NEUROTIC DISORDER

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INTRODUCTION
Neurotic Disorder, Neurosis refers to a class
of functional mental disorder involving
distress but not delusion or hallucinations,
where behavior is not outside socially
acceptable norms. It is also known as
psychoneurosis or neurotic disorder.
 DEFINITION

Neurotic Disorder is a less severe form of psychiatric

disorder, where patient’s show either excessive or
prolonged emotional reaction to any given stress. These
disorder are not caused by organic disease of the brain
and however severe, do not inolve hallucinations and
dellusions.
 CLASSIFICATION
 Phobic anxiety disorder.
 Generalized anxiety disorder.

 Panic disorder.

 Obsessive compulsive disorder.

 Dissociative and conversion disorder.

 Reaction to severe stress and adjustment disorder.

 Somatoform disorder.

 Other neurotic disorder.

F44 DISSOCIATIVE(CONVERSION)
DISORDER
 Conversion disorder is characterised by the following
clinical features:
 1. Presence of symptoms or deficits affecting motor

neurological disorder.
 2. Sudden onset.

 3. Development of symptoms usually in the presence of

a significant psychosocial stress.

 4. Patient does not intentionally produce the symptoms.

 There are two different types of disturbances in

conversion disorder.
a) Dissociative motor disorder
The motor disturbances usually involve either
paralysis or abnormal movements. The
symptoms distribution is according to the
patient knowledge of nervous system. These
movements either occur or increase when
attention is directed towards them, and may
disappear when patient is unobserved.
b) Sensory disorder

All sensory modalities such as touch, pain,

temperature and position sense.
DISSOCIATIVE DISORDER
 These disorder are charecterised
by the following clinical features.

1. Disturbance in the normally

integrated functions of
consciousness, identity and /or
memory.
2. Onset is usually sudden and the
disturbance is usually temporary.
3. Detailed physical examination
and investigations do not reveal
any abnormality that can explain
the symptoms adequately.
The common clinical types are given below
1. Dissociative Amnesia: This occurs mostly in
adolescent and young adults. It is characterised by
sudden inability to recall important personal
information.
2. .Dissociative Fague: It is characterised by episodes of
wandering away(usually away from home).
3. . Multiple personality Disorder: In this person is
dominated by two or more personalities, of which
only one is being manifest at a time.
4. Trance and possesion disorder: It is characterised by
the control of persons personality by a spirit during
the episodes.
REACTION TO STRESS AND ADJUSTMENT
DISORDER
 This category includes:
1. Acute stress reaction
2. Post- traumatic stress disorder
3. Adjustment disorders
1. Acute stress reaction:
It is charcterised by symptoms like anxiety,despair
and anger or overactivity. This symptoms are clearly
related to the stressor. If removal from the stressful
environment is possible the symptoms resolve rapidly.

2. Post Traumatic Stress Disorder:-

 Post traumatic stress disorder is of a reaction to

extreme stressors such as floods, earthquacks, war,

rape or serious physical assault . The main symptoms
are persistent anxiety, irritibilty, insomnia, intense
imagenary recurring distressing dreams, inability to
feel emotion and diminished interest in activity.
 The symptoms may develop after a period of latency

within 6 months after stress or may be delayed.

3. Adjustment Disorder

 Adjustment disorder are one of the commoner

psychiatric disorder seen in the clinical practice.
 Most frequently seen in adolescent and women. This

disorder is characterised by those disorder which occur

within 1month of a significant life change.
 This occurs due to poor coping skills or personality

factors. Most patient recover within a period of

3months.
Treatment

1. Supportive psychotherapy remains the treatment of

choice .
2. Crisis intervention is useful in some patient, by helping
to quickly to resolve the stressful life situation which
has led to the onset of adjustment disorder.
3. Stress management training and coping skills training.
4. Drug treatment may be needed in some patient for
the management of anxiety(benzodiazepines) or
depressive symptoms(antidepressants).
SOMATOFORM DISORDER
The somatoform disorders are characterised by repeated
presentation with physical symptoms which do not have
any adequate physical basis.
Somatoform disorder are devided into the following
categories:
1. Somatization disorder
2. Hypochondiasis
3. Somatoform autonomic Dysfunction
4. Persistant somatoform pain disorder
Multiple somatic symptoms in absence of any physical
disorder.
1. Somatization Disorder:
Multiple somatic symptoms in absence of any
physical disorder

The symptoms are recurrent and chronic(of

many years duration, usually): at least 2
years duration is needed for diagnose.
The symptoms are presented in dramatic
manner, and involve multiple organ systems.
The common symptoms include
gastrointestinal(abdominal pain, beltching,
nausea, vomoting, regurgitation) abnormal
skin sensations(numbness, soreness, itching,
tingling, burning).
There is frequent change of treating physicians.
Persistent refusal to accept the advice or reassurance of
several doctors that there is no physical explanation for
the symptoms.
. Some degree of impairment of social and family
functioning attributable to the nature of the symptoms
and resulting behavior.
Presence of conversion symptoms is common
 2. Hypochondiasis
Hypochondiasis is defined as persistent
preoccupation with a fear or belief of having a
serious disease despite repeated medical
reassurance.

3. Somatoform Autonomic Dysfunction

In this disorder the symptoms are
predominantly under autonomic control, as if
they were due to a physical disorder. Some of
them include palpitation,
hiccoughs,hyperventilation, irritable bowel,
dysuria.
 4. Persistent Somatoform Pain Disprder
The main feature is the disorder is severe,
persistent pain without any physical basis. It
may be of sufficient severity so as to cause
social or occupational impairment.
preoccupation with the pain is common.
1. Treatment
Drug Therapy
Antidepressants
Benzodiazepines

Psychological Treatment
Supportive psychotherapy
Relaxation therapy
OTHER NEUROTIC DISORDER

In ICD-10, the other neurotic disorder are devided

into following categories.
 Neurasthenia: This disorder is characterised by

complaints of increased fatigue after mental

effort, feelings of muscular pain, dizzines,
tension, headache, sleep disturbance, inability
to relax, irritability and dyspepsia.
 Depersonalisation Disorder: It is characterised

by an alteration in the perception or experience

of self, so that the feeling of one’s own reality is
temporarily changed or lost.
CLINICAL FEATURES OF
DEPERSONALISATION

1. The onset and termination of episodes is

usually sudden.
2. The episodes of depersonalisation causing
significant social, interpersonal or
occupational impairment.
3. Marked distress and anxiety results, as the
experience is high unpleasant.
4. Insight into the illness is usually present.
5. A feeling of loss of control on one’s action
and speech may occur.
Treatment
The treatment is usually not very successful though co-
morbid symptoms of anxiety and depression can often
be treated.
 Supportive psychotherapy.

 Drug therapy with antidepressants, rarely antipsychotic

may also be tried.

OTHER SPECIFIED NEUROTIC DISORDER

( Culture bound syndromes)
In ICD-10, this category includes miscellaneous disorders
which are occurs in certain cultures, e.g. dhat
syndrome, koro,latah, wihtigo, piblokto and amok
 Dhat Syndrome: Dhat syndrome which is prevalent in
the Indian subcontinent. This is characterised by
1. Complaint of passage of dhat in urine.

2. Multiple somatic symptoms.

3. Asthenia(physical or mental exhaustion).

4. Anxiety or depression may be present.

5. Sexual dysfunction may occur: Dhat is a whitish

discharge passed in urine and believed to be seen by
the patient.

Treatment
1.Couselling and psychotherapy.
2.Symptomatic treatment of underlying anxiety,
depression
 Amok: It is characterized by a sudden unprovoked
episode of rage, in which the effected person runs or
kills any person who is encountered on the way. This
condition is usually seen in south-east Asia.

 Wihtigo: The affected person has the belief that he has

been transformed in to a wihtigo, a cannibal monster.

 Piblokto: In this the affected person is often a female,

who screams and tears off her clothes and throws
herself on ice in extremely cold conditions. This episode
usually lasts for 1-2 hours.
 Latah syndrome: This syndrome is reported from
south-east Asia and Japan. Occurring more often in
women, latah is typically characterized by the
presence of automatic disorders. It is precipitated by a
sudden stimulus, such as loud sound.

 Some Indian Culture-bound Syndromes: In addition to

that syndrome, amok described that culture-bound
syndromes seen in India include Suchi-bai, ascetic
syndrome, nupital psychosis, and Jhinjhinia