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Psychiatry lecture course

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									Psychogenic mental
Psychogenic disorders are caused
 by stress or psychological
 Psychogenic disorders (Karl Jaspers’
1) The disorder develops following a
   psychological trauma
2) The contents of the patient’s experiences
   (e.g. delusions) proceeds from the
   nature of the stressful event and there is
   a psychologically understandable
   association between them
3) All the course of the disorder is
   associated with the traumatic situation,
   its disappearance or de-actualization
   promotes the cessation (or
   improvement) of the disorder
  Components of the stress response
- Emotional responses
To threat: fear
To loss: depression
- Somatic responses
To threat: autonomic arousal
To loss: reduced physical activity
- Psychological responses
Coping strategies
Mechanisms of defense
• Coping strategy is a conscious
- Potentially adaptive
Working through problems
Coming to terms with situations
- Maladaptive – immediately reduce
  emotional response
Excessive use of alcohol
Histrionic behaviour
Deliberate self-harm
Mechanisms of defense are
Regression is the adoption of
 behaviour appropriate for earlier
 stages of development.
Repression is the exclusion of painful
 impulses, desires, or fears from the
 conscious mind.
Denial is an unconscious defense
  mechanism characterized by refusal
  to acknowledge painful realities,
  thoughts, or feelings
Displacement is an unconscious shift of
  emotions, affect, or desires from the
  original object to a more acceptable
  or immediate substitute.
Projection is the attribution of one's
  own attitudes, feelings, or desires to
  someone or something
 Defense mechanisms used for long-
              term problems:
Reaction formation is a defense
 mechanism by which an objectionable
 impulse is expressed in an opposite or
 contrasting behaviour
Rationalization is a false but
 acceptable explanation for behaviour
 which has a less acceptable origin.
Sublimation is unconscious diversion of
  unacceptable impulses into more
  acceptable outlets.
Identification is unconscious adoption
  of characteristics or activities of
  another person.
 Classification of reactions to stressful
Acute reactions – follow a sudden
 intense stressor, last a few days.
Post-traumatic stress disorder – is
 prolonged and abnormal response to
 a very intense stressor.
Adjustment disorder is more gradual
 and prolonged response to stressful
 experiences involving changes in
 one’s life.
        Acute reactions
• Anxiety – panic attacks
• Fear – poor sleep, restlessness,
  difficulty in concentration
• Physical symptoms – autonomic
  arousal (palpitations and tremor)
• Depression
         Acute reactions
• Coping strategy is avoidance;
  histrionic behaviour, aggression,
  excessive use of alcohol or drugs,
  deliberate self-harm.
• Defense mechanisms are denial or
  repressions; regression,
  displacement, projection.
 Treatment of acute reactions
• Reducing the emotional response –
  empathetic listening, short-term anxiolytics
  or hypnotics
• Encouraging to recall of the events
• Helping to improve coping skills
• Helping with residual problems (i.e.
Post-traumatic stress disorder
• Natural disasters
• Fires
• Transport accidents
• War
• Serious assaults of the person
Post-traumatic stress disorder
1. Persistent anxiety, irritability,
   insomnia, poor concentration
2. Persisting defense mechanisms of
   avoidance and denial, “flashbacks”,
   distressing dreams
3. Detachment, inability to feel
   emotions, diminished interest in
   activities, or anxiety and depression
Post-traumatic stress disorder
• Treatment
- To recall the stressful experiences
  and to express the associated
  emotions to an understanding and
  reassuring person
- Anxiolytic drug
- Hypnotic drug for several nights
     Adjustment disorder
• Is the psychological reaction involved
  in adapting to new circumstances.

• Divorce, major change at work, birth
  of a handicapped child etc.

• It starts more gradually and last
     Adjustment disorder
• Treatment
- Relieve anxiety by expression of
- anxiolytic drug
- discuss problems to reduce denial
  and avoidance
- provide problem-solving or crisis

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