Chapter 8

Neurotic , stress-related and somatoform disorders

 NEUROSIS
• a class of functional mental disorder associated with
distress but not delusions or hallucinations, where
behavior is not outside socially acceptable norms.
psychoneurosis or neurotic disorder.
• be employed in psychoanalytic theory & practice.
 Classifications
• F40. Phobic anxiety disorders 怕
• F41. Other anxiety disorders
• F42. Obsessive-compulsive disorder
• F43.Reaction to severe stress & adjustment disorders
• F44. Dissociative disorders
• F45. Somatoform disorders
• F48. Other neurotic disorders
 Phobic anxiety disorders
• dread.
• palpitations or feeling faint & secondary fears of
dying, losing control, or going mad. Contemplating
entry to the phobic situation usually generates
anticipatory anxiety.
• Phobic anxiety & depression coexist.
 phobic anxiety disorders
• specific phobia
• social phobia
• social phobia
 Anxiety disorders
• Normal & pathological one
• Trait anxiety 特征性

• State anxiety
• generalized anxiety disorder
• panic disorder
 anxiety symptoms
• Physical
motoric symptoms tremors 震颤
automomic & visceral symptoms
Psychological
cognitive symptoms
perceptual sympotms derealization depersonalization

affective symptoms
others symptoms
 Common anxiety symptoms
• Body
• Chest
• Emotions (see mood)
• Fears
 Fears
• what people think of you
• being trapped in a place with no exits
• Constant feeling of being overwhelmed.
• Fear of being in public
• dying
• losing control
• impending doom悬空的不幸
• mistakes or fool
• passing out 不省人事
• losing your mind
• irrational things, objects, circumstances, or situations
• crazy, of dying, of impending doom, of normal things, unusual fee

• self awareness / self-consciousness

• washrooms
• to seat
• as headache, sweating, muscle spasms,
palpitations, & hypertension, --- fatigue or
even exhaustion.
 Generalized anxiety disorder
• generalized & persistent
• persistent nervousness, trembling, muscular
tensions, sweating, lightheadedness, palpitations,
dizziness& epigastric discomfort. Fears
• Anxiety: neurosis reaction
• Excludes: neurasthenia / depressive disorder
 Panic disorder 1.5~2% 惊恐急性
• recurrent attacks of severe anxiety (panic),
• unpredictable sudden onset
palpitations, chest pain, choking sensations, dizziness
& feelings of unreality (depersonalization or
derealization).
• secondary fear of dying, losing control, or going
mad. depressive disorder
• secondary to depression. Panic: attack . state
Excludes: panic disorder with agoraphobia 广场
 Etiolgoy
• Psychodynamic theory signal anxiety
• Behavioral theory
• Congnitive behavioral theory(CBT) selective
• Biological theory
genetic evidence
chemically induced anxiety states lactate infusion
GABA-benzodiaizepine R.
γ- aminobutyric acid
Other neurotransmitters
Neuroanatomical basis locus ceruleus ,limbic system
Organic anxiety disorder 器质性焦虑障碍
 Biological theory
• genetic evidence
chemically induced anxiety states lactate infusion
GABA-benzodiaizepine R.
γ- aminobutyric acid
Other neurotransmitters
Neuroanatomical basis locus ceruleus ,limbic system
Organic anxiety disorder
 Therapy
• Psychotherapy
• Relaxation techniques
• Other behavior therapies
• Drug treatment
talk therapy, meditation, biofeedback,
hypnosis& acupuncture.
 A friend invites you to a big party.
• #1:The party sounds like a lot of fun. I love going
out & meeting new people!
Happy, excited
#2:Parties aren’t my thing. I’d much rather stay in
& watch a movie.
Neutral
#3: I never know what to say or do at parties. I’ll
make a fool of myself if I go.
Anxious, sad
Thought challenging in cognitive behavioral therapy

• Identifying your negative thoughts.

• Challenging your negative thoughts.
• Replacing negative thoughts with realistic thoughts.
 Challenging Negative Thoughts
• Negative thought What if I pass out on the subway?
• Cognitive distortion
• realistic thought Predicting the worstI’ve never passed out
before, so it’s unlikely that I will on the subway.If I pass
out, it will be terrible! Blowing things out of proportionIf I
faint, I’ll come to in a few moments. That’s not so
terrible.People will think I’m crazy.Jumping to
conclusionsPeople are more likely to be concerned if I’m
okay.
 Systematic desensitization
• Learning relaxation skills
• Creating a step-by-step list.
• Working through the steps
 Facing a Fear of Flying
• Step 1: photos
• Step 2: video.
• Step 3: real planes take off.
• Step 4: plane ticket.
• Step 5: Pack for your flight.
• Step 6: Drive to the airport.
• Step 7: Check in for your flight.
• Step 8: Wait for boarding.
• Step 9: Get on the plane.
• Step 10: Take the flight.
Anti-anxiety drugs
 Anti-anxiety drugs
tranquilizers,
slowing down the CNS.
relaxing & calming
sleeping pills & muscle relaxants.
 Benzodiazepines
• Xanax (alprazolam)
• Klonopin (clonazepam)
• Valium (diazepam)
• Ativan (lorazepam)
fast acting—30~1h
depression. doses -- depressive symptoms & suicidal
thoughts & feelings.
emotional blunting or numbness.
feelings of pleasure or pain.
 Common side-effects of benzodiazepines or tranquilizers

• Drowsiness, lack of energy

• Clumsiness, slow reflexes
• Slurred speech
• Confusion & disorientation
• Depression
• Dizziness, lightheadedness
• Impaired thinking & judgement
• Memory loss, forgetfulness
• Nausea, stomach upset
• Blurred or double vision
 Paradoxical effects of anti-anxiety drugs
• sedating properties-- paradoxical excitement.
increased anxiety, irritability& agitation.
• Mania
• Hostility & rage
• Aggressive or impulsive behavior
• Hallucinations
• children, the elderly& people with developmental
disabilities.
• Taking anti-anxiety medication with
alcohol, prescription painkillers, or sleeping
pills can be deadly.
• antihistamines
• Antidepressants -- Prozac & Zoloft
 People over 65.
• confusion, amnesia, loss of balance, and
cognitive impairment that looks like
dementia. Anti-anxiety drug use in the
elderly is associated with an increased risk
of falls, broken hips and legs, and car
accidents.
 Pregnant women.
• Placenta-- dependence : baby--withdrawal :
muscle weakness, irritability, sleep &
breathing problems& trembling. breast milk
 People - substance abuse.
• alcohol or drugs
• benzodiazepines –quickly, addictive-
abuse
• alcohol or other illicit drugs.
 Anti-anxiety drug dependence &withdrawal
• benzodiazepines - Xanax, Klonopin, Valium, &
Ativan - short-term use
• physically dependent
• Psychological dependence
 dependent on benzodiazepines if:
• ≥4 months
• cope 克服
• ill or anxious or others .
• effect ↓
• extra pill during a stressful time.
• could not sleep a wink.
• increased dose.
• increased alcohol
• interfering --sick days off work, family or relationship problems,
difficulty coping, memory .
• never run out of your pills.
• You carry your pills with you “just in case.”