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:


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:

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


People who dramatize


People who are anxious, fearful or avoidant

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:

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:

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:

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:

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:

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.


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) :


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:


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.

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.