Adult Psychiatry
SEXUAL DISORDER
SEXUAL DISORDER
Sexual disorders or sexual dysfunctions are difficulty experienced by an individual or a couple during any stage of a usual sexual activity, including physical pleasure, desire, preference, arousal or orgasm. For treatment and/or hospitalization it requires a person to feel extreme distress and interpersonal strain for a minimum of 6 months. Paraphilia (abnormal sexual activity) are disorders of deviant sexuality.
TYPES OF SEXUAL DISORDERS:
EXHIBITIONISM
This involves a compulsion to display one’s private parts to strangers. This is often followed by masturbation to attain orgasm. Exhibitionism is exclusively seen in males and the stranger is usually a female.
FETISHISM
This involves having sexual arousal either solely or with a non-living object, rather than onto another human being. Frequently, fetish objects are garments such as shoes, underwear, etc. Persons who rely on pornography for sexual arousal probably qualify as fetishists.
FROTTEURISM
This involves a compulsion to rub oneself against strangers in a sexual manner. Like exhibitionism and other impulse control disorders, frotteurism tends to involve a cycle of tension build-up that is relieved by acting out in exciting ways.
PAEDOPHILIA
This occurs when a sexually mature adult engaging in sexual behaviour with pre-pubescent children. Paedophiles may be exclusively child focused, or they may also be interested in adult sexuality. Paedophiles commonly rationalize their deviant behaviour (which may include fondling only or actual child-rape) as being educational and/or for the child’s benefit. They may also believe that their child victim has sexually seduced them.
SEXUAL MASOCHISM AND SADISM
This involves persons who engage in sexual encounters where the focus is on causing (sadism) or receiving (masochism) physical and emotional pain, embarrassment and humiliation.
TRANSVESTISM
This occurs when an otherwise ‘normal’ heterosexual male has fantasies about and/or acts out dressing up in woman’s clothing. Such cross dressing is commonly experienced as sexually stimulating.
VOYEURISM OR ‘PEEPING TOM’
This behaviour involves compulsive fantasizing about and/or acting out engaging in spying on someone (who does not know they are being observed) in the act of disrobing. This sort of behaviour is very common amongst the general population; it is not diagnosable as a disorder unless it becomes a compulsive part of a person’s sexual routine.
SIGNS AND SYMPTOMS OF SEXUAL DISORDERS:
Women with sexual arousal disorder and male with erectile disorder have persistent or recurrent inability to attain, or to maintain arousal/erection until completion of the sexual activity. The disturbance causes marked distress or interpersonal difficulty.
Men with persistent or recurrent ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it. The disturbance causes marked distress or interpersonal difficulty. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).
Men and Women with orgasmic disorder have persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm. The disturbance causes marked distress or interpersonal difficulty.
Men or women with Dyspareunia have recurrent or persistent episodes of genital pain associated with sexual intercourse. The disturbance causes marked distress or interpersonal difficulty.
The above disorders or disturbance are not better accounted for by another Axis I disorder (except another Sexual Dysfunction), and is not due exclusively to the direct physiological effects of a substance (e.g a drug of abuse, a medication) or a general medical condition.
PERSONALITY DISORDERS
PERSONALITY DISORDERS
Personality disorders are conditions of people’s basic character – so there is no ‘normal functioning’ to return to. The disordered personality become normal way of functioning, and appropriate treatment means learning entirely new ways of living.
SIGNS AND SYMPTOMS OF PERSONALITY DISORDERS:
The thoughts, feelings and behaviors that characterize personality disorders are:
Inflexible – i.e. they are rigid and are resistant to change.
Maladaptive – i.e. they are unhealthy ways of relating with others.
People with personality disorders usually don’t realize they have a problem. They think or experience themselves as normal and often feel that the people they interact with are the ones with the problems.
TYPES OF PERSONALITY DISORDERS:
People with odd and strange behavior
Paranoid – suspicious, distrustful, may be dangerous.
Schizoid – emotionally and interpersonally cut off, unresponsive or insensitive to others, otherwise called a ‘loner’.
People who dramatize
Histrionic – dramatic, wants attention, but emotionally shallow/superficial.
Narcissistic – inflated sense of self-importance, perfectionist.
Antisocial – behaviors that disregard laws, norms and rights of others.
Borderline –difficulty in building and / or maintaining relationships, impulsive, sense of emptiness and instability in thoughts, feelings and behavior.
People who are anxious, fearful or avoidant
Obsessive Compulsive – rigid, controlled, perfectionist.
Avoidant –rejection and abandonment, fears negative evaluation,
Dependent –dependent on others for self-esteem,submissive, fears abandonment.
The disorders within each type of personality may share some common behavior, they may also have characters of other personality types.
COURSE OF PERSONALITY DISORDER:
Personality disorder might be longstanding – i.e. begin at a relatively early age or chronic – i.e. continue over time or pervasive – i.e. occur across most contexts.
EATING DISORDER
EATING DISORDER
Eating disorder is a psychological disorder defined by abnormal eating habit that negatively affect a person’s physical as well as emotional health. Obsessions with food, body weight, and body shape may also signal an eating disorder. Three types of eating disorder has been studied; Anorexia nervosa, Bulimia nervosa and Binge-eating disorder
ANOREXIA NERVOSA
People with anorexia nervosa may see themselves as overweight or bulky, even when they are dangerously underweight or skinny. They typically weigh themselves repeatedlyand severely limit the amount of food they eat. Anorexia nervosa has the highest mortality rate of any psychological disorder. While many young women and men with this disorder die from complications associated with undernourishment, others die of suicide.
SIGNS AND SYMPTOMS OF ANOREXIA NERVOSA:
People with anorexia nervosa may have extremely limited eating and have a strong fear of gaining weight.
People with anorexia nervosa have a relentless pursuit for skinniness and show unwillingness to maintain a normal, healthy weight.
People with anorexia nervosa have distorted body image and a self-esteem that is heavily influenced by perceptions of body weight and shape.
Other symptoms may develop over time, including; thinning of the bones, anemia, weakness, brittle hair/nails, dry/yellowish skin, severe constipation, low blood pressure, decelerated breathing and pulse, reduced function of the heart, brain damage, organ failure, fatigue, sluggishness and infertility.
BULIMIA NERVOSA
People with bulimia nervosa have repeated incidents of eating abnormally large amounts of food and feeling a lack of control over these incidents. This binge-eating is followed by behaviour that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviours. Contrasting anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or relatively normal weight.
SIGNS AND SYMPTOMS OF BULIMIA NERVOSA:
People with bulimia nervosa have persistently swollen and sore throat.
Due to increased exposure of stomach acid, people with bulimia nervosa have damaged tooth enamel and increasingly sensitive or decayed tooth. They also have acid reflux disorder, intestinal distress and other gastrointestinal problems.
People with bulimia nervosa have severe dehydration from purging of fluids and electrolyte/metabolite imbalance (too low or too high levels of sodium, calcium, potassium and other minerals), which can lead to stroke or heart attack.
BINGE-EATING DISORDER
Different from bulimia nervosa, episodes of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are overweight or obese. Binge-eating is the most common eating disorder.
SIGNS AND SYMPTOMS OF BINGE – EATING DISORDER:
People with binge-eating disorder eat abnormally large amount of food in a specific time. They tend to eat fast during binge episodes and feel distressed, ashamed, or guilty about their eating habits.
COURSE OF EATING DISORDER:
Eating disorders frequently occur during the teen-age years, but may also develop during babyhood or later in life. Eating disorder affects both genders, although rates among women are 2½ times higher than rates among men.
Young athletes such as gymnasts, runners, body builders, rowers, wrestlers, dancers, and swimmers are especially vulnerable to developing eating disorders. Because these individuals tend to be competitive by nature and their sports engrossment often necessitates the practice of weight restriction.
MOOD DISORDERS
Some days we feel on top of the world, and other days we feel “down” and dejected. Some fluctuations in moods are a normal part of life, as we react to the events of the day. For hospitalization and psychological assessment, significant and prolonged disturbances in mood is considered. Three major categories of mood disorders are mania, depressive disorder and Bipolar Affective Disorder (BPAD).
MANIA
Mania is the mood of an abnormally, persistently elevated, irritable mood.
SYMPTOMS OF MANIA:
People with mania may have an excessively happy mood, typically associated with a sense of grandness. They feel unbelievably good about themselves, to the extent that they often believe they can do anything.
People with mania often engage in more activities than usual. This increase in activity often becomes excessive to the point of being dangerous. E.g., they may go on shopping sprees, spend money that go well beyond their means, and incur enormous levels of debt. They may drive recklessly and tend to leave responsibilities behind. They may have an increased sexual drive and may involve in sexual activities putting themselves at risk for sexually transmitted diseases and relationship conflicts.
When an attempt is made to stop such behaviour they become extremely irritable and might use violent methods to assault themselves or use abusive words.
People with mania feel highly energetic that they have a decreased need for sleep, even staying awake for days at a time and might not feel hungry for days.
People with mania are highly distractible and have poor concentration, as their mind races with a million thoughts (flight of ideas) and new ideas.
People with mania speak very quickly as others can barely get a word during his conversations. Other symptoms include; increased sociability, familiarity and impaired judgment.
COURSE OF MANIA:
This period of abnormal mood must last at least one week for hospitalization and psychological investigation. Manic episodes can last from a few weeks to a few months in length, and they are often preceded by stressful life events. While the average age for a first manic incidence is in the early twenties, some occur in the teen-age years. Those who have their first episode in their teens often have a history of behaviour problems.
DEPRESSIVE DISORDER
Every person occasionally feels blue or sad. But these feelings are usually short-lived. When a person have depression and if it interferes with daily life and cause discomfort for both the patient and the family member (s), then they should look for hospitalization and psychological assessments.
SIGNS AND SYMPTOMS OF DEPRESSIVE DISORDER:
People with the depressive disorder suffer from depressed or sad mood. They lose interest in things that they usually enjoy.
People with a depressive disorder often show low level of energy, extreme fatigue and poor concentration. They have no motivation to do their daily activities, often find themselves unable to get out of bed and unable to complete school or work assignments.
People with depressive disorder have low self-esteem, feel worthless and blame themselves for all that has gone wrong in their life and in the world. They also tend to feel hopeless about their future.
People with depressive disorder have thoughts of suicides and suicide attempts, feel changes in appetite and sleep habits.
People with the depressive disorder tend to withdraw socially, feel insecure in relationships and expect rejection from others.
COURSE OF DEPRESSIVE DISORDER:
Depressive disorder follows a recurrent course. Depression is one of the biggest risk factors for suicide; with around 15% of depressed people committing suicide. Depression affects people of all ages, including children. Early-onset predicts a worse course of depression over time, so depression in childhood and teenage years is a serious problem that can lead to ongoing difficulties throughout life.
BIPOLAR AFFECTIVE DISORDER (BPAD):
BPAD is characterized by recurrent episodes of mania and depressive disorder in the same person at different times. These episodes can occur in any sequence. The treatment aims at preventing either manic or depressive episode. However, once the episode has started, the treatment will be focussed on treating the symptoms and simultaneously work on the remission of the symptoms. Some people may be absolutely symptoms free for months to years whereas others may relapse more frequently.
SLEEP DISORDERS
Sleep disorders are a group of conditions that affect the ability to sleep on a regular basis. Most of us have experienced trouble sleeping at one time or another. This is normal and usually temporary; due to stress or other outside factors. But if it continues and interfere with your daily life, you may be suffering from a sleep disorder. The lack of quality sleep can have a negative impact on your energy, emotional balance, and health.
Some common sleep disorders include sleep apnea (temporary cessation of respiration), narcolepsy (Excessive sleepiness at inappropriate times), cataplexy (sudden and transient loss of muscle tone while awake), and sleeping sickness (disruption of sleep cycle due to infection).Other disorders include sleepwalking, night terrors and bed wetting. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.
SIGNS AND SYMPTOMS OF SLEEP DISORDER:
Adults with sleep disorder feel sleepy or irritable during the day. They find difficulty staying awake while sitting (i.e. watching television, reading a book), driving, etc.
Adults with sleep disorder have memory problems, emotional outbursts and difficulty concentrating at work, school, or home.
Sleep disorders in adults may increase the chances of developing hypertension, heart disease, mood disorders and memory problems. If indicated, following an outpatient evaluation, patients are referred for an overnight sleep study.
Some common sleep disorder symptoms to look for in children are snoring/breathing difficulties while sleeping, bedtime refusal, insomnia, sleepwalking, sleep terrors, nightmares or night time fears, unusual sleep behaviours, excessive daytime sleepiness, bedwetting and difficulty falling or remaining asleep.
Sleep disorders in children can lead to behaviour problems and mood disturbances. A paediatric neurologist evaluates children, suspected of suffering from sleep dysfunction. If indicated, following an outpatient evaluation, patients are referred for an overnight sleep study
ANXIETY DISORDERS
Anxiety is a common experience – almost everyone would have felt some level of anxiety in their lives. In many situations, it is a normal adaptive experience, physiologically preparing our bodies to respond when we sense danger. Our autonomic nervous system gets us ready for fight or flight and then, when the danger has passed, composures us back down again so that we can go back to normal functioning.
Anxiety disorder involves fear or nervous in response to something that is not inherently frightening or dangerous, e.g. it is normal to feel anxious in response to poisonous snakes, but it less normal to feel anxious or restless in response to picture of snake.
SIGNS AND SYMPTOMS OF ANXIETY:
People with anxiety disorders have emotional symptoms such as fear, nervousness, and worries, physical symptoms such as tremors, palpitations, shortness of breath, heart pounding, sweating, dryness of mouth, urgency to urinate and cognitive symptoms such as fear provoking thoughts.
TYPES OF ANXIETY DISORDERS:
Social phobia is a strong fear of being judged by others and of being embarrassed in public. People with social phobia are afraid of doing common things in front of other people, e.g. they might be afraid to sign a cheque in front of a cashier or they might be afraid to eat, drink or talk in front of other people, or use a public washroom. Because of such social fears, they start avoiding social situations such as marriages and meetings.
Specific phobia is characterized by fear and avoidance of a particular object or situation, e.g. dogs, escalator, cockroaches, etc. This anxiety may be limited, occurring in response to the target and may result in impairment during specific situation, e.g. someone who is afraid of escalator may lead a very normal, productive life but simply unable to use an escalator.
Panic disorder or a panic attack is a sudden episode of intense fear that activates severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, one might think that he/she is losing control, having a heart attack or even dying. Many people have encountered one or two episodes of panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if one had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, he/she may have a condition called panic disorder.
Generalized anxiety disorder (GAD) is characterized by an (extended period – six months or more – of chronic) uncontrollable worry about numerous things. All of us worry about things like health, money, future or family problems. But people with GAD are extremely worried about these daily routine events, even when there is a little or no reason to worry about them. They often think that things will always go bad.
Post-Traumatic Stress Disorder (PTSD) occur in response to many types of events, including natural disasters such as tsunami, accidents, rape and physical abuse. And it isn’t just the victim who is vulnerable to the disorder e.g. someone who observes severe physical abuse is also at risk. PTSD has a unique set of symptoms. The target of fear is the trauma itself, which creates severe anxiety, so the sufferer will desperately try to avoid anything associated with the trauma. They may even lose their memory of the event.
OBSESSIVE COMPULSIVE DISORDER (OCD) is a type of anxiety disorder characterized by the presence of obsessions and/or compulsions that the person is unable to control and hence the failure to do so leads to marked distress and that are severe enough to hinder with the activities of daily life.
People with OCD feel the need to check things repeatedly, or have certain thoughts that are repetitive or perform routines and rituals over and over. Frequent repetitive unreasonable thoughts are called obsessions. These obsessions make a person anxious or tensed. In order to overcome this anxiety, they will feel intense urge to repeatedly perform certain behaviours called compulsions. Performing the compulsions gives temporary relief from the anxiety created by obsessive or compulsive thoughts.
SIGNS AND SYMPTOMS OF OBSESSIVE COMPULSIVE DISORDER (OCD) :
People with OCD have repeated thoughts about different things, such as fear of germs, dirt, thieves, hurting loved ones, conflicts with religious beliefs.
People with OCD do the same rituals over and over such as washing hands, locking and unlocking doors, counting money or other valuables , keeping not needed items, or repeating the same steps again and again, e.g. if a person is obsessed with germs or dirt, the person may develop a compulsion to wash their hands over and over again.
SUICIDE
Suicide is an act of intentionally killing oneself. It is one of the major public health concerns worldwide and identification of potentially suicidal person is the most difficult tasks in healthcare. Para suicidal behaviour or repeated self-injurious behaviour are also most common in people with other psychiatric problems such as depression, anxiety, etc.
SIGNS AND SYMPTOMS OF SUICIDE:
Potential suicidal person often talks about suicide, involve in getting the means to take their own life, such as hanging rope or sleeping pills, withdraw from social contact, have mood swings, fluctuated emotions and bring preoccupied with death, dying or violence.
Potential suicidal person often feels trapped or hopeless about a situation, shows sudden increase in use of alcohol or drugs and sudden change in normal routine, including eating or sleeping patterns. They also involve in doing risky or self-destructive things, such as using drugs or driving recklessly.
SCHIZOPHRENIA
Schizophrenia is a brain health disorder that disturbs the way an individual sees, thinks and acts in the world around him or her. People with schizophrenia have often a significant loss of contact with reality and an altered perception of reality.
With such a blurred line between the real and the imaginary, people with schizophrenia have difficulty (or even frightened) to engage in activities of daily life. In response, people with schizophrenia may pull out from the outside world or act out in confusion and fear.
Schizophrenia typically has its onset in late adolescence or early adulthood.
SIGNS AND SYMPTOMS OF SCHIZOPHRENIA:
Hallucinations (Disturbances in perception):
Hallucination – perceiving things that are not there for e.g things a person sees, hears, smells, tastes or feels that no one else can see, hear, smell, taste or feel.
Auditoryhallucination (hearing voices of people commenting about their behaviour)
Visual hallucination (seeing the god or the devil)
Tactilehallucinations (feeling that insects are crawling under the skin)
Olfactory hallucination (smelling odours that no one else senses)
Gustatory hallucination (tasting something that isn’t really there, typically an unpleasant flavour)
Among these, the most common type is auditory hallucination.
Disturbances in thought:
Thought broadcasting/insertion/blocking:
A person with schizophrenia may believe that their thoughts have been taken from them and is being broadcasted to other people (thought broadcasting). They may also believe that someone is using a secret equipment to insert thoughts into the mind (thought insertion) or that someone is stealing or blocking the thoughts and so while speaking the person becomes blank (thought blocking).
Delusions:
Believing things that are not true – this is a particularly common symptom. A person with schizophrenia may believe that the neighbours are plotting against or planning to kill them (persecutory delusion). Everything will be interpreted in the context of delusion, even things that are meant to help, such as medication will be misunderstood as poison. The person may also feel that they are being watched and followed by someone (paranoid delusion) and may also believe that some of their neighbours are talking about him from a distance (delusion of reference).
COURSE OF SCHIZOPHRENIA:
Schizophrenia is a chronic psychological disorder. Although some people have brief episodes of schizophrenic like behaviour, most people with psychological symptoms of schizophrenia suffer from indications for their entire lives.
The manifestation of symptoms can also take a number of different forms. E.g., some people may be delusional but may still be able to take basic care of them, carry on a conversation and succeed in school and work, whereas others may be completely weakened by the disorder.