manilestations are charactersed by presence ol obsesslons and compulsions

manilestations are charactersed by presence ol obsesslons and compulsions Obsesslons are recurrent or perslstent Ideas. thoughts. images or Impulses compulsions are urges or Impulses io action that when put Into operation lead to compulsive acts which ara performed either according to certain rules or in a stereotyped manner Obsessions and compulsion have certain features in common -(a) An idea or impulse Intrudes impellingly into an indvidual'sconsclous awareness (b) A leeling of intense anxiety accompanies the central manilestation and leads the Individual to take counter measures against the Initial idea or Impulse (c) The obsession or compulsion is ego-alien.i,e. Is experienced as being foreign to andnot apart of one's experience of oneself . it isundesirable and unacceptable (d) The indivdual recognises the obsession or compulsion as being absurd or Irrational (e) The suffering indiVidual feels a strong need to resist those obsessions or compulsions When the symptorrs become severe, the patient may develop additional symptoms of anxiety and/or depression PROGNOSIS - Natural remissions of symptoms are known, hence the prognosis Is not always gloomy Prognosis is bad when the personality is obsessional and symptoms are severe and of long-standing Management 1 Drugs - Fluoxetine (20-GQmg/day) or sanraline(50-3cO mo/day) or clomiprarrine (75-200 mg/day) Trazodon (50-400 mg/day) is also effective in some cases 2 Psychotherapy- Supportive as well as analytical gives satisfactory results In some cases 3 Behaviour therapy - Satisfactory results are seen in some cases IV Hysteria Types of hysterical dsorders-1 Conversion dsordesr-fHysterical neurosis, conversion type) Here the special senses or voluniary nervoue system are affected causing symptoms such as blindness, dealness. paralysis, akinasias, etc for which there is no organic basis Often the patient shows an inappropriate lack of concern ('ta-belle"infterence about those symptoms which may actually provide secondary gains by winning sympathy 2 Dissoclative disorder - (Hysierlcal neurosis, dtssociative type) Here alterations may occur In the patients state of conaclousness or In his identify to produce such symptoms as amnesia ambullism fugue and multiple personality Etiology Tnere is sufficienavidence to suggest that the symptoms ara psychogenic and that the environmental factors are the important etiologcal faclors 1 Age - The peak Incidence is balween the ages of 20 to 35 years 2 Sex - incidence is higher in females 3 Intellgence - People with low intelligence more Iikely 4 Personality - Commonest is histrionic: personality (characteristcs • dramatizing and exhibitionistic, attention seeking, immature. having shallow andsuperticial emotional relationships] 5 Maritalstatus - Mora comrnon In unmarried widowed and divorcees 6 Socio-cultural factors - More common in primitive, developing and less sophisticated or cultured societies 7 Psychoanalytical theories - Hysterical symptoms are viewed as symbolic representations and distorted expressions of unresolved intrapsychic conflicts about one's sexual drive (libido) When the libidinal energy manifesis itself as somatic symptoms through the ego-defence mechanism of conversion, the resulting disorder is known as conversion disorder When the libidinal energy marifests as psychological symptome through the defense mechanism of disociation, the resulting disorder is labelled dissociaiive disorder Clincal manifestations 1 SYMPTOMS OF CONVERSION DISORDER - These ariee because of the involvement of voluntary neuromuscular system (a) Motor symptoms - These are of two types (i) Akinesia e. g. paresie or paralysis involving a part of the body monoplegia, hemiplegia, paraplegia, etc (ii) Hyperkinesia and dyskinesia e. g .tremors, tortcollis, convulons or fits (b) Sensory symptoms These can be in the form of anaesthesia, hypaaesthesia. hyperaesthesia and paraesesthesia This dtsturbance can affect all the general sensations Special organs of sense, like those for sight, hearingr smell andtastecanalso be disturbed resulting in blindness. deafness. etc (c) Visceral symptoms - Common ones are hiccoughs vomiting, dyspnoea, dysphagia, aphonia, etc 2 SYMPTOMS OF DISSOCIATION DISORDER - (a) Somnambulism and sormiloquy. (b) Amnesia • cicunscribed and covers up the psychologically traumatic event (c) Trance -An altered state of consciousness lasting for a few minutes to a few hours, during which the patientappears to be oblivious of tne surroundings (d) Fugue-An altered state of conslousness wherein the patient travels long distances over a period of days and subsequently has amnesia for the entire episode (e) Multiple parsonalities like those of Dr Jakyl and Mr Hyde (f) Ganser'ssyndrome,a rare disordercharacrisedby giving of "approximate answers", somatic or paychological hysterical symptoms, hallucinations and an apparent clouding of consciousness Characteistics of hysterical symotoms- 1 Absence of organic basis for symptoms 2 Theyserve both primary gain (resolution of intrapsychic confficts) and secondary gain (obtaining sympathy and attention) 3 In conversion disorder - (a) Symptoms seldom occur when patient is alone, on the other hand, symptoms are exaggerated in presence of other persons (b)