M.I. Pyrogov Vinnitsa National Medical University
Chair of Psychiatry and Addictology
GENERAL CHARACTERISTIC OF PSYCHOGENIC DISORDERS.
Abstracts of lecture
Lecturer: Associated Professor, PhD Teklyuk S.V.
Vinnytsya 2009 y.
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Plan of the lecture
I.
II.
III.
IV.
GENERAL CHARACTERISTIC OF PSYCHOGENIC DISORDERS.
1. Definition of psychogenic disease.
2. Classification of psychogenic diseases.
NEUROTIC DISORDERS.
1. Definition and general characteristic of neurotic diseases.
2. Classification of neurotic diseases.
1). Acute reaction to stress:
 Hysterical reactions
 Psychasthenic reactions
 Neurasthenic reactions
 Depressive reactions
 Paralysis of emotions
2). Neuroses:
 Neurasthenia
 Hysteria
 Neurosis of obsessions
 Neurotic anxious disorders
 Neurotic depression
3. Etiology and pathogenesis of neuroses and neurotic reactions.
4. Differential diagnosis
5. The treatment of patients with neurotic disorders
6. Prognosis
SOMATOFORM DISORDERS.
1. Definition and general characteristic of somatoform disorders.
2. Etiology and pathogenesis.
3. Classification of clinical manifestations.
1) Somatized disorder.
2) Hypochondriacal disorder.
3) Somatoform autonomic dysfunction.
4) Chronic somatoform painful disorder.
5) Anorexia nervosa.
6) Bulimia nervosa.
4. The differential diagnosis.
5. The treatment of patients with somatoform disorder.
6. Rehabilitative measures
REACTIVE PSYCHOSES.
1. Etiology and pathogenesis.
2. Classification of Reactions to Stressful Experience.
3. Acute reactions (psychogenic psychoses):
1) Affective-shock reactions.
2) Hysterical psychoses.
3) Reactive depressions.
4) Reactive paranoids.
5) Reactive paranoic states.
4. Age-specific peculiarities of psychogenic psychoses..
5. Differential diagnosis..
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6. Treatment of patients with reactive psychoses.
7. Prognosis.
V. POSTTRAUMATIC STRESS DISORDERS.
1. Definition and general characteristic of post-traumatic stress disorder.
2. Clinical picture.
3. Treatment.
VI. ADJUSTMENT DISORDERS.
1. Definition and general characteristic of adjustment disorders.
2. Clinical picture.
3. Special forms of adjustment disorders.
4. Treatment.
List of recommended literature
Basic literature.
1. Concise Oxford Textbook of Psychiatry. M. Gelder, D. Gath, R.Mayou. –
Oxford; New York; Tokyo; Oxford University Press, 2007. – 953 p.
2. Modern Synopsis of Psychiatry. A.M. Freedman, H.I. Kaplan, B.J. Sadock. –
USA, 1982. – 433 p.
3. Psychiatric Dictionary / 5th ed. R.J. Campbell. – Oxford; New York; Oxford
University Press, – 1981. – 693 p.
4. Psychopatology and addictive Disorders / Ed. By Meyer. - New York; London,
1986. – 283 p.
5. Psychiatry: course of lecture /Ed.by V.S. Bitensky. – Odessa, 2005. – 336 p.
6. Zimbardo Ph.G. Psychology and Life. - USA, 19991. – 189 p.
Additional literature.
1. Brundtland G.H. Mental health in the 21st century // Bulletin of the World
Helth Organization. – 2000. - №87. – Р. 411.
2. Desjarlais R., Eisenberg L., Good B. et al. World Mental Health: Problems
and Priorities in Low-Income Countries. – New York: Oxford University
Press, 1995. – 144 p.
3. Marsella A., Kleinman A., Good B. Cross-cultural studies of depressive
disorders. An overview. Culture and depression. – Berkley: University of
California Press, 1985. – 213 p.
4. Mulrow C.D., Williams J.W. Jr., Trivedi M., et al. Treatment of depression:
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newer pharmacotherapies. Rockville, MD: Agency for Health Care Policy and
Research, 1999. – 253 р.
5. Murray C.J.L., Lopez A.D. The global burden of disease: a comprehensive
assessment of mortality and disability from disease, injuries and risk factors in
1990 and projected to 2020. Cambridge, MA: Harvard University Press, 1996. –
68 p.
6. Kielholz P. Masked Depression. — Berne, 1973. – 97 p.
7. Lopez-Ibor J. J. The Present Status of Psychotropic Drugs / Ed. by A. Cerletti,
F. J. Bove. - New York, 1999. - 519 p
8. Preskorn, S.H. Outpatient management of depression: A guide for the Primarycare
practitioner/
S.H.
Preskorn.
-
Wichita;
Kansas:
Professional
Communications,Inc., 1994. - 147 p.
9. Ustun T.B., Sartorius N. Mental Illness in General Health Care. An
International Study. – Chichester: John Willey @ Sons Ltd, 1995. – 336 p.
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GENERAL CHARACTERISTIC OF PSYCHOGENIC DISORDERS.
NEUROTIC AND SOMATOFORM DISORDERS: AETIOLOGY, PATHOGENESIS,
CLASSIFICATION
Psychogenic diseases are a large and clinically varied group of diseases resulting from an effect
of acute or long-term psychic traumas which manifest themselves by both mental and
somatoneurological disorders and, as a rule, are irreversible.
Among psychogenic diseases there are neurotic, stress-related disturbances, acute and protracted
situational psychoses, somatoform disorders and psychosomatic diseases, as well as posttraumatic
stress disorders (psychogenic development of the personality).
Psychogenic diseases are caused by a psychic trauma, i.e. some events which affect significant
aspects of existence of the human being and result in deep psychological feelings. These may be
subjectively significant events, i.e. those which are pathogenic for the majority of people. Besides,
the psyche may be traumatized by conventionally pathogenic events which cause feelings in an
individual because of his peculiar hierarchy of values.
Unfavourable psychogenic effects on the human being cause stress in him, i.e. a nonspecific
reaction at the physiological, psychological and behavioural levels. Stress may exert some positive,
mobilizing influence, but may result in disorganization of the organism activity. The stress, which
exerts a negative influence and causes various disturbances and even diseases, is termed distress.
The disease is far from being caused by every unfavourable influence and in every person, as
any personality uses its own inherited specific ways for processing feelings which neutralize their
pathogenic effect and are called psychological protection. There are psychologically well and
poorly protected individuals; it is in the latter cases that psychogenic diseases develop more
frequently. The so-called extreme types of higher nervous activity, described by Pavlov, are the
most vulnerable ones. These are weak, strong unrestrained and also extreme manifestations of the
artistic and thinking type. Besides constitutional (hereditary) causes of the psychologically weak
protection the latter can be caused by previous diseases, overstrain and other harmful influences, A
part in the development of psychogenies is also played by the severity and personality significance
of the psychic trauma (the trauma should fit the personality like a key to a lock), its acuteness and
duration of its course, peculiarities of the intellect, general state of health, absence of possibilities to
get any real help.
Classification of neurotic disorders
I.Acute reaction to stress
1 .Depressive reactions
2.Neurasthenic reactions
3.Hysterical reactions
4.Psychasthenic reactions
5. Paralysis of emotions
II. Neuroses
1 .Neurasthenia
2.Hysteria
3.Neurosis of obsessions
4.Neurotic anxious disorders
5.Neurotic depression
III.Neuroses in children
1 .Systemic (monosymptomatic)
neuroses
2.Neuroses of fear
3.Pathological habitual actions
4.Peculiarities of "classical"
neuroses in children
I. Acute reaction to stress (neurotic reactions). Neurotic reactions are acute responses to stress, the
psyche being traumatized here by intimate-personal feelings. These may be a failure to satisfy some
desires by the relatives, disappointment in a friend, an unfair (in the patient's opinion) remark in
presence of people of his age. Such reactions are more commonly observed in adolescents. According to
ICD-10, they are encoded as F43.
There are no data about the morbidity rate of neurotic reactions, because in the overwhelming
majority of cases these patients do not take medical advice. The clinical forms of neurotic reactions
depend upon peculiarities in the patient's personality; their development is caused by a bad
psychological protection of the personality which makes it impossible to find an adequate way out of the
given situation. The duration of these reactions is from a few minutes to several days. First of all,
mental symptoms are reduced, while autonomic disorders last longer.
According to their clinical peculiarities, there are several forms of neurotic reactions.
Depressive reaction (F43.2) may develop 1-2 days following a psychic trauma; such a form of
responding is mostly typical for a weak type of the higher nervous activity. The mood worsens,
tearfulness appears, the patient's attention is focused on the psychic trauma and its consequences.
Some cases develop overvalued ideas of self-condemnation and self-humiliation with resultant
suicidal thoughts and even acts. Suicides may have severe consequences and necessitate
resuscitation of the patients. Low spirits are accompanied by sleep disturbance, bad general
state.
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