Types of stress reactions and disorders
Specific reactions to stress take various forms, depending on the intensity of the psychological trauma and the personality traits of the individual.
- Affective-shock reactions: develop in the event of a sudden threat to life. Impairment of consciousness is characteristic.
- Reactive paranoid: provoked by isolation factors, such as being in a foreign-language environment.
- Hysterical psychoses: against the background of severe psychological trauma, pseudodementia or manifestations of "childish" behavior may occur.
- Reactive depression: a psychogenic mood disorder for which cognitive psychotherapy is most effective.
- Post-traumatic stress disorder (PTSD): among typical manifestations, refusal of medical care is noted.
A typical outcome of acute reactive psychoses is complete recovery.
Neuroses: forms and features
Neuroses often act as a manifestation of psychopathy decompensation. Neurasthenia is considered the most favorable course variant. Any neurosis can be accompanied by somatovegetative disorders.
- Neurasthenia: requires a combination of therapy and adequate rest. Psychotherapy is the leading method. At the first stage, relaxation is used (autogenic training, massage), and at the second stage, activating techniques are applied.
- Obsessive-phobic neurosis: includes obsessions and anxiety neurosis. Treatment is predominantly pharmacotherapeutic (antidepressants). Patients are poorly suggestible, so hypnosis is ineffective. Behavioral therapy is indicated (biofeedback, confrontation, desensitization).
- Hysterical neurosis: based on the mechanisms of repression, dissociation, and conversion. Manifests as demonstrative behavior associated with psychological trauma (no organic lesions). A specific symptom is globus hystericus (sensation of a lump in the throat) or swallowing disorders. Patients are highly suggestible, so hypnosis and placebo methods (physiotherapy, homeopathy) yield good results.
Neurotic reactions
These are short-term episodes (tears, a single outburst of anger, psychogenic headache, difficulty falling asleep) in healthy people.
They occur against the background of overwork or obvious, but not catastrophic stress (an exam, an argument). Such behavior is psychologically understandable to others. These reactions cause discomfort, but do not disrupt the general lifestyle. They usually resolve after rest and do not require special psychotherapy. It is sufficient for the doctor to listen to the patient. The use of benzodiazepines is acceptable to ensure rest and prevent exhaustion.
Principles of treatment for psychogenic disorders
The basis of therapy is a combination of psychotherapy and pharmacotherapy, as well as the widespread use of non-specific methods (physiotherapy, massage). Treatment is predominantly outpatient; hospitalization is mainly needed for isolation from the stressor.
| Drug group | Purpose of use | Examples |
|---|---|---|
| Antidepressants | The basis of treatment for obsessive-phobic neurosis; panic attacks | Agomelatine, fluvoxamine, paroxetine, clomipramine |
| Nootropics | Fatigue, asthenia | Piracetam, aminophenylbutyric acid |
| Tranquilizers | Relief of acute anxiety (short-acting), insomnia | Lorazepam, alprazolam, zopiclone |
| Mild antipsychotics | Irritability, monothematic fears, psychopathic traits | Thioridazine, alimemazine, periciazine |
During treatment, it is important to consider the placebo effect and the risk of dependence development, especially when using long-acting benzodiazepines.
Briefly: answers to topical questions
What types of intrapersonal conflicts (according to V.N. Myasishchev) lead to the development of neuroses?
According to V.N. Myasishchev, each type of neurosis is characterized by a specific type of intrapersonal conflict. The following variant contradictions are distinguished:
- Hysteria — contradiction between the desire to dominate and the unwillingness to bear responsibility.
- Obsessive-phobic neurosis and psychasthenia — contradiction between the pursuit of happiness and a hypertrophied sense of duty.
- Neurasthenia — mismatch between real abilities/skills and the overestimated tasks that the patient sets for themselves.
Class and exam questions
How to distinguish asthenia from depression and apathy?
In endogenous depression, symptoms are worse in the morning (early awakening is typical). In asthenia, fatigue increases toward the evening, and in the morning the patient feels unrested. In apathy, there is no physical fatigue, but there is a complete reluctance to do anything (fatigue before starting work) and no somatic complaints.
What to do if a patient complains of hysterical symptoms?
It is mandatory to conduct a thorough objective examination to exclude somatic or organic pathology. Hysteria can mask severe diseases, such as tumors or endocrine disorders.
What do frequent repeated visits with non-pathological complaints indicate?
This may indicate psychopathic character traits, the onset of an endogenous disease (such as schizophrenia), or hidden somatic pathology.
What else to study on this topic
- Criteria for distinguishing obsessions in schizophrenia from obsessive-phobic neurosis.
- Masks of hysterical somatoform disorders.
- Psychoorganic syndrome and its manifestations.
- Neurotic personality development.
Master the entire topic in the "Psychiatry" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on the topic "Specific reactions to severe stress" and 499 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 7 video lessons on the subject
Other topics in "Chapter 24. Disorders due to emotional stress"
The entire section "Chapter 24. Disorders due to emotional stress"Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.