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Diagnosis   

Neurotic disorders

Several different diagnostic labels fall under the header of neurotic and stress related disorders. This section will deal with them in two separate categories 'Anxiety related disorders' and 'Stress related disorders'.

Anxiety related disorders...

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Phobic anxiety disorder

• Anxiety certain well-defined situations (not at present dangerous)

• Situations avoided or endured with dread (anticipatory anxiety)

• Symptoms like palpitations or feeling faint

• Secondary fears of dying, losing control, or going mad

• Phobic anxiety and depression often coexist

• Agoraphobia, Social phobias, Specific (isolated) phobias...

- 'Is there a certain situation that causes you so much anxiety that you have to avoid them?'

- 'Do you get feelings of impending doom like you are losing control or dying?'

- 'When this happens does it come out of the blue or in response to something?'

- 'How do you feel in social situations or crowded places...?'

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Panic disorder (episodic paroxysmal anxiety)

• Recurrent attacks of severe anxiety (panic)

• Somatic symptoms

• Feelings of unreality depersonalization or derealisation

• Recurrent over 1 month

- 'Have you ever had a sudden rush of intense fear and nervousness where you can feel your heart pound and you get short of breath?'

- 'How do you physically feel when it happens? do you get... dizziness, dry mouth, sweating, light-headedness, palpitations, dizziness, and epigastric discomfort?'

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Generalized anxiety disorder

• Anxiety that is generalized and persistent

• Complaints of persistent nervousness, trembling, muscular tensions, sweating light-headedness, palpitations, dizziness, and epigastric discomfort

• May fluctuate

- 'Do you find that you have persistent worry or you worry alot more than others around you?  What is it that worries you?'

- 'How do you physically feel when it happens? do you get... dizziness, dry mouth, sweating, light-headedness, palpitations, dizziness, and epigastric discomfort?'

- 'Over the past months have you experienced…
… continual nervousness?
… trembling?
… muscle tension?
… sweating or light headedness?
… palpitations?
… dizziness?
… stomach pain?'

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Obsessive-compulsive disorder

• Recurrent obsessional thoughts or compulsive acts

• Obsessional thoughts are ideas, images, or impulses that enter the patient's mind, involuntary and often repugnant

• Compulsive acts or rituals are stereotyped behaviours that are repeated to prevent some objectively unlikely event, often involving harm to or caused by the patient

• Anxiety often present. If compulsive acts are resisted the anxiety gets worse

- 'Do you have any intrusive or unpleasant thoughts come into your head that you can’t stop?'

- 'Do you ever have to do carry out an act to avert something bad happening? What happens if you try to resist?'

- 'Do you ever have to constantly carry out a certain task/s like wash your hands or check and recheck doors and windows?'

- 'Do you always have to keep things in perfect order, clean and tidy?
Do you feel anxious or worried often especially if try to resist carrying out the urge?'

- 'How much time do you need to get ready to leave the house to go out?' (rituals may delay patient by hours)

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Stress related disorders

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Acute stress reaction

• Immediate emotional response to exceptional physical and mental stress and that usually subsides within hours or days

• State of "daze" with some constriction of the field of consciousness and narrowing of attention and disorientation

• Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are commonly present

Adjustment disorders

• Prolonged reaction to stress arising in the period of adaptation to a significant life change or a stressful life event

• Preoccupation with event

• Conduct disorders may be an associated feature, particularly in adolescents

• Symptoms of depressed mood, anxiety or worry

- Establish if the patient has experienced something that has caused them significant stress...

- 'Have you experienced flashbacks, dreams or nightmares reliving the trauma?'

- 'Is this often on you mind nowadays?'

- 'Have you been had any angry outbursts or got into any fights?'

- 'How had you overall mood been? Have you experienced more anxiety or worry recently?'

- 'Can you concentrate normally, for example read a newspaper or watch a TV programme?'

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Post-traumatic stress disorder (PTSD)

• Delayed or protracted response to a stressful event or situation (threatening or catastrophic in nature)

• Repeated episodes of reliving of the trauma; flashbacks, dreams or nightmares

• Sense of "numbness" and emotional blunting

• Detachment, unresponsiveness, anhedonia, and avoidance of activities and situations reminiscent of the trauma

• State of autonomic hyperarousal with hypervigilance and insomnia

• Anxiety, depression and suicidal ideation are common

- Establish if the patient has experienced something that was extremely traumatising for them...

- 'Have you experienced flashbacks, dreams or nightmares reliving the trauma?'

- 'Do you avoid activities or situations which might remind you of the trauma?'

- 'Have you been feeling numb like you can’t feel emotions?'

- 'Do you still enjoy your hobbies and leisure time?'

- 'Have you felt jumpy and on edge?'

- 'How has your sleeping been?'

- 'Have you felt life was not worth living?'
- 'Have you had any thoughts of ending it all?'

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Dissociative (conversion) disorders

• Loss of the normal integration between memories of the past, awareness of identity and sensations, and control of bodily movements

• Tend to remit after a few weeks or months

• Chronic disorders may develop if the onset is associated with insoluble problems or interpersonal difficulties

• Psychogenic in origin, being timed closely with traumatic events, insoluble and intolerable problems, or disturbed relationships