your fear. Well, and the experience you get at the same time, new information (maybe something you did not know or subsided) further contributes to the restoration of faith in itself.

apply such an antidepressant as Anafranil (clomipramine).

Vasily, where did you get? Just only indicated the most common and effective drugs.

Hello! My panic begins (excitement, nausea, heartbeat), when I'm going to the subway, car. It started after I went by car at sea. With all these types of transport, I have any negative. Very hard with it lives, the problem is far from home. Tell me what to do?

Nata, contact a specialist (psychiatrist, psychotherapist).

Good evening. Tell me, please, what happens to me: I recently went to the store and it was bad there because there is a lot of people, I am exactly what I was lost in the crowd, I did not understand what I do there, why I came there, I came It was very scary to go there. And I look at everyone, as if in a dream, and people passing past me as pictures. I quickly came out on the fresh air and it became better for me. Also and on the bus I was bad, at this time it covers the lack of air, the palms sweat and the feeling as if I was about to faint, as if I was going crazy, and it was still scary. In general, lately I am very tense, every rustle, cry of children, light, the loud sounds scares me, I shudder, I seemed to strain from fear, and it gets worse from it. I am standing at a neurologist registered with a diagnosis of epilepsy, but I have no attacks for a very long time. I do not know what happens to me, I am very afraid that my disease will come back to me. Tell me, please, with me.

Good afternoon, a very similar situation, almost one in one, but began after some time after the nervous breakdown and lasts almost a year. Recently, it seems easier. How did you cope with her?

Julia, considering that you suffer epilepsy (even if you didn't even have attacks for a long time), I recommend you to apply for advice to a neurologist or epileptologist. You may need to pursue treatment correction.

Before describing your problem, I will tell a small background. Probably it is important.

Since childhood, I am very impressionable. Attention to the surrounding and compassion never was alien to me. Always loved pets, shot down by a car puppy or kitten, always caused shock, long experiences. I complained and my poultry, which was sent to the soup.

Once at the age of 5-6, I saw in the film the scene of man's decapitation. This picture has fallen in my head for a long time. I wondered how can you be so cruel?

Then, as we agreed, I hurt these fears, explaining that it happens on the roads sometimes and personally I could not influence this, and some pets are specifically crocated to kill and eat. This is a necessity, which if you are not a vegetarian, not avoid. I understood myself and what people are to the impossibility of cruel. It can be said that with age I developed some kind of "thick-water" in order not to take similar phenomena close to the heart. I clarify, I did not cruel, just probably worked as a protective mechanism in order not to torment myself.

Now I am 31 years old, not so long ago I married. Recently looked at the movie "Game of Thrones". Very interesting movie, exciting plot. But scenes of violence using cold weapons - with an excess. All the way in the film will cut, knock their enemies, cut off their heads right and left. It was a little refreshing the children's fears that I wrote above.

Recently, in my life there is a host of many factors causing psychological stress:

My work is connected with people, investigating different conflicts, disputes, crimes, come across often with moral mud. It is not always possible not to miss other people's negative emotions through yourself. In a word, a lot of stress, I became nervous, irritable, too aggressive.

To all, my spouse is pregnant now. The psychological state of pregnant women is very specific. Mood may change hourly. If earlier before pregnancy, her attempt to dominate our pair was taken by me very quickly and without problems, now it's just a catastrophe - any irritation can lead to hysterics, just - she immediately in tears. It is impossible to argue with it now, excessive emotionality, capriciousness is put on the blades any rational arguments. In the sense that I just began to go to conflict, so that my wife's nervousness and predisposition is predisposed for stressing and the child. Care from the conflict without its permission does not remove my psychological stress, there is no outstand, which could be merged negative emotions. That is, if earlier it was possible to strictly say "stop", a serious look to stop barbing, now I can't do this because of the care of the spouse and the child.

Against the background of all these stress factors, I had one very disastrous association - at the peak of the conflict, the scenes of cold weapons were flooded in the mind of the consciousness (different crucial-cutting items). That is, being irritated, angry, I clearly introduced myself as a picture in the movies, that I pinched from hopelessness, closed the opponent with a knife. This association is still strengthened by the fact that somehow once my wife with my wife very much more than ever quarreled on that day when I helped the test to enter the piglet. In the consciousness and postponed the bundle "Conflict -\u003e that is sharp, cutting." If I'm not mistaken, the term "anchor" is used in psychology, when one event in memory is fixed with reference to another.

I first realized this, I was terrible and threw me in cold sweat, Because in fact, no one, and even more so closest, I do not want to hurt pain, suffering, no harm.

I understand that my accumulated psychological fatigue caused by the impact of many stress factors simultaneously led to the fact that at some short moment during the conflict, I flashed a picture, similar to my children's fears, hoped from movies / television, to which I would not have thought of my life without seeing such shocking things on the screen.

The above has led me to an extremely depressed state, depressive state.

Knowing the main reason, I began to take a sedative (Valerian extract and other herbs, Novo-Passitis).

Now about a month I drink sedative and we can say that my mental state almost completely came to balance.

However, I am worried about what, firstly, I'm terribly ashamed first of all before myself, that I, an adult man with a fairly strong self-controlling and will, who never allowed himself to harm anyone and even think about it, allowed him in his mind Such.

Intuition suggests me that we must add more positive emotions into practice.

I will be very grateful for the advice. Thanks a lot in advance!

QW, there are many popular techniques when negative thoughts are splashing into some destructive actions, and it really helps restore the balance, not to do anything bad. For example, people beat dishes, cut some things, clothes. You can even exercise with a boxing pear, trying to throw off the entire accumulated negative during the strikes.

In principle, nothing terrible is that during conflict you imagine something cake or cutting, no. You understand that you will not do anything in real life, you do not want anyone, but the fact that you are able to experience anger, rage are normal human feelings, which no one is insured.

We look for yourself the way to "spill" the accumulated negative - suitable anything, the main thing is that bad thoughts and emotions are not accumulated and did not destroy you from the inside.

When I was 40 years old, an event happened - the strange death of my friend, quite a healthy woman. After 5-6 days, in the weekend, I flew in the garden, I got a coffee and decided to do a little fishering. But suddenly felt bad. I endured a couple of hours, I thought it would pass, and then called an ambulance, and the doctors discovered the pressure of 170/100. Five years have treated pressure, but with him a fear of death appeared. There were practically no preparations for hypertensive results, and panic attacks were only participating.

He turned into the separation of neurosis. Two weeks from shock doses - as in a dream .... Then he was discharged with the prescription to drink Anafranil. Two years, it significantly reduced the frequency and duration of panic attacks. But then cases frequent and of course were accompanied by high testimony Pressure. I do not know what was primary? Pressure or attack? Slowly learned to live with it.

Now, after several stays in the neurosis department, the doctors stopped at a dose of 150 mg serochel per day in two receptions: 100 for the night and 50 during the day. Of the antidepressants, the most acting was the adepless. The rest (pyrazidol, amitriptyline, Oleval) something or do not work, or even worse. Fears: spaces, appearance at unfamiliar people, performances, even a toast to say a problem. At home I'm afraid to argue with my wife, children, guests, not provoking the attack. Inside, of course, the feeling of injustice remains.

In short, life is not happy at all. And I just 55. I look at other people deprived of this disease, they are like the heroes of aliens for me.

And I want to live like they.

Help me please!? Can medical preparations some? With his precinct afraid to speak this topic. Suddenly he and serochel will cancel?

Igor, you need to simultaneously treat both panic attacks and hypertension. I can not recommend any drugs, because at first it is necessary to carry out a full examination, evaluate the patient's condition (and not only complaints), and only after that you can make some conclusions, pick up treatment.

What else can I advise in your case - to turn to a psychotherapist (just first to find out the specialists about it, try to find out reviews).

With panic attacks, the maximum result gives a combination of medication treatment with psychotherapy. After all, it is necessary not only with the help of drugs to eliminate the available symptoms, but also change your view on problem situations.

For the past few years, I have panic fear attacks, horrors dreaming even in a dream. I can wake up as if paralyzed and scary to open my eyes. Sometimes I catch myself thinking that I think about how I would save someone from loved ones or myself, how funny it would not sound, from fire / robbery and it becomes scary, it's as if uncontrollable thoughts, I don't want to think about bad, and it automatically. And it still happens that I imagine, involuntarily, which looks out, for example, in the window and fall.

Also, I have a very bad dream, at night I do not sleep at all, I fall asleep in the morning and even if I sleep for a long time and firmly, as if I didn't get enough sleep. I tried not to sleep for a few days, then fall asleep, but the next day everything is repeated again. You know, if I won a million, I would not think how to spend it cool, but how to get rid of it, as from a potential threat.

Phobic disorders

Phobic disorder (phobia) - sudden intensive fear, steadily emerging due to certain objects, actions or situations. Combined with avoiding frightening situations and anxiety waiting. Light forms of phobias are widespread, but the diagnosis of "phobic disorder" is established only when the fear limits the patient and negatively affects the various parties of his life: personal relationships, social activity, professional implementation. The diagnosis is carried out on the basis of anamnesis. Treatment - psychotherapy, pharmacotherapy.

Phobic disorders

Fobic disorders - intensive unreasonable fear that occurs when contacting certain objects, in contact with specific situations or the need to make certain actions. At the same time, patients with phobic disorder retain the critical perception of reality and aware of the unreasonableness of their own fears. The exact amount of phobias is unknown, however, there are lists in which more than 300 species of this disorder are indicated. Phobic disorders are widespread. A single panic attack associated with getting into the phobic situation is experiencing every tenth resident of the Earth.

Clinically significant phobic disorders are detected from about 1% of the population, but the degree of their influence on the life of patients can differ significantly depending on the type and severity of phobias, as well as on the likelihood of contact with the object of fear. Women suffer from phobic disorders twice as many men. Typically, phobias arise aged section, the manifestation over the age of 40 is extremely rare. Treatment of this pathology is carried out by specialists in the field of psychotherapy, psychiatry and clinical psychology.

Causes of phobic disorders

The exact cause of the development of phobias is not installed. There are several concepts explaining the occurrence of this disorder. From a biological point of view, phobic disorders are provoked by the hereditary conditioned or acquired impaired balance of certain substances in the brain. It has been established that people suffering from phobic disorders, there is an increase in the level of catecholamines, the blockade of receptors regulating the metabolism of the GABA, excessive stimulation of beta-adrenergic receptors and some other disorders.

Psychoanalytics view phobic disorder as a protective mechanism of the psyche that allows you to control the level of hidden anxiety and symbolically reflects certain tabulated patient presentations. An object that causes an alarm, but not amenable to control, together with the sense of anxiety, displaces the unconscious and is transferred to another object, something resembling the first that provokes the development of phobic disorder. For example, anxiety, with a sense of hopelessness of his own position in relations with other people, is transformed into fear of closed spaces (claustrophobia).

Specialists in the field of behavioral therapy believe that phobic disorder is the result of the fastening of the patient's irreversible reaction. Once, having experienced a panic in some situation, the patient connects its condition with a specific object, and subsequently this object becomes an incentive provoking the panic reaction. It follows from this that to eliminate phobic disorder it is necessary to "make it possible", to develop a new reaction to the usual stimulus.

Sometimes adults broadcast their fears to children. For example, if the child sees how mom is frightened by spiders, in the subsequent he can also form arachnophobia. If parents constantly tell the child that dogs are dangerous, and require that he keeps away from them, the child increases the likelihood of a film fob. In some patients, there is a clear relationship of phobic disorder with acute mental injuries. For example, claustrophobia can develop after staying in a closed overgrown car or under the rubble arising from an earthquake or production catastrophe.

Classification of phobic disorders

Three groups of phobic disorders are distinguished: sociophobia, agoraphobia and specific (simple) phobias. Psychologists and psychotherapists have several hundreds of simple phobias, including, as well-known - claustrophobia (fear of closed spaces) or Aerofobia (fear of flying on airplanes), and fairly exotic for most people Arctophobia (fear of teddy toys), tetrafobia (fear of the number Four) or megalofobia (fear of large items).

Agorafobia - a phobic disorder manifested by fear to be in a place or situation, of which it is impossible to immediately leave or in which it is impossible to immediately receive assistance in the event of an intensive alarm. Patients suffering from this phobic disorder can avoid areas, wide streets, crowded shopping centers, public transport, theaters, train stations, educational audiences and other similar places. The severity of phobia can differ significantly. Some patients retain performance and behave quite active lifestyle, other phobic disorder expressed so vividly that patients cease to leave the house.

Sociophobia is a phobic disorder, characterized by severe alarm and fear when entering certain social situations. Anxiety and fear are developing in connection with concerns to experience humiliation without justifying the expectations of others, demonstrate to other people their weakness and insolvency through a shiver, redness of the face, nausea and other physiological reactions. Patients with this phobic disorder may be afraid to speak publicly, to use public baths, take food along with other people, etc.

Specific phobias are phobic disorders that are manifested by fear when colliding with a specific object or situation. The most common disorders of this group are acrofobia (height fear), zoophobia (animal fear), claustrophobia (fear of closed spaces), airfoot (fear of flying on airplanes), hemophobia (blood fear), tripanophobia (fear of pain). The influence of phobic disorder on the patient's life is determined not only by the severity of fear, but also by the probability of a collision with the object of phobia, for example, for the citizen of the Ostrodophobia (fear of snakes) is practically insignificant, and for a rural resident can represent a serious problem.

Symptoms of phobic disorders

The general symptoms of phobic disorders are intense acute fear when colliding with a phobia object, avoiding, anxiety of expectations and awareness of the irrationality of their own fear. Fear of contact with the object provokes some narrowing of consciousness and is usually accompanied by stormy vegetative reactions. The patient with phobic disorder is fully focused on a frightening object, to some extent ceases to track the environment and partially loses control over its own behavior. Possible breathing, increased sweating, dizziness, weakness in the legs, heartbeat and other vegetative symptoms.

The first collisions with the object of phobic disorder provoke a panic attack. Subsequent fear is aggravated, depletes the patient, prevents its normal existence. In the desire to eliminate the unpleasant feeling and make life more acceptable patient with phobic disorder begins to avoid frightening situations. Subsequently, the avoidance is fixed and becomes familiar to the patrol. Panic attacks stop, but the reason for their termination is not the disappearance of phobic disorder, but the lack of contact with the object.

Expected anxiety is manifested by fear when presenting a frightening object or awareness of the need to get into a contact situation with this object. Erased vegetative reactions arise, thoughts about intolerance to such a situation appear; The patient suffering from phobic disorder is planning to prevent contact. For example, a large shopping center for example, a major shopping center displays alternative options (visiting small shops selling similar goods), a patient with claustrophobia before a visit to the office located on the upper floors of the building, will find out if there are stairs in this building that can be used instead elevator, etc.

Patients with phobic disorders are aware of the irrationality of their own fears, but the usual rational arguments (their surrounding) do not affect the perception of a frightening facility or situation. Some patients who were forced to regularly stay in frightening situations, begin to take alcoholic or sedatives. With phobic disorders, the risk of developing alcoholism, dependence on tranquilizers and other drugs increases. Expanding fear, restrictions in social, professional and personal life often provoke depression. In addition, phobic disorders are often combined with generalized anxiety disorder and obsessive-compulsive disorder.

Diagnosis and treatment of phobic disorders

The diagnosis is established on the basis of anamnesis, clarified from the patient's words. In the process of diagnosing phobic disorders, the king scale is used for self-assessment, the alarm scale and Bek depression and other psychodiagnostic techniques. When diagnosing, DSM-4 criteria are taken into account. Tactics of treatment is determined individually taking into account the species, duration and severity of phobic disorder, the presence of concomitant disorders, the psychological state of the patient and its readiness for the use of certain methods.

The most effective psychotherapeutic methodology for the treatment of phobic disorders is cognitive-behavioral therapy. In the process of treatment, various techniques are used. Most often system dessensitization is used against the background of deep muscle relaxation. Initially, a psychologist or psychotherapist teaches a patient with phobic disorder with special receptions of relaxation, and then helps him gradually dive into frightening situations. Along with system sensitization, the principle of visibility (observation of other people in the frightening patient situations) and other techniques can be used.

Psychoanalysts believe that phobic disorder is an external symptom, an expression of severe internal conflict. To eliminate phobia, it is necessary to detect and eliminate the conflict lying on it. As a means to identify a problem hiding behind phobic disorder, conversations and analysis of the sick dreams are used. In the process of work, the patient not only detects and works in the internal conflict, but also strengthens its "I", and also gets rid of the usual pathological regression reaction in response to traumatic external influences.

If necessary, cognitive behavioral therapy and psychoanalysis in phobic disorders are carried out against the background of drug treatment with antidepressants and tranquilizers. Medicinal preparations are usually prescribed short courses to avoid addiction. The forecast is determined by the severity of phobic disorder, the presence of concomitant diseases, the level of patient motivation and its readiness for active work. With adequate therapy, in most cases it is possible to achieve improvement or long-term remission.

Alarming-phobic disorders - This group of disorders is associated with psychological reasons and external factors (it is necessary to take into account the relative nature of the psychotrauma).

Etiology and pathogenesisPsychotraming stimuli, information on family or love troubles, the loss of loved ones, the collapse of hopes, official troubles, the upcoming punishment for the offense, the threat of life, health or well-being. A stimulus can be a single hyphenous - while we are talking about acute mental injury, or a repeated weak irritant - in this case, they talk about chronic mental injury or a psychotrauming situation. The importance of information for this individual determines the degree of its pathogenicity. Weakening nervous system of disease - cranial and brain injuries, infections, intoxication, diseases of internal organs and glands internal secretion, as well as long-term lack of sleep, overwork, nutritional impairment and long-term emotional stress - all these factors predispose to the emergence of psychogenic diseases.

Anxiety - Emotional experience characterized by discomfort from the uncertainty of perspective and having a certain biological meaning: mobilizing the resources of the body, providing behavior in extreme states.

Separate anxiety options:
adaptive
pathological

The evolutionary value of anxiety is to mobilize the body in extreme situations. A certain level of anxiety is necessary for normal vital activity and human productivity. Normal alarmit helps to adapt to different situations, it increases in the conditions of high subjective importance of choice, external threat, with lack of information and time. Pathological anxietyAlthough it can be provoked by external circumstances, due to internal psychological and physiological causes. It is disproportionately a real threat or not related to it, and most importantly - is not adequate to the significance of the situation and dramatically reduces productivity and adaptation capabilities.

Anxiety is:
Situational and endogenic
Top or continuous
Most often short-term

When it becomes so pronounced that it begins to interfere with life, the diagnosis is made - anxiety disorder.

Clinical symptoms of alarming disorders are divided into:
general - include mental and vegetative features with the characteristic polysystem of somatic violations
specific - determine the specific type of alarming disorder, which is inherent in a complex psychopathological structure, including:
- parole manifestations
- Permanent manifestations

Parcel anxietyit is characterized by a packaging attack, which represents a clearly discharged episode of strong fear or discomfort, as a result of which they dramatically occur and reaches maximum severity for 10-20 minutes four (or more) symptoms of the following:

vegetative symptoms:
Reinforced or rapid heartbeat or pulse
sweating
feeling of lack of air or stuffiness
Safety of suffocation
Pain or discomfort in the chest
Nausea or gastrointestinal disorders
Feeling of dizziness, instability, approaching fainting
Paresthesia (feelings of numbness or tingling)
Outbreaks or heat stuff

cognitive symptoms:
Derealization or depersonalization
Fear of loss of control or fear of going crazy
fear of death

motor symptoms:
tremor or inner trembling

Anxiety disorder is diagnosedWhen many of the specific symptoms of anxiety are expressed simultaneously for at least a few weeks (constantly or periodically) and to such an extent that it prevents the normal functioning of the individual (this encourages the attending physician or the patient himself to consult a specialist).

Generally accepted diagnostic criteria for alarming disorders are contained in DSM-IV and ICD-10. These criteria are divided into:
quality - a description of typical symptoms
quantitative - how many of these symptoms should be at the same time being attended how often they should occur and how long to last for diagnosis

Depending on the compliance with these criteria, it is possible to state the fact that in the patient or subclinical alarmeither anxiety disorder.

Subclinical anxiety

In the most part of the patients who appeal to the general practitioner, insufficiently manifestations of specific symptoms for the diagnosis of any disturbing disorder, the main signs of the disease are represented by non-specific vegetative symptoms, which deactivate psychogenic manifestations. Recent epidemiological studies have shown a high prevalence in the population of patients with subclinical (sub-step) disturbing disorders. Subclinical anxiety- Two disturbing symptoms and more present at the same age at the individual for at least 2 weeks and leading to social disadaptation. The basis of the disease is non-specific polysystem vegetative violations with a tendency to rapid variability in the nature and intensity of manifestations, mainly related to the increase in sympathetic tone.

Patients most often make complaints:
Increased fatigue
weakness
Tension
Increased irritability
Difficulties in focusing and switching attention
Motor voltage - fussiness, headaches, tremor, inability to relax
Disorders of the Sleep-Wake Cycle
anxiety
excitement
Alarm expectations
Periodic seizures of heartbeat
Difficulty breathing
Nausea
chills
Intestinal disorders

In case of inspection, these patients may detect dryness skin Pokrov, Hyperhydrosis of palms and stop, enhance arterial pressure.

Classification

According to the ICD-10, alarming disorders are divided into:

Anxious-phobic
agoraphobia
social phobia
Specific phobia
Other alarm disorders
Panic disorder
Generalized anxiety disorder (GTR)
Mixed anxious-depressive disorder
obsessive-compulsive disorders
Heavy Stress Reactions
Adaptation disorders (where post-traumatic stress disorder is included)

Alarm-phobic disorders F40

Etiology: anxious-phobic disorders arise on a special psycho-drug constitutional soil, which is characterized by imperidity, anxiety, emotionality, shyness, timidity. Beginning by type of conditional reflex. Initially, fear occurs if there is a pathogenic situation, then when memories and, finally, fills all thinking, turning into obsession. Clinic: manifest themselves to specific obsessive fear and anxiety arising in a certain situation accompanied by vegetative dysfunction. As a result, these situations or objects are avoiding or transferred with a sense of fear. Old authors called this group of diseases "garden of Greek roots" with a prefix - phobia, for example, claustrophobia, misophobia, agoraphobia. The behavior of patients is appropriate. Fear with phobias is conditional - that is, it appears only under certain conditions and outside these conditions does not occur. Differential diagnosis: It should be differentiated with obsessions (pineapple), which develop on other constitutional soil (pedantry, jam, decency, rigidity), as well as organic disordersaccompanied by anxiety - cardiovascular, pulmonary, neurological, endocrine, intoxication, abstitients.

Agorafobia F40.0.

Fear of open spaces, crowds and inability to return to a safe place, the fear of losing consciousness in a crowded place, the lack of immediate access to the exit. There is psychogenically in people with a fairly developed imagination, more often in women. Manifestations may precede depressive episodes. Began how the fear of open spaces, the symptoms is enriched with the fear of the crowd, the inability to immediately return to a safe place (home), fear of traveling one in transport. As a result, patients are adadapped and become chained to the house. The lack of immediate access to the exit sharply enhances fear. The flow of wave-like, tends to chronic. If there is an attempt to dramatically leave the occurrence of fear, the diagnosis of agoraphobia with panic disorder is made. It should be differentiated with a depressive episode, if the phobia appeared by the appearance of a discrepancy.

Social phobia F40.1.

Fear to experience attention from the surrounding - public speeches is combined with reduced self-esteem and fear of criticism. In premorbide, strict estimated education in childhood, the lack of encouragement from parents, forming a low level of self-assessment. The desire by any ways to conquer interest and recognize others. Beginning more often in adolescence from fear of response at the blackboard or at any other evaluation situation fixing reflexively. Social phobias can be isolated and consisted in the specific nature of fear - with public speeches, food, meetings with the opposite sex. If phobic experiences apply to all situations outside the family circle, they talk about the diffuse nature of the social phobia. Patients complain of redness of the face, the feeling of coma in the throat, heartbeat, dry mouth, weakness in the legs, the impossibility of focusing on action. The emerging avoidance of critical situations leads to partial or complete social isolation.

Specific (isolated) phobia F40.2

Phobia, limited strictly defined situations and not emerging out. Develop in childhood or adolescence. The launcher is isolated. Fear of animals, heights, closed spaces, exams, thunderstorms, darkness, flights in airplanes, urination and defecation in public toilets, receiving certain foods, treatment from a dental doctor, blood type or damage, fear of sick of a certain disease.

Other alarm disorders F41

The manifestations of anxiety are combined with other symptoms and are not limited to a special situation. Phobic or obsessive elements may be present, but they are secondary and less severe.

Panic disorder (episodic paroxysmal alarm) F41.0

See: Article "Panic Disorder" in the section "Neurology and Neurosurgery" medical portal website

Generalized alarming disorder (GTR) F41.1

Etiology: Chronic stress, more often found in women. There is a non-fixed, persistent anxiety, a complaint against nervousness, trembling, muscle tension, sweating, dizziness and discomfort in the epigastric area. The generalized and persistent nature is not limited to the surrounding situation and the situation. Fears that the patient or his relatives will soon get sick or with them an accident will occur, as well as other unrest and bad premonitions. Currently waved with a tendency to chronification. The main feature of the GTR (the most frequent from mental disorders) is anxiety, which is generalized and persistent, is not limited to any specific circumstances and does not even arise with an obvious preferred in these circumstances (that is, it is "non-fixed").

For diagnosis, primary alarm symptoms should be present in the patient for at least a few weeks. Most often in this capacity are:
Concerns - concern about future failures, feeling of excitement, difficulties in concentration, etc.
Motor voltage - fussiness, headaches of stress, shivering, inability to relax
Vegetative hyperactivity - sweating, tachycardia or tachipne, epigastric discomfort, dizziness, dry mouth, etc.

Clinical and epidemiological studies have shown high conjugacy of the GTR with such somatic diseases as allergic, bronchial asthma, lumbalgia, migraine, metabolic diseases, gastrointestinal tract.

Ossessive-compulsive frustration F42

Obsessive thoughts and (or) actions. In French (P. Janet) and the domestic literature - psychos, in German - pineapple, in the Anglo-Saxon - obsessive-compulsive disorder. Play the role of biological (injury in childbirth, changes in EEG), genetic (frequency of pathology in the nearest relatives - 3-7% compared with 0.5% with other types of alarming disorders), psychogenic factors (violation of normal growth and development related to Anal sadistic phase). Complaints for repeating painful obsessive thoughts, images or deductions that are perceived as meaningless, which in stereotypical form again and again come to the patient's mind and cause an unsuccessful attempt to resist. Combulsive actions or rituals are repeated again and again stereotypical actions, the meaning of which is to prevent any objectively unlikely events. The obsessions and compulsices are experienced as alien, absurd and irrational. The patient suffers from them and resists. The most commonly obsessive fear of pollution (mizophobia), obsessive doubts accompanied by compulsive inspections, and obsessive slowness, in which the obsessions and compulsices are combined and the patient very slowly performs everyday affairs.

Mainly obsessive thoughts or reflections (mental chewing) F42.0

Subjectively unpleasant, useless ideas, fears, images, philosophical arguments on anxisutive alternatives that do not lead to decisions. Impringly compulsive actions (obsessive rituals) F42.1 obsessive actions relating to continuous control over the prevention of a potentially dangerous situation or in order and accuracy. At the heart - fear (for example, fear of pollution, leading to the obsessive wash of the hands). Combulsive ritual actions can occupy a daily clock per day and are combined with indecisiveness and slowness. It is often combined to equally violation of both thinking and behavior, in which case mixed obsessive thoughts and actions are diagnosed (F44.2).

Reaction to heavy stress and adaptation violations F43

Disorders arising from an extremely strong stress of a life event or a significant change in life leading to continuously continuing unpleasant circumstances, resulting in an adaptation disorder. An important point is the relative nature of the psychotrauma (that is, individual, often a special vulnerability).

Acute reaction to stress F43.0

Ethiology: strong traumatic experience (natural disaster, accident, rape, loss of loved ones). Clinic: Stunning with a narrowing of consciousness, decline in attention, inadequate reaction to external incentives, disorientation. In the future, care from the situation is up to a dissociative stupor or assessment and hyperactivity (escape or fugance reaction). Usually passes within hours or days. The risk of developing the disease increases with physical exhaustion or in the elderly.

Post-traumatic stress disorder F43.1

Developing in persons who experienced emotional or physical stress (fighting, disaster, attacks of bandits, rape, fire in the house). Clinic: Experitance of injury again and again (in a dream, thoughts and awake), emotional deafness to all other experiences in life, including relations with other people, concomitant symptoms in the form of vegetative lability, depression and cognitive violations. Mental discharge is expressed in care of social activity, loss of interest in everyday activity and decrease the ability to experience emotions. Excessive excitement leads to difficulties of falling asleep, nightmares and high gravity. The type of disturbing disorder and the degree of its severity varies widely from various patients. Often the symptoms of various mental disorders are combined with each other and with other diseases. Angedonia develops. Heavier stress tolerate children and old people. Duration of disorder more than 1 month.

Adaptation disorders F43.2.

Disorder that prevents social functioning and productivity that occurs during the adaptation period to a significant change in life or stress (loss of loved ones, the experience of separation, migration, refugee position). Beginning - within a month after a stressful event, duration - up to 6 months. Etiology: The impact of the stress factor against the background of individual predisposition or vulnerability. Clinic: Depression, anxiety, anxiety, inability to cope, plan or continue to remain in a situation, reducing productivity in everyday affairs. Adolescents may have aggressive or dissocial behavior.

Corsacksi syndrome it is the unity of productive and negative disorders, so assigning it to a group of positive psychopathological syndromes to a certain extent conditionally.

Leading symptoms - Anterograd amnesia in the form of the impossibility of reproducing current events with sufficient safety of memories of the facts preceding the beginning of the disease, paramnezia (pseudo-resection and replacement rates), gross non-microticity to all manifestations of the disease (anosognosia). The inability to reproduce current events is either a consequence of disruption of memorization, fixation, or the result of a preemptive memory violation, Ecuchory.

Mandatory symptoms - amnesic disorientation in time, place of surrounding persons with the inability to remember their names and function; A variety of affective (confusion, anxiety, aggravation, carelessness, emotional lability) and motor disorders (hypodynamia, fussiness). A clinical feature in the Corsakov syndrome, which distinguishes him from dementia is to preserve sufficient situational intelligence. The latter is detected only when objects and phenomena requiring comprehension are in front of the eyes of the patient, in the sphere of its immediate perception. Thinking of patients is unproductive due to the surface and narrowness of judgments and conclusions based on old, mainly routine ideas and concepts. The speech of their template consists of stereotypical phrases and revolutions, monotonne, is not connected with the internal need, but with external impressions. With the first contact, the patient may even seem witty and resourceful, but the verification of its statements are stereotypical speech patterns. Depending on the characteristics of the structure and the flow of Korsakovsky syndrome, two forms are distinguished:

Regressing Corsakovsky syndrome.An important feature is a gradual decrease in the severity of amnesia. The patient begins to memorize the current events in the increasing volume. At the same time, it begins to remember some facts and events that previously could not remember and reproduce. This suggests that under this form of syndrome, the presenter is an ethiff disorder, fixation is to a lesser extent.

Stationary form of Korsakovsky syndrome.A distinctive feature is the preservation of amnesia of the same degree of severity with a tendency to compensate for remote stages of the flow. The manifestation of compensation is to compile various reminders, maintaining record books, etc., operating by side associations, working out and using some mnemonic techniques. In this form, the fixation function (fixation amnesia) is predominantly suffering.

Korsakovsky syndrome is the most important clinical component of alcohol Corsakovsky polynelectric psychosis.

12 Depersonalization and Derevalization syndrome. Clinical options.: Clinic: Violated self-awareness of the psychic or physician; painfully nonsense (delusional denso) is a confusion

Violations of perception of space and time: dejavu; Zhamiev; Derealization and depersonalization.

Derealization - Alienation of the peace of perception (Jaspers), the disorder of perception of the surrounding reality is the feeling of lowland, alienity, unnaturalness, the unreality of the surrounding + patient is difficult to determine how everything has changed ("as if", "as it were," "like", "through the glass", "The sounds are muted, as if the ears are shredded by cotton"). Several / one analyzer is involved (not m. The variety of taste) + can concern the space of relationships (everything is moving somewhere) ratio (everything is very slow). With a pronounced step. disappears. h-in reality.

Relationships Yavl-I:dejavu + Jamaisvu + already experienced, tested - occurs both in healthy, the cat-x Dereal can manifest itself in the form of an inverted-familiar area of \u200b\u200b180 degrees. (Do not know which way to go) + often combines with deputy people.

Depersonalization har-Xia alienation of his thoughts, affects, actions, their "me", body / parts, which is perceived by the side.

Vital - I do not exist,

Somatopsychic : Sonvostiy body schemes, without changing the proportions of the body and its parts (ch-in alien to the whole body, parts - "not mine");

Outopsychiatric: the feeling of alien psychos. Forms (I see, I'm not hearing) + alien to the speech, changing your own "me", the disappearance of the person - the meeting in Sztzfren - Dilirizatsa-DEMERSON-th Syndr., (Multi-section, propriceps-x, signals inside organs, joint, ligaments ).

13 obsessive-phobic syndrome. Structure. Clinical and social importance.

Obsessive fears; nosophobia; Sociophobia; contrasting fears of phobias and rituals

Syndromes of obsessions

The obsessions syndromes usually occur against asthenia and are found in two main versions: obsessive and phobic.

Obsessive syndrome. The leading and major symptoms are obsessive doubts, the score, memories, contrast and abstract thoughts, "mental gum", attractions and motor rituals. Additional includes the painful states of mental discomfort, emotional stress, powerlessness and helplessness of their overcoming.

In an isolated form (without phobias), the syndrome is found in psychopathy, organic brain diseases, sluggish schizophrenia.

Phobic syndrome. The leading and main symptom of it is the diverse obsessive fears. The syndrome debuts, as a rule, an undifferentiated fear. Then there are and gradually grow emotional stress and mental discomfort. Against this background, the fear (phobia), covering the patient under certain conditions or with mental experiences, is acute. Initially, monophobia arises, which usually turns over time with other, close and connected content. For example, agarofobia is joined to cardiophobia, the fear of transporting transport, claustrophobia, tanatophobia, etc. The exception is sociophobia, which usually retain isolated character.

Nozophobia are most diverse. Most often there are cardiophobia, carcurtobia, alienophobia, etc. These phobias are usually introduced into the consciousness of patients, despite the obvious absurdity, and continue to exist, contrary to all attempts to get rid of them. Quickly join rituals giving patients some short-term relief and removing mental discomfort.

Phobic syndrome occurs with all the forms of neurosis, but is most fully represented in the neurosis of obsessive states when it is accompanied by emotional depression.

With organic diseases of the brain, phobias first act as obsessions, taking the nature of violence. In case of schizophrenia, the phobia is acquired by a systematic nature, the content of them becomes extremely distracted, the first, second, and so paragraphs are formed by the first, second, etc.. Emotional charge (phobias without fear) is powered into them, they become an intellectual is amitated, the struggle component is lost. In the future, they can acquire features or utasive ideas, or motor stereotypes, approaching catatonic symptoms.

Nearness - diseases caused by the impact of psychotrauming factors. Mental injury is usually events threatening the future that generate the uncertainty of the situation requiring the adoption of responsible decisions.

Neurosis - a breakdown of higher nervous activity, they can continue from several days to several years.

The psychogenic nature of the disease is determined by the existence of the relationship between the clinical picture of neurosis, the peculiarities of the system of relations of the patient and pathogenic conflict situation, as well as the specificity of clinical manifestations characterized by the dominance of emotional-affective and somatic disorders.

Neuroses may occur in people with any type of nervous system, but in each case they arise as a result of various intensity and duration of mental injuries. Psychogenic factors leading to neurosis are primarily social factors. For the occurrence of the disease, not only innate typological features of the personality and its condition at the time of the action of mental injury, but also the views, the identity settings arising in the process of its formation, which determine its attitude to one or another events, the ability to criticize the surrounding, allowing Determine the "strategy of behavior" even in a difficult situation, the ability to overcome the vital difficulties, find a way out of the difficult situation.

According to the international statistical classification of diseases and health problems (ICD-10), individual syndromes and even individual symptoms of different forms of neurotic disorders are assigned to neurosis, and even individual symptoms of different forms of neurotic disorders, which differs from the prevailing ideas about neurosis in our country and makes it difficult Nonological diagnosis. Currently; In our country, neurosis is attributed to neurosis, hysteria and neurosis of obsessive states.

The diagnoses of "neurosis", the "asthenic state" are legitimate only when the neurological and somatic diseases of organic nature are eliminated, manifested by neurotic, i.e., in essence, neurotic complaints. The directions of the survey are determined by the extreme variety of symptoms occurring at neurosis.

Neurosis and headache

There is a significant frequency of headaches. They subdivides on pain with the predominant participation of neuromuscular or neuro-vascular mechanisms and without significantly severe neuromuscular and neuro-vascular disorders.

With a headache due to mostly neuromuscular mechanisms, patients complain about "external pressure", tightening or tension, as well as paresthesia, skin soreness in the head area. For the headache of neuro-vascular genesis, a constant sensation of ripples in the head is characterized, which is sharply enhanced with the exacerbation of the conflict situation.

The neurotic headache is usually moderate, without a certain localization and most often occurs during antipathy to the work performed or in conditions of concentration of attention during a significant work.

In neurosis, cardiivalgia and heart rate disorders. Cardialgias are not stopped by antispasmodics; They are often combined with cardiophobia and death fear. Relatively rare respiratory disorders in the form of freight and slowing, surface and deep breathing, the sensation of the lack of air, the rapid transition from the inhalation to exhalation, etc. In neurosis, there are three respiratory disorder syndrome: a violation of the respiratory rhythm, laryngospasm and neurotic oscota. In neurosis, gastrointestinal disorders (esophagus spasm, anorexia, belching, jeeping, vomiting, gastralgia, intestinal crises, etc.).

Sexual disorders in neurosis in men can manifest themselves in the form of disorders of erection and ejaculation (weakening or absence), reduction of sexual waste, orgasm changes (with the preserved ejaculation), and in women - a decrease in sexual entry, unpleasant sensations with orgasm, anorgazmia.

Neurosis and breaking sleep

Almost all patients with neurosis disturbed sleep. The main types of neurotic sleep disorders are disappearance (press disorders), a shallow sleep with awakening, shortened sleep due to early awakening and dissismark.

Fallup disorders are three types.

The 1st type is the lack of desire to sleep or repeating short-term drowsiness, a dormant state, quickly interrupted by long-time awake with disturbing thoughts and ideas.

The 2nd type - the patient relatively quickly falls asleep, but after 5-10 minutes it wakes up and in the subsequent can not fall asleep; Newly painfully experiencing a conflict situation.

3rd type - normal or increased drowsiness accompanied by increased sensitivity To external, especially sound stimuli.

A shallow awakening sleep is characterized by unpleasant, sometimes nightmarish dreams interrupting the dream and causing a state of anxiety and fear, as a result of which the patient cannot sleep again. Sometimes sleep is interrupted without visible reasons. A shortened sleep is characterized by a sudden awakening between the 4-6th hours of sleep, then the patient flows into a radiant state, but again wakes up. In other cases, sleep is interrupted in the same clock, and in the future there is a dormant state, turning 30-40 minutes to normal awakening in a normal sleep.

Disssony is characterized by a sleep of sufficient duration and satisfactory depth, but not giving the feeling of rest; Sick after awakening complain of lethargy, a breaking, heaviness in the head.

In terms of frequency, the specified sleep disorders are distributed in the following order (descending frequency): sleeping, dissensity, shallow dust with awakening and sleep, shorten due to early awakening.

In contrast to described above disorders of neurotic genesis during encephalitis, insomnia is monotonous, monotonous and very stubborn character. Impaired emotional components of the initial and final stages of sleep; Dissemary sharply expressed. In organic diseases, the combination of insomnia at night with drowsiness during the day; Sleep disorders in organic diseases are extremely resistant to therapy.

Almost all patients with neurosis are observed. vegetative disorders According to sympathetic or Vagotonia or combinations, the predominance of tone is more often a sympathetic nervous system.

Sympathetic and adrenal and vaginswasular crises, often observed in patients with neurosis, are usually due to organic changes in the hypothalamic (current process or its residual phenomena) of the region or endocrine system. Neurotic symptoms detected during criesubles are a reaction to crises. The most characteristic of neurosis syndromes: asthenic, obsessic, phobic, hypochondriac and neurotic depression syndrome.

Differential diagnosis of clinical syndromes observed in neurosis

Most often, neuroses are manifested by the following syndromes: astehenic, obsessive, phobic, hypochondriac and neurotic depression syndrome.

Asthenic syndrome includes actually asthenia, vegetative violations and sleep disorders. Asthenium actually is characterized by increased fatigue, a decrease in working capacity, worsening memory and attention. These violations are usually accompanied by increased excitability, irritability, emotional instability and mood lability, which inadequately increases with insignificant success and deteriorates sharply at the slightest failure. Emotional reactions are inadequate than the power of an irritant.

It is also characteristic of impatience and bad wait tolerance.

Vegetative disorders are manifested by the pulse lability and blood pressure, headache, common and distal hyperhydrous, resistant dermographic reactions, and others. Sleep disorders are expressed in difficulty falling asleep, surfaceness and intermittentness of sleep, sometimes with nightmarish dreams.

Asthenic syndrome is manifested in hypersthenic, hypoconatic forms, as well as irritable weakness. For hypersthenic forms, elevated irritability is characterized, incontinence, impatience, as well as increased activity that does not lead to success due to a sharp distractibility, unmotivated switching from one type of activity to another, each of which is unfinished. Frequently weak and tear. In case of hypoxium, there is a decrease in performance, a sense of constant fatigue, lethargy and drowsiness, loss of interest in the surrounding. Irritable weakness It consists in increased excitability in combination with weakness, increased depletion, fast transitions from hyperstitution to the hypostility, i.e. from excessive activity to apathy. Asthenic syndrome is most characteristic for neurasthenia and asthenic states of various genes.

Ossessional syndrome

Obsessional syndrome is a violation of the intellectual sphere, which manifests itself with the sudden appearance of thoughts, ideas and other phenomena, not currently related to the state of consciousness and therefore perceived patients as alien, emotionally unpleasant, but with the understanding that all this is his own, and not imposed from outside. The obsessive syndrome occurs under clear consciousness and saved criticism; It distinguishes him from Brad. This syndrome is accompanied by obsessive doubts with constant uncertainty in the correctness and completion of various actions and the desire to recheck their execution; an obsessive account, playback in the memory of names, surnames, dates; by the obsessive memory of the psychotrambulating situation, which led to the neurotic breakdown; obsessive movements or actions, etc.

Phobic syndrome

Phobic syndrome is a violation of the emotional sphere, characterized by the obsessive experience of fear with a clear plot, exacerbating in certain situations, but if there is enough criticism of the patient to its state.

Phobias have a bright, figurative, sensual character, are extremely extremely tolerated by patients due to often unsuccessful struggle with them. With sharp bidding of fear, patients can consider the danger that experienced is quite real.

In neurons, it is most often found cardiophobia, carcurtobia, Lisopobius (obsessive fear of madness), agoraphobia (obsessive fear of squares, wide streets), claustrophobia (fear of closed rooms), gypsophobia (height fear), fear of space and movement in it, erethobia (fear of redness ), sociophobia (fear of a public speech), fear due to the impossibility of swallowing food in the presence of outsiders, the fear of vomiting in society, nosophobia (obsessive fear for their heart, fear of madness, fear of cancer), obsessive-compulsive (obsessive fear of pollution or The combination of fear of pollution and infection; the obsessive fear of injury to their children) and other phobias (fear of snakes, ghosts, houses, etc.). Phobias are found various forms neuroses, but they are the most bright in the neurosis of obsessive states.

Hypochondriac syndrome

Hypochondriac syndrome is found with many neuropsychiatric diseases and with all the forms of neurosis. For hypochondria, excessive fear of their health is characterized, focusing on it and the tendency to attribute themselves missing diseases. In neurosis, the hypochondriac syndrome is manifested by persistent complaints about unusual painful sensations in various parts of the body, often combined with a decrease in mood, anxiety and fear fixed, dominant, obsessive or utasive ideas.

In neurosis, combined with topical organic lesions of the brain or its residual phenomena (especially diancephal localization), the syndrome acquires the character of the senthenetopathic-ipochondria. Sennestopathy is manifested in the form of paresthesia and other unusual sensations - tightening the entire body, passing the current through it, etc.

Neurotic depression syndrome

The neurotic depression syndrome reflects the psychotrauming situation; Frequently combined with other neurotic symptoms. The background of mood is reduced, but the feelings of longing does not happen. The reduced mood is usually combined with severe emotional lability, often with asthenia, alarm, worsening appetite and insomnia. The mood oscillations during the day with neurotic depression are usually not so pronounced, as with endogenous depression, it is easier to treat than endogenous. Mental and motor intensity, self-evaluation ideas, suicide trends are not typical. The neurotic depression is differentiated from the reactive, also due to psychotrauming factors. IN clinical picture The latter also has a "psychological understanding of experiences". However, with reactive depression, symptoms reaches the degree of reactive psychosis - affect reaches the degree of longing, the depression is observed, inhibition or motor arousal. Consciousness is narrowed, self-evidence and suicidal thoughts appear.

Differentiation of psychotic depression from neurotic is based on significant differences in symptoms.

With a psychotic depression, the most pathognomonic symptom is the desire to die. In addition, there is a rough disorganization of the individual with a separation from the real world, often the sudden occurrence of a psychotic state, anosognosia, delusional ideas of self-esteem and guilt, manic episodes in an anamnesis. For psychotic depression, the positive effect of the use of ashidepressants and recurrent flow is characterized.

For neurotic depression, the safety of the basic personal qualities is characteristic; the psychologically understandable emergence and awareness of the painful state; The presence in the clinical picture of phobias of obsessive, sometimes severe hysterical manifestations.

Neuroses of obsessive states

The neurosis of obsessive states is characterized by the fact that the clinical picture is exhausted by phobias and obsessions (obsessions). The obsessive symptoms are the cause of decompensation.

Consciousness is not changed, the criticism of its state is preserved, patients are able to deal with obsession to a certain extent. Even during the deterioration of the state, patients try to hide the obsessions, are quite active, assembled. With the neurosis of obsessive states, various phobias are most frequent.

Less often obsessive thoughts, fears, memories, doubts, movements and actions; Patients appreciate them as a manifestation of the disease belong to them critically. The obsessions and phobias may occur in the same patient in various combinations.

In addition to them, there are accompanying neurotic symptoms in the form of increased irritability, fatigue, reduction of the concentration of attention, sleep disorders, deterioration.

Upon the protracted course of the neurosis of obsessive states, the features of anxiety character may appear.

The obsessive thoughts of hypochondriac content may occur in patients with neurasthenia. Their fixation, hypochondriatic processing usually contributes to various unpleasant somatic sensations.

Phobias at neurasthenia are rare.

The obsessions and phobias in neurasthenia are distinguished by nonstopness, significantly less brightness and expressiveness than with the neurosis of obsessive states.

Sometimes obsessions can be observed in hysteria, in this case they are the nature of greater demonstration, emotional saturation, care from difficulties, "escape to illness" than the actual experience of obsessions. Obsessive thoughts in hysteria are rare. Sometimes with it there are obsessive performances in the form of visual and auditory hallucinations, as well as various fixed fears that have developed under the influence of sharp impressions. They are distinguished by inconsistency, variability, dependence on the slightest changes in the surrounding situation, demonstrativity, patients emphasize the severity of their condition and the unusualness of their disease.

Often, significant difficulties represent the differentiation of neurosis of obsessive states from sluggish current schizophrenia.

Many authors indicate the following features characteristic of obsessions: the lack of imagery, the pallor of emotional components, monotony, monotony of obsessions, their unmotivation and suddenness of the occurrence; The abundance of meaningless and unmotivated rituals. In the deepening of the painful process, the accession of stereotypical motor and ideator rituals is often observed. Prognostically unfavorable and testifying in favor of sluggish current schizophrenia are obsessive doubts arising in the complication of obsessive syndrome.

The changes in the nature of the obsessions are usually independent of external factors, as it is typical of neurosis. When schizophrenia, obsessions are often combined with the symptoms of the derrania and depersonalization. The degree of critical attitude towards obsessive phenomena and the fight against them are defined in differential diagnosis. With a low-armred form of schizophrenia at the beginning of the disease, patients are crucial to a certain extent critically refer to the ideas of a obsessive nature and regard them as painful.

Pathological ideas do not worry conviction and are constantly questioned; Patients regard these ideas as alien to their personalities and strive for their overcoming, opposing the system of protective measures, and only as schizophrenia progressing, the critical attitude towards the obsessions weakens, disappears the painful experience of fruitless struggle against them. All of the obsessions on schizophrenia applies to phobiam. In manic-depressive psychosis, obsessive states usually arise in the depressive phase; They are closely related to the beginning of the attack of depression and disappear with its ending. In neurosis of obsessive states, depression is not characteristic.

Observing conditions may occur at encephalitis. They are due to the reaction of patients with an alarming-mensive nature of the disease, as well as related to complex psychogencies associated with organic disease. The obsessions in such cases are dominated in the clinical picture and are characterized by irresistibility, stereotype, often suddenness of the offensive.

There is also a fear of pollution (mizophobia), with which patients are fighting, forcing themselves to stop washing, understanding his meaninglessness. However, gradually phobias take an increasingly dominant nature and become enforced. Over time, the experience of obsessions disappears, and under suitable conditions, patients continue to stereotypically committed by the ritual, in particular, wash their hands. During this period, they, for example, suffer from not because of the contamination, but on the lack of necessary conditions for washing.

With epilepsy, "influx of thoughts", "violent desires", "violent attractions" can be observed. They are characterized by short-term, paroxysmality, sharp affective saturation, lack of communication with mental trauma. Patients overcome them with great difficulty.

These special states are associated with violations in the field of deposits and cannot be attributed to true obsessive states. It is noted in patients with epilepsy obsessive need for moving, removing or destruction of individual items, in the statement of obsessive meaningless phrases, individual phrases, scraps of memories or painful doubts, the meaning and importance of which patients are poorly realized and not able to describe them.

At the same time, patients with epilepsy in the period of asthenization may occur psychogenically due to obsessive manifestations characterized by special viscosity and perseverance.

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2016-07-01 Phobic anxiety disorder

Recently, the concept of "panic attack" has been firmly settled in our lives. This is a attack of panic, or uncontrolled fear that occurs in certain situations. The main feature of the panic attack is its irrationality, that is, the reason that caused fear is not really threatening for a person. Most people at least once experienced a irrational attack of panic. If the panic attacks are repeated and negatively affect the quality of life - it's about anxious disorder.

Fobic anxiety disorder or anxious-phobic neurosis is a disease in which a person responds to safe stimuli of the attack of fear.

The reason for the occurrence of the attack of panic can be one, less often - several. This disease is also called a phobia, with a prefix in the Greek, denoting the cause for fear:

• claustrophobia (fear of closed space),
• agorafobia (fear of open space),
• aquaphobia (fear of water, fear swim),
• anthropophobia (fear of people, communication), etc.

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Social alarming disorder is manifested in the form of fear of being in humans, in the center of attention, in combination with the fear of becoming disgraced, that is, to get a negative assessment of its actions from others. Social phobia can be isolated or generalized. Both forms of disorder lead to avoiding the alarming situations, that is, patients do not find another way, how to remove the alarming state, except for self-insulation.